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Osteopathy and breathing

By Seb Contreras, Jun 13 2016 08:03AM

This week is National Breathe Easy Week. I, like the majority of people take for granted the ease in which I take each breath, except of course when I'm running the Great Knaresborough Bed Race, like last weekend. Then, for 2 miles or 15 minutes I fought for every breath of air so that I could keep up with my stronger and fitter teammates!

In this latest blog I wanted to discuss how the musculoskeletal works to allow us to breath, and how it can work better...

The Functioning of the Ventilatory System

The lungs are totally reliant on the 'thoracic pump', which is influenced by the entire musculoskeletal system under the command of a variety of neural controls. For air to enter the lungs there must be a pressure gradient between the lungs and the atmosphere, created by an expansion of the rib cage. At rest this is caused by the diaphragm, but when breathing is required to be more rapid and forceful to increase gas exchange, for example in sport (or the Bed Race), the accessory/secondary muscles of breathing also work in order to increase the volume of the thoracic cavity. The accessory muscles of inspiration are the external intercostals that elevate the ribs, the sternocleidomastoid that elevates the sternum, the scalenes that elevate the upper two ribs and pectoralis minor that elevates ribs three to five.

Expiration (breathing out) at rest, unlike breathing in, is a passive process resulting from the elastic recoil of the rib cage and lungs when the diaphragm relaxes. However, during exercise the secondary muscles of expiration become active because more forceful expiration is required to meet the physiological demands. These muscles are the internal intercostals, which pull the ribs down, and the abdominal muscles, which contract to bring the lower ribs down and compress the organs in the abdomen to the force the diaphragm up. Another important mechanical influence of active expiration is the lumbar lordosis (the natural curve in the small of the back) with the quadratus lumborum muscle.

The actions of these muscles are controlled neurologically by an area in the brainstem, setting the breathing rhythm in response to various signals throughout the body.

To summarise, breathing relies not just on clear airways or healthy lungs, but the mechanical pump made up of the ribs, thoracic spine, diaphragm and the accessory respiratory muscles under the control of the nervous system, to change the pressure of the lungs in relation to the atmosphere for gas exchange to occur. The ventilation system's high level of dependence on the musculoskeletal system is exhibited most dramatically in a paralytic state induced by poisons that disable the musculoskeletal system, halting breathing. Similarly, when a person fractures a rib, breathing is compromised to the extent that is parallel with the number of broken ribs.

What does Osteopathy have to do with the Respiratory System?

The philosophy of osteopathy maintains that the structure and the function of the body are interrelated. Osteopaths place emphasis on normal body mechanics of the musculoskeletal system being fundamental to good health, that is better structure allows for better function. Related to the respiratory system this means those anatomical structures related to breathing that were mentioned above need to have minimum disturbance to give optimum breathing function.

Researchers such as Bockenhauer and Guiney demonstrated the therapeutic benefits of certain osteopathic techniques on breathing function in certain conditions such as asthma. Unfortunately, there is no specific treatment that will help all symptoms related to breathing function in every patient. Osteopathy is a diagnostic and therapeutic system. To understand what intervention or interventions, be it treatment or exercise prescription need to be applied to normalise the musculoskeletal structures that support the breathing, a thorough case history and examination is carried out. Osteopaths will pay particular attention to the mechanical factors involved in breathing. This includes:

- The state of the muscles attaching to the rib cage and spine. If any of the muscles are too tight, there can be an affect on the body's ability to breath efficiently.

- The range of movement available at the joints of the ribs as well as the spine, especially the thoracic spine (mid back). If these joints are too stiff it will limit the ability of the rib cage to expand. It is essential for the rib cage to expand to allow air to enter the lungs.

- One's posture. Deviations from the ideal posture can have an impact on both muscle tension and joint mobility as described above. It is therefore very important to address any poor posture in patients with breathing problems.

If you have a respiratory condition such as asthma, recurrent bronchitis or COPD and would like to know if osteopathy can help you, please contact our team of osteopaths.


1. Bockenhauer, S, Julliard, K, Lo, K, Huang, E, & Sheth, A (2002), Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma, Journal of the American Osteopathic Association, vol 102(7), pp371-375

2. Guiney, P, Chou, R, Vianna, A & Lovenheim, J (2005), Effects of osteopathic manipulative treatment on pediatric patients with asthma: A Randomized controlled trial, The Journal of the American Osteopathic Association, vol 105 (1), pp7-12.

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