The Respiratory Musculature

by Tyler Cymet, DO, FACOFP

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    00:00 It's also important to note that respiratory muscles can fatigue and as they fatigue the way a person breathes changes. In the emergency room, this is a particular issue because it can foreshadow respiratory failure. You can tell when somebody is tiring out and having severe changes and you can also feel the bogginess and feel the changes to the muscles as they lose their ability to function.

    00:26 Muscle fatigue is a factor in respiratory failure particularly in severe asthmatics and most signs of respiratory failure are actually signs of respiratory muscle failure. That's how we predict it.

    00:39 We do know when people start to breathe quicker when they are driven by hypoxemia or hypercarbia but the fatigue and the failure itself is a failure of the musculoskeletal system. So respiratory muscle fatigue has been identified in COPD and this is what drives people hospitalization and need for assistance on occasion needing intubation and taking over of the respiratory function of the body. And respiratory fatigue also worsens pulmonary edema and other secondary conditions from the respiratory issues. We want to treat the thoracic cage and treat the lungs to improve compliance.

    01:21 It does help reduce the workload of breathing and will decrease the instance of fatigue of the respiratory system. You may also affect the functioning of the lung itself. And beginner for people to the MOPSE study done by Kendi Hensel at the University of North Texas has a good sign of what can be done to help people with respiratory conditions with OMM and what the benefit is and where it is. Because we know that when you look at breathing, you are looking at the relationship of the skeletal muscles and oxygen exchange. The longer the muscle, the better off you are. Typical findings in obstructive lung disease produce inefficient muscle contractions because the diaphragm becomes flattened and you have short hypertrophied accessory muscles that aren't functioning well.

    02:15 When people have long-term pulmonary problems, it changes the shape of the thoracic cage. You are going to see barrel chest developed in patients with COPD just from the work of breathing and the remodeling of the bones secondary to the changes in muscle functioning. You may have shortened respiratory muscles in somebody who develops a barrel chest that maintains the barrel shape and just has it continually worsen and the increased resting tone interfaces with the blood supply to the muscles. So it's going to maintain this dysfunction. The reason blood supply matters is when you have an increased oxygen demand and decreased supply of blood, you're going to go in to an 02:57.348 --> 03:01.955 anaerobic metabolism, you're going to become more acidic and the risk of respiratory failure increases. A good part of what OMM does is maintain aerobic metabolism and prevent deterioration tissue breakdown by preventing you from going into an anaerobic metabolism because anaerobic metabolism is less efficient and more caustic and becomes a downward spiral. So OMT is going to increase the aerobic metabolism, increase return of fluids into the vascular system and help people function better. So, the way we do this is by enhancing the overall movement of the thorax and allowing the motion to be fluid and allowing the increased intrathoracic pressure to allow for oxygen exchange. Here we have a good picture of the diaphragm showing how the diaphragm is pulling down and where it's pulling down and where you are going to see the motion both anterior and lateral of lungs, so you have good motion of the ribs to enhance respiration. The contraction of the muscles is what is the work of breathing and what is the energy expenditure and it's a complex interplay of forces that is coordinating this. It's sometimes difficult to focus on one aspect of it but looking at the overall end result and looking at oxygen saturation levels are a good sign of what's going on and a good secondary marker. Because when you are breathing and when you do have the diaphragm pulling down, you can see that the orientation of the ribs change, the orientation of the accessory muscles change and it affects all the functioning of the breathing and that is why the work of breathing enhances so tremendously. When you get breathing pathology when you develop CODP and when the diaphragm starts to change, it's no longer as efficient and the work of breathing becomes centered more in the interosseous muscles and more in the larger secondary muscles than in the primary muscle of the diaphragm. Here is just a representation of what's going on with the ribs with motion and how the ribs are going to help enhance the space and by enlarging the thoracic cavity pulling oxygen into the lungs. So, the contraction of multiple muscle groups at once is much more efficient than having an asynchronous contraction and as part of why fluidity of motion and synchronicity of breathing matters. Another representation of the diaphragm and how the diaphragm working with the ribs is the most effective form of breathing.

    05:37 So when you're monitoring a patient with breathing problems, look for neutral mechanics, look for fluidity of motion and make sure that you are being efficient and helping the person efficiently breathe. If you don't have the rib cage working with the diaphragm, that's called paradoxical motion.

    05:55 When you have them working in opposite directions, the paradoxical motion is a sign that the person is decompensating, deteriorating and an intervention is needed to help the patient or they will continue to get worse.

    About the Lecture

    The lecture The Respiratory Musculature by Tyler Cymet, DO, FACOFP is from the course Osteopathic Treatment and Clinical Application by System.

    Included Quiz Questions

    1. Rib 7 inhalation dysfunction
    2. Rib 1 inhalation dysfunction
    3. Rib 2 inhalation dysfunction
    4. Rib 7 exhalation dysfunction
    5. Rib 2 exhalation dysfunction

    Author of lecture The Respiratory Musculature

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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