Physiotherapy and Dysfunctional Breathing (HVS)

Traditionally, the physiotherapy management of people with dysfunctional breathing or hyperventilation syndrome is breathing re-training. There is increasing clinical evidence that structural and functional changes develop in the muscles and connective tissues of the chest wall, abdomen and back when the upper chest accessory pattern of breathing is used over time. When treatment includes breathing techniques only it is difficult for a person with chronic hyperventilation, who has developed muscle and connective tissue changes, to revert to using the normal lower chest diaphragmatic breathing pattern. In clinical practice when the problems which have developed in the musculoskeletal system are addressed, the patient reverts more quickly to the lower chest pattern of breathing but there is as yet little evidence to support this clinical finding.

• Other: Breathing re-training
  Breathing re-training
• Other: Breathing re-training and musculoskeletal techniques
  Breathing re-training and musculoskeletal physiotherapy techniques including mobilisation techniques to normalise muscle and joint restrictions, doming of the diaphragm to enhance contraction and relaxation, and rib raising to free restriction in rib cage motion.

• Active Comparator: 1
  Breathing re-training
  Intervention: Other: Breathing re-training
• Active Comparator: 2
  Breathing re-training and musculoskeletal physiotherapy techniques
  Intervention: Other: Breathing re-training and musculoskeletal techniques

Inclusion Criteria:

• diagnosis of dysfunctional breathing (Nijmegen score of more than 23)

Exclusion Criteria:

• active metastatic disease
• osteoporotic disease
• dysfunctional breathing as a consequence of respiratory or cardiac disease