Failed Back Surgery Syndrome: Review and New Hypotheses


Failed back surgery syndrome: review and new hypotheses
Bruno Bordoni, Fabiola Marelli

Dove Medical Press published this Open Access Full Text Article from the Journal of Pain Research about Failed Back Surgery Syndrome (FBSS), asking if diaphragm dysfunction plays a bigger part in persistent chronic lower back pain than previously thought.

The commentary says that the dysfunction of the diaphragm muscle is not even considered when trying to understand the causes that lead to FBSS i.e. texts in literature do not mention the subject.

In conclusion:

The commentary concludes saying “the diaphragm itself could be a source of pain, due to the change of its proprioceptors or irritation of the phrenic nerve and the vagus nerve. If scientific research were to prove that the diaphragm muscle plays an important role in FBSS, the therapeutic approach might provide an additional step toward improving the clinical condition and quality of life in this patient population.”

Read the full Commentary in pdf here >

Asthma In Older Women

Physician’s Weekly recently reported that older women are more likely to report having asthma than older men, and also have a 30% higher asthma-related mortality rate.

To discover why, Dr. Alan P. Baptist (MD,MPH) conducted a literature review in which he found data suggesting that hormonal changes during the menstrual cycle often play a large role in asthma symptoms. Other risk factors were also identified.

As a result of his review, Dr. Baptist recommended that physicians use Peak Flow Meters to assess asthma in older women because this particular group has a decreased perception of breathlessness.

There have been other scientific studies showing that women’s breathing does indeed differ to that of men’s and results in women feeling more out of breath. One study showed that the diaphragm in women had to work harder to compensate for smaller lungs and therefore narrower airways.

Another study found that the respiratory muscles in women used more energy when breathing, consuming a greater amount of oxygen.

One very recent study that was conducted on physically active young adults also showed that even in this younger and more active age group subjective differences appear which may partly be due to underlying differences in breathing patterns and operating lung volumes during exercise.

Women of any age therefore could benefit from exercising their breathing muscles, the inspiratory muscles (mainly the diaphragm and intercostals), with POWERbreathe to make them stronger and more resistant to fatigue. And because POWERbreathe is drug-free, it has no side effects or drug interactions.

Gender differences in dimensions of dyspnea in active young adults


Sex differences in the intensity and qualitative dimensions of exertional dyspnea in physically active young adults
Julia M. Cory, Michele R. Schaeffer, Sabrina S. Wilkie et al

The purpose of this study was to explore the development of qualitative dimensions of dyspnea in a group of 70 physically active, healthy young adults.

The young participants were asked to record two things throughout each stage of a symptom limited incremental cycle exercise test:

1. Intensity of their breathing discomfort using the Borg 0-10 scale.
2. Select a phrase that best described their breathing from a standardized list (“work/effort”, “unsatisfied inspiration”, “unsatisfied expiration”).

During the study, at peak exercise women were significantly more likely to select the phrases: “my breathing feels shallow”, “I cannot get enough air in”, “I cannot take a deep breath in”, and “my breath does not go in all the way”.

Findings from the study suggested that men and women do not differ in their perceived quality of dyspnea during submaximal exercise, but subjective differences appear at maximal exercise and may be related, perhaps in part, to underlying differences in breathing patterns and operating lung volumes during exercise.

Read the full study here >

Proper Breathing – POWERbreathe Can Help

Your primary breathing muscle is your diaphragm; a dome shaped thin sheet of muscle separating your rib cage from your abdomen.

When you inhale this dome shape flattens out as your diaphragm contracts, pushing down on the contents of your abdomen (your gut) and increasing the space in your chest cavity.

Because your gut has to go somewhere as your diaphragm descends, it forces it down and out and your tummy expands. Because of this, this natural, healthy and proper way of breathing is often referred to as abdominal breathing or diaphragmatic breathing.

If you do already have a good breathing technique it can often go awry when you start exercising as you demand more air and your breathing increases to compensate. This is when your breathing technique can change from good diaphragmatic breathing to reverse breathing i.e. pulling in your tummy as you breathe in and letting your tummy go as you breathe out.

Because your diaphragm is a muscle, you can train it like any other muscle to become stronger and helping you retain that good diaphragmatic breathing even when pushed to your limit. POWERbreathe targets your inspiratory muscles – not only your diaphragm but also your intercostal muscles, the tiny muscles in between your ribs, which are recruited during a slightly forced respiration.

You’ll notice when training with POWERbreathe that you have to work harder to breathe in. This is the effect of resistance training acting on your inspiratory muscles. When breathing out, POWERbreathe offers no resistance because when you exhale normally, your diaphragm and intercostals naturally relax and move back up, pushing the air from your lungs.

POWERbreathe For Older People In Slovenia

POWERbreathe Slovenia, with the kind assistance from Tanja, a physiotherapist at Ljubljana hospital, held two POWERbreathe training sessions for over 100 physiotherapists who’ll be implementing POWERbreathe Inspiratory Muscle Training (IMT) as one of the therapies they’ll be using with the older population within their communities.

Older adults experience a higher intensity of breathlessness than younger people, simply because of advancing years or as a result of illness, but by exercising and strengthening their breathing muscles (their inspiratory muscles) with POWERbreathe, they will learn how to breathe well again.

Research has in fact shown that IMT may be a useful technique for positively influencing exercise capacity and physical activity in elderly individuals.

Why POWERbreathe is ideal for the senior population

  • It’s scientifically proven to reduce breathlessness and restore breathing power
  • Does not involve drugs and has no interactions with other drugs
  • It’s quick and easy to use and effective within 4-weeks
  • It increases breathing muscle strength by 30 – 50%

Other therapies the physio’s will be including is Nordic walking and general exercise to get this more sedentary group moving, with the intention of making savings in the long-term for the health service.

You can view photos taken at the training sessions on POWERbreathe Facebook.

POWERbreathe For Patients With Spinal Cord Injury

Grupo GNAP in Salvador – Bahia offers specialised care in neurological rehabilitation, offering rehabilitation to their spinal cord injury patients that is efficient and motivating.

Respiratory approach to the neurological patient

GNAP believes that the treatment of neurological patients should not be limited to a motor or sensory approach of the limbs and trunk only, but also to their respiratory ability, because in many patient cases a reduction in functional performance limitations is associated with their respiratory ability.

To verify this, using the POWERbreathe K5 with Breathe-Link Live Feedback Software, they assess the patient’s respiratory ability by asking them to perform specific tasks, after which they identify issues and begin a course of POWERbreathe Inspiratory Muscle Training to help them improve not only their respiratory function but in turn their functional performance.

We’d like to thank Mateus Esquivel, Departamento De Fisioterapia Sbc Bahia and Fabio Carvalho, Physical therapist, expert in physical therapy neurofuncionnal and MBA in Business Management (FGV) from GNAP for bringing this important and encouraging work to our attention. Thank you!


Effects of Inspiratory Muscle Training in older adults


The Effects of Inspiratory Muscle Training in Older Adults
Mills D, Johnson M, Barnett Y, Smith W, Sharpe G

This research, published in Medicine & Science in Sports & Exercise (April 2015 – Volume 47 – Issue 4 – p 691–697) concluded that Inspiratory Muscle Training (IMT) elicits some positive changes in inspiratory muscle function and structure in healthy older adults…

“Declining inspiratory muscle function and structure and systemic low-level inflammation and oxidative stress may contribute to morbidity and mortality during normal ageing. Therefore, we examined the effects of inspiratory muscle training (IMT) in older adults on inspiratory muscle function and structure and systemic inflammation and oxidative stress, and reexamined the reported positive effects of IMT on respiratory muscle strength, inspiratory muscle endurance, spirometry, exercise performance, physical activity levels (PAL), and quality of life (QoL).”

“These novel data indicate that in healthy older adults, IMT elicits some positive changes in inspiratory muscle function and structure but neither attenuates systemic inflammation and oxidative stress nor improves exercise performance, PAL, or QoL.”

Read The Effects of Inspiratory Muscle Training in Older Adults

Discover POWERbreathe used in Research here >

Breathe deeply with POWERbreathe for more energy

Deep breathing reaches the deepest depths of your lungs, and by practicing POWERbreathe inspiratory muscle training you’ll be training your respiratory muscles to breathe deeply into your diaphragm, taking in as much air as possible, breathing more in per breath.

As you’re breathing in more air per breath, you’re receiving more oxygen into your body, giving you more energy.

Senior consultant at the National heart Institute, India, and Founder, SAANS Foundation in India, Partha Pratim Bose offers a good example of this,

“By deep breathing exercises you breathe more per breath. If you breathe more per breath you expand your lungs more, you receive more oxygen. You will feel more energetic and also save your breaths. For example, if you breathe 250 ml per breath and your requirement is 5 litres then you need 20 breaths per minute. If you breathe more breath say double i.e. 500ml then you will require only ten breaths. So by breathing deep you breathe less and you feel better and conserve energy.”

Thankfully you can train your breathing muscles to breathe deep, as your respiratory muscles respond in the same way as skeletal muscles do to a training stimuli as they undergo adaptations to their structure and function. POWERbreathe is one such training stimuli, using the principles of resistance training to strengthen the inspiratory muscles. Its pressure loaded inspiratory valve offers the resistance on the inhale, while an unloaded expiratory valve allows for normal, passive exhalation.

How POWERbreathe Works >

You can read about other benefits of deep conscious breathing in Bose’s article ‘Wellness: Breathe like a tortoise, live like a king’ and here in POWERbreathe Benefits.

The value of breathing retraining

This interesting article, written by osteopath Leon Chaitow, reviews ‘The Value of Breathing Retraining for Better Posture, Balance & Less Pain and Dyskinesis.’

It talks about how problems arising from poor posture, such as back pain for instance, can come about as a result of faulty breathing mechanics.

Chaitow refers to the study, ‘Inspiratory Muscle Training Affects Proprioceptive Use and Low Back Pain’ which supports evidence that breathing training can be successful in rehabilitating function as well as reducing a variety of symptoms.

Participants in the study completed an Inspiratory Muscle Training (IMT) program using the POWERbreathe Medic over a period of 8 weeks, “known as an effective training duration”.

The study concluded: “After 8 wks of high IMT, individuals with LBP (low back pain) showed an increased reliance on back proprioceptive signals during postural control and improved inspiratory muscle strength and severity of LBP, not seen after low IMT. Hence, IMT may facilitate the proprioceptive involvement of the trunk in postural control in individuals with LBP and thus might be a useful rehabilitation tool for these patients.

Read more about the POWERbreathe Medic Classic (used in this study) and the second generation POWERbreathe Medic Plus.

Alleviate screen apnoea by breathing deeply

‘Screen apnoea’ is a new, 21st Century condition. The term is a play on the name for the serious condition, ‘sleep apnoea’. Sufferers with sleep apnoea may stop breathing for short periods of time while they sleep. Surprisingly, a similar thing happens to users of electronic devices. Findings show that people have a tendency to hold their breath while communicating electronically.

About screen apnoea

Screen apnoea is a term now in use by those treating office workers. Findings from a 2009 study leads to this diagnosis. In fact, findings show that while using mobile devices, participants hold their breath and begin to breathe shallowly and rapidly. Additionally, researchers at UCI ICS, (Gloria Mark, Stephen Voida, and Anthony Cardello), formally validate this impact of email, using heart rate variability. Their research shows that our heart rate starts to increase. Furthermore, evidence shows that we tense our muscles while sending and receiving text messages or emails. Although the trial only invited 12 participants, anecdotal evidence is now proving this to be the case.

Have you ever noticed that when you’re really focussed and concentrating hard, you have a tendency to hold your breath? And when concentrating on a small screen, this can result in a tightness in the neck and shoulders. Consequently, this hunching of the body may also cause back pain, thanks to the compromised posture.

Back pain

In a 2006 study of more than 38,000 women, researchers found that back pain was more strongly related to breathing disorders than to obesity or physical activity. This is because the main breathing muscle, the diaphragm, is also one of the core muscles that supports and stabilises the torso. So when the diaphragm’s dual role of breathing and stabilisation is too great, breathing wins out.

Improve your breathing strength

All is not lost though, because the breathing muscles can be exercised to improve their strength and stamina. One of the most effective – and simple – ways of achieving this is through Inspiratory Muscle Training (IMT). IMT uses a resistance that you breathe IN against. It’s this that strengthens your breathing muscles, and in turn, improves your breathing stamina. Furthermore, IMT will help you to breathe deeply into your diaphragm, as opposed to your chest. Finally, IMT is a good teaching practice for your breathing, in an age when we seem to be suffering from screen apnoea.