My thoughts on breathing...
A bit more information as it occurs to me about how breathing impacts your health and well-being. If you have questions or want me to address a particular topic, please don't hesitate to contact me!
Just last week I was asked to speak to the Respirology Division at the Alberta Children's Hospital here in Calgary about some of the work I have been doing with treating vocal cord dysfunction. And it became quite clear that they are seeing many patients that have some sort of excerise induced vocal cord dysfunction (EIVCD). EIVCD is described as an inappropriate closure of the vocal cords on inhalation during strenuous activity. Usually, when we breathe in, the vocal cords widen, to allow for air to enter the airways and lungs. When we exhale they may close slightly, and when we talk they narrow more, and then they completely close when we cough and swallow. But sometimes, the reflexive opening and closing becomes dysfunctional and we see the vocal cords coming together on the in breath. As you can imagine, this makes breathing very difficult: symptoms of EIVCD are shortness of breath, inspiratory stridor (a hoarse wheezing on inhale), and tightness of the throat. Sometimes this can be quite alarming and may lead to hyperventilation and panic.
Often EIVCD is misdiagnosed as asthma, although it does tend to occur in conjunction with asthma. A few clues that the vocal cords may be involved is the report of throat tightness - usually in asthma it is chest tightness; inspiratory sounds - with asthma it is generally a wheeze on breathing out; and if symptoms do not resolve with taking a bronchodilator (like Ventolin) EIVCD should be suspected. Of note, it is three times more likely to occur in females than males.
So all that being said, where does breathing fit into this? Well, there is some evidence to indicate that the muscles that help open the vocal folds are linked to the movement of the diaphragm. That is, the downward motion of the diaphragm that occurs during inhale assists in the activation of these "throat opening" muscles. In all of the patients I have seen with complaints of EIVCD, they have demonstrated a breathing pattern that relies heavily on the accessory muscles of breathing located in the neck and chest, with very little activation of the diaphragm. We also know there is a link between tight muscles in the neck and tight muscles around the larynx (where the vocal cords are located).
Management of EIVCD generally includes education and breathing retraining. Patients who have an understanding about what is going are less likely to panic when experiencing symptoms. Learning new breathing patterns that help to relax tense neck muscles and activate the diaphragm assist in decreasing the frequency and severity of events. "Rescue breathing" exercises are also taught to help gain control in an acute episode. I also include postural retraining and manual therapy to address neck muscle tension. There is also some evidence showing that low load inspiratory muscle training assists in restoring reflexive opening of the vocal folds. I have certainly noticed clinically an improvement in breathing patterns when adding this modality to my treatment programs.
If you or someone you know has asthma, and struggles during strenuous exercise, take note of your symptoms and compare them to the ones mentioned here. If you are finding it has been hard to manage your symptoms to this point, perhaps you may want to consider if exercise induced vocal cord dysfunction is involved.
8/15/2017 02:11:28 am
Hi! I was diagnosed with EIVCD within the last 4 months. As I live in New Zealand, the diagnosis is not widely known or researched by the specialists nearby. I was wondering if you had any strategies I could try to lessen the pain? I'm aware that the progress and effect if different with each patient but am willing to give any suggestions a try. I haven't done any exercise since 2014 because of a heart problem that was resolved last august, but am now struggling to get back into it due to the vicious throat pain caused by EIVCD. Feel free to email me or comment back?
Hi Makayla. Actually, you are in luck! New Zealand has plenty of physios that are experts in breathing! If you are in Auckland, I would recommend visiting Breathing Works. If not, check out www.bradcliff.com and search find a clinic for a certified therapist near you. Please feel free to email me directly (available on website) and I can help you connect with someone if need be! Jessica
10/4/2017 11:55:49 pm
Hi!, I've just played google doctor and found you website. I have a 12 year boy who has struggled with breathing only while playing sports, this has been going on since he was 8 years. GP has put him on numerous inhalers which have never worked. In the last 18 mths we have been under the hospital. They have done lots of tests and all come back clear and told his lungs are clear and breath tests are what they should be. They are stumped and I feel like an over reacting Mother! Now from what I have just read here this really does sound like Riley. Can you please point me in the right direction of how we can test to see if Riley has VCD. I am based in Brisbane Australia.
10/5/2017 08:00:49 am
Can you please send me an email at email@example.com and I can try and direct you in the right direction, or we can do an on-line consult.
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I'm a physiotherapist who is passionate about educating anyone and everyone about the impact breathing has on our health.