The fundamental objective of respiration is to regulate our bodies' chemistry through proper ventilation of C02. This regulation must occur whether breathing is relaxed or stressed, such as during the acrobatics of talking, emotional encounters, or physical challenges. Proper breathing mechanics, through optimal use of the diaphragm helps us control our intra- abdominal pressure and center of gravity. This control is essential in maintaining good core stability. When respiratory chemistry is altered, it has profound short-term and long-term effects. It can trigger, exacerbate, and/or cause a wide range of physical deficits in health and performance. Additionally, if the diaphragm is not the primary muscle of respiration, good chemistry can be compromised. Chemistry needs to be optimal regardless of what you may be doing. Therefore, breathing chemistry and mechanics are absolutely essential when evaluating and training for core stability.

Good breathing chemistry is all about carbon dioxide (COz) regulation. Although C02 is - considered a "waste product" in the sense that it is a byproduct of metabolism, carbon dioxide plays a critical role in acid-base physiology. Although some carbon dioxide (CC^) is excreted during exhalation, a significant portion of it is retained in the blood where it regulates pH levels vital to the distribution of oxygen and glucose to tissues such as the brain. At rest only about 12-14 of carbon dioxide is actually excreted. In healthy people arterial carbon dioxide is precisely maintained at 40mm Hg, even during exercise when carbon dioxide production may increase tenfold.

Deregulated COz chemistry results from either underbreathing or overbreathing. Underbreathing behavior is rare in healthy people. It results in respiratory acidosis which brings on obvious, immediate, and uncomfortable sensations. An example of this is when we exercise. As metabolic demand of our cells increases, we meet that demand by increasing respiratory rate and depth of our breath. Over-breathing behavior is more common, more subtle and less obvious. It is the result of breathing either too fast, too deeply, or both. This can happen during exercise and even at rest. When we over-breath we excrete too much C02 during exhalation. This triggers a respiratory alkalosis (increased pH) brought on by a deficiency of carbon dioxide in extracellular fluid (e.g., blood plasma). This C02 deficiency is a condition known as hypocapnia. The effects can be insidious but dramatic.

Hypocapnia leads to physiological changes such as:

• hypoxia (oxygen deficit)
• hemoglobin alterations affecting the release of oxygen and nitric acid (a vasodilator)
• cerebral vasoconstriction
• coronary and bronchial constriction
• cerebral glucose deficit
• ischemia (localized anemia)
• buffer depletion (bicarbonates and phosphates)
• neuronal excitability (sodium shifts)
• magnesium-calcium imbalance
• hypokalemia (plasma potassium deficit)
• hyponatremia (plasma sodium deficit)
• antioxidant depletion
• platelet aggregation
• muscle fatigue, spasm, weakness, and pain.

It is important to understand the interrelationship between respiratory chemistry and muscle function. Poor chemistry, like that in hypocapnia, leads to increased excitability of the global mobilizer or larger muscles of the body and creates tension in the fascia because of oxygen depleted smooth muscle. These restrictions lead to an inability of the diaphragm to expand through the lower rib cage to meet our metabolic needs and also provide optimal core stability. Compensatory patterns of breathing then become more prominent and chemistry is altered leading to more motor control changes.

Recently, research has shown that restoring good respiration not only decreases pain, but is an invaluable component to retraining proper core muscle activation. Restoring good respiratory chemistry and breathing retraining is vital in the rehabilitation process. Patients who demonstrate an abnormal breathing pattern, have difficulty regaining or maintaining normal motor control patterns and recruitment of the core musculature, benefit greatly from capnograph training.

Capnobreath training (where capno means C02) teaches good respiratory chemistry within a range of good breathing mechanics. It assists with re-establishing a coordinated breathing rate and depth by the diaphragm through a brain stem reflex mechanism that can easily be altered consciously or unconsciously.

* Ascent Physical Therapy is at the forefront of bringing new technology and cutting-edge treatment techniques to northern Nevada as it is the only physical therapy facility incorporating capnograph training into its clinical practice.

Last Updated: July 27, 2010
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