Breathing Pattern : It matter`s

“Breathing underlies all dynamic movement and function.”

there is always question in mind that what is the appropriate time and way to assess breathing.

The most efficient method to educate patients about normal and abnormal breathing patterns is to give a verbal cues.
Recognising and Treating Breathing Disorders. It is incredibly well written and packed with information from multiple clinical domains and approaches. The goal for these next few blogs is to summarise the key learnings from the book and highlight areas of focus to improve clinical assesment of breathing pattern.


Breathing is vital for human life. This book has helped me understand how breathing is so important in our daily clinical practice.  We just have to start think out of the box.


In the early 1980’s when physiotherapists (Innocenti and Cluff) discussed about the impact of Co2 levels in human body and their associated symptoms,  hyperventilation syndrome (HVS) ( Bradley et Gilbert., 2014, p.3-5). they found is :

  • Reduced Co2 causes increased pH and a more alkaline environment. 
  • Increased breathing rate leads to reduced CO2 levels and respiratory alkalosis. 
  • Physiological effects of HVS include exhaustion, tingling, cramps, weakness, irregularities of heart rhythm and more. 
  • Psychological effects of HVS include tiredness, sensory disturbance and dizziness. 

Breathing pattern disorders(BPD) describe as a variety of different presentations that often lead to hyperventilation syndrome or changes in carbon dioxide levels. It is essential to fortify from the beginning that BPD is now not a disease, but a disorder that can coexist with many diesease and some thing that also mimics other disease process.(Chaitow, Bradley et Gilbert., 2014, p.4). BPD are symptoms and signs of abnormal breathing that present in patients who have systemic changes as well and altered movement pattern.

“Structure and function are intertwined and interdependent, in respiration as in most other body processes.” (Chaitow, Bradley et Gilbert., 2014, p.5).


  • The upper seven ribs should move synchronously with the sternum and move anteriorly during inspiration, not cranially. 
  • Visible accessory muscle activation is not seen in normal quiet breathing. 
  • When the diaphragm and intercostal muscles activate, the thoracic cavity should enlarge anteriorly and laterally at the same time. 
  • During inspiration, the lower ribs shoulder expand laterally with the thoracic cavity. 
  • Normal alignment of the clavicle is considered a 25-30 degrees angle from the horizontal while the thoracic spine is neutral position. 
  • Ribs should be align with the pelvis. (Konlar, Kobesova, Valouchova et Bitnar., 2014, p. 13). 
  • PaCo2 35-40 mmhg, Bicarbonate 24 mEg/L, pH 7.4, SpO2 95-98%, respiratory rate is 10-14 breaths per minute, and breathing occurs through nose (Bradley., 2014, p.64).
  • There should be a relaxed pause at the end of exhalation to allow for diaphragm to relax.


[restrict]These are a few symptoms which We see more commonly, not the entire list (Bradley., 2002, p. 48):

  • Neuro signs: increased sympathetic NS activation, reduced concentration and memory, tremors, sweating, palpitations, dizziness, weakness, visual disturbance, spinal hyperreflexia
  • Cardiac signs: chest pain
  • Gastro signs: gulping, bloating, burping.

The diagnosis of hyperventilation syndrome (HVS) is a clinical one. The symptoms are

  • Air hunger,
  • Dry cough,
  • sighing,
  • Pain,
  • Myalgia,
  • Increased muscle tone,
  • Dizziness,
  • Headache,
  • Fainting,
  • Tingling,
  • Chest pain,
  • Arrhythmia and impaired thinking.

As physical therapists we can look at breathing patterns (abdominal, pursed lip, apical, paradoxical etc), controlled pause, respiratory rate, heart rate – which we will go into more detail in the next blog. 


“The nasal cycle, which is part of an overall body cycle, is controlled by the hypothalamus. Increased airflow through the right nostril is correlated to increased left brain activity and enhanced verbal performance, whereas increased airflow through the left nostril is associated with increased right brain activity and enhance spatial performance.” (Bartley., 2014, p.46). 

Nasal breathing:

  • There is twice as much airway resistance in nasal breathing compared to mouth breathing,
  • This causes an increased in total lung volume, functional residual capacity, and improved arterial oxygen concentration (about 10% increase) (Gilbert., 2014, p. 82).
  • Nasal breathing is achieved by placing the tongue gently behind the top teeth on the hard palate during inspiration. No noise should be heard when inhaling.
  • Slower breathing is better for O2 and Co2 concentrati

Building nose breathing into the assessment:

  • Is the patient a nose or mouth breather?
  • Mouth breathing is connected with nasal obstruction and congestion. 
  • Do they have a septal deviation? This would cause a unilateral nasal obstruction
  • Do they report snoring or sleep apnoea? 
  • They they have other symptoms such as sneezing, itchy nose or eyes or nasal discharge or fascial pain?

What is homeostasis? 

There is a very well designed system within our body that maintains our pH levels whch is vital for function of human body. The outcome of a balanced flow of oxygen and carbon dioxide is that our tissues get a steady supply of oxygenated blood and that carbon dioxide remains stable. Breathing is fundamental in maintaining this balance, which is known as homeostasis. (Gilbert., 2014, p 61). 

In summary, breathing is vital to our survival. There are many things which we need to consider ,How to observe breathing, questions for breathing difficulties and educate patients about normal versus abdnormal breathing techniques, This blog was focussed on understand the importance of breathing and the next blog is focussed deeply on improving assessment. 

Patients don’t choose to breath abnormally. Their bodies are forcing them to adapt to a compansatory pattern and our role as therapists is to understand the underlying drivers.


Chaitow, L., Gilbert, C., & Morrison, D. (2014). Recognizing and Treating Breathing Disorders E-Book. Elsevier Health Sciences.

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