Tuesday, May 13, 2008



            RIBS:  12 in total (2 are floating)

                        Protects the lings and heart

STERUM:  Breast Bone at front of the chest

Costo-sterum and costo-vertebral joints: where the ribs meet the sternum at the    front and the vertebrae in the back

            SCAPULAR:  complex (shoulder blade): attaches to the back of the rib cage


The joints of the rib cage (costo-sternal and costo-vertebral) can become irritated with repetitive coughing.  You may experience pain in the front of your chest or at the back where the joints are..  If you experience a sudden onset of severe pain, this pain may indicate rib fracture. You should ask your doctor so she/he can provide with proper pain management. You may be at risk of rib fracture if you are know to have osteoporosis or if you have prolonged courses of steroids (Prednizone).

To avoid rib fracture or irritated joints, you should practise controlled coughing techniques.

If your ribs are stiff due to your lung disease and (air trapping), you will need to do some thoracic mobility exercises to maintain movement you have or try to improve it.

Pursed exhalation creates positive pressure in the lung to prevent air trapping.


1.    DIAPHRAGM: Main muscle of breathing. Repsonsible for 60 to 80 percent of the work during inspiration.  Domed shaped. Creates negative pressure in lung to bring air in.

2.    INTERCOSTALS:  Small muscles located in between each ribs. Responsible for 40 percent of the air intake during inhalation

3   ACCESSORY MUSCLES:  muscles of the neck, not designed to work all the

time. Used by people with ling disease when in distress or because they have

developed poor breathing pattern.


The normal ratio of breathing is 1:2, inspiration/expiration. For example, if uou breathe in for 2 seconds you should breathe out in 4 seconds.

When we breathe in,  inspiration  or inhalation

-The diaphragm contracts and shortens which flattens it. It allows more space for the lungs to expand.

-The intercostals contract which makes the ribs move out and up in a “Bucket handle” swinging movement.

When we breathe out, expiration or exhalation

-The diaphragm passively returns to its dome shape.

-The intercostals relax and allow the ribs to return to their starting position.

-The abdominal muscles help to push the air out during forced expiration. This happens when doing your flow tests or when coughing.  If you use your abdominal muscles all the time, as some people with lung disease do, the muscles get tired which leaves you fatigued.

-People with emphysema have a slow and prolonged forced expiration.

Impact of problems with muscles of breathing

-Harder to breathe when carrying heavy parcels because the muscles in your arms and chest are being used to lift instead of helping you breathe properly. What are the possible solutions to this problem?   Cary lighter loads, use a cart, get your groceries delivered, let you legs do more of the work when lifting from the floor.  These tips should make it easier on your breathing and on your heart.

-Obstacles that can make breathing more difficult:  obesity, pregnancy, a large meal, bloating, and poor posture.

All of theses can push up on your diaphragm and don’t allow it to flatten out on inspiration, The lungs don’t have as much room to expand thus making you short of breath.

How position can affect your diaphragm

Lying flat on your spine (supine):

-The resting level of the diaphragm rises up towards the lungs.

-Gravity pulls down on the ribs, making it harder to move them up.

- The organs are pushed up towards the diaphragm and it makes it more difficult to breathe.

Solution: Lie with pillows positioned under the upper back and head

Sitting :

-Gravity helps the diaphragm flatten out by pulling down on it.

-Better position for breathing as long as your back is supported and shoulders relaxed.


Heart:  Located between the lungs in the centre of the chest and to the left. Pumps  the blood  throughout  the  body.

Lungs :  There are two lungs, the right has three lobes and the left has two lobes. The air comes into the lungs through the nose or mouth, travels down the trachea which divides into the left and right bronchus into the respective lungs.  Each bronchus then divides into smaller bronchi which become bronchioles and finally the alveoli (air sacs).  This is where the air exchange happens.    The capillaries’ (Tiny blood vessels) surround the alveoli, the fresh oxygen comes in and the carbon dioxide is exhaled out.

Inside the bronchus and bronchioles are the cilia.  Their job is to.help any secretions move up and out of the  respiratory system.   They are in constant movement.  This movement is affected by any toxic substance inhaled into the lings including cigarette smoke. If the cilia are do not work properly, the secretions tend to pool in the lungs and may cause an infection or an inflammation.  Once they are damaged, it is permanent  The cilea do not regrow..


ENDURANCE or AEROBIC training means:

Exercising at a low intensity for a long duration while using large muscle groups. The exercise should be comfortable and enjoyable. Examples include walking and biking.

The goal in doing endurance exercise is to train your muscles to be more efficient, or better, at using oxygen. The end result will make physical activities feel easier and allow you to do more.

Normal Responses during exercise:  Increased heart rate, Increased breathing rate and mild increase of shortness of breath.

For endurance training, you should be in an appropriate “Training Zone”   This can be monitored by the following :

Heart rate (your age-related traing zone)

Shortness of breath (2 – 4 out of 10 on the SOB scale, or 2 above resting level)

The talk test (you can still talk during exercise)

HOW OFTEN ??  The goal will be to achieve 20 to 30 minutes, 5 days a week

HOW LONG??   Forever !!!!!  “If you don’t keep it, you lose it”

We also aim to deisgnyour exercise program so that it is specific to functional needs and goals.  For example, if your goal is to be able to walk up a hill to get to church, we will train you to walk using an incline on the treadmill. Training only on a bicyle in this case would not necessarily allow you to fully reach yout goal.

PRECAUTIONS with endurance training:

Chest, arm or jaw pain or pressure

Unexplained swelling in your legs

Increased SOB or bad lung infection

Increased blood pressure

If you have a dramatic change in your medical condition as above, or are hospitalized, consult your physiotherapist or doctor before resuming exercise.

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