Whenever I mention breathing to my clients, the reply is usually along the lines of “Breathing? Don’t we all know how to do that already?”
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Of course, we all breathe, but how we breathe is the interesting part. Do you breathe with your ribcage moving outwards, to the sides and back? Or do you breathe by moving your ribcage upwards, using your neck and shoulder muscles to raise it?  

​During inspiration, when we breath in, our ribcage must expand to make space for the lungs to inflate. This happens due to the muscular action of the diaphragm and the intercostal muscles (the muscles between our ribs). The intercostals pull the ribs up and outwards while the diaphragm flattens and pushes the lower ribs out to the sides. Both actions create space in the ribcage for lung expansion.  
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The diaphragm is dome shaped and its vertical fibres attach to the lower ribs. When it’s contracted it flattens and these fibres push the lower ribs outwards as they shorten (1). This movement is known as lateral excursion. You can imagine it like an umbrella opening.  

We also need mid-back expansion when we breath. This is the movement of the back, just under the shoulder blades, at the level of the bra-line. Known as posterior excursion, mid-back expansion ensures that the diaphragm can also work to stabilise us in the upright position (2). When we lack good movement of the diaphragm, it reduces our ability to maintain our balance (3). This leads to stiffness in other muscles in the torso, as they take up the slack, causing pain and tension in this area.  
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If we raise our shoulders when we breathe this shows that we are in a shallow breathing pattern.  It means our ribcage is rising upwards to create space for the lungs to expand. To do this, we are pulling the ribcage upwards using accessory breathing muscles; the muscles that attach from the shoulder to the ribcage (pectoralis minor) and the muscles that attach from the neck to the ribcage (the sternocleidomastoid and the scalenes). This can lead to neck and shoulder pain and tension, and headaches.  

So, what does this mean? Essentially, it means we need to pay attention to the way we breathe. 

When we learn to breathe using lateral and posterior excursion, we improve the strength of the diaphragm and increase the ability of our ribcage to move. Improved ribcage mobility takes the pressure off the neck and shoulders, decreasing pain, tension and headaches. It allows the diaphragm to move through its full range of motion, becoming stronger and more efficient.    

When we breathe using our diaphragm, we activate the vagus nerve which leads to an increased parasympathetic nervous system response, slowing our heart rate and breathing, and calming us down.
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Good diaphragm breathing increases our blood oxygen levels, promoting tissue healing and repair (4)  and improving energy and cognition. Anxiety and dizziness reduce as our ability to expel carbon dioxide from the body improves. We get less aches and pains in our neck and shoulders. Our posture improves along with the stability of the spine, reducing back ache. Mobility of the ribcage and mid-back improves, increasing movement in the areas that should move, and stability in the areas that should be stable.

Shallow breathing patterns are very common during everyday stress and especially so during this time of uncertainty. Diaphragmatic breathing is fundamental to our health and wellbeing, and now more than ever we need to breathe well. 

1. Wallden, M. (2017). The diaphragm; More than an inspired design. Journal of Bodywork and Movement Therapies, 21(2), 342-349. https://doi.org/10.1016/j.jbmt.2017.03.013
2. Osar, E. (2014). Corrective exercise solutions to common hip and shoulder dysfunction. Lotus Publishing.
3. Kocjan, J., Gzik-Zroska, B., Nowakowska, K., Burkacki, M., Suchoń, S., Michnik, R., Czyżewski, D., & Adamek, M. (2018). Impact of diaphragm function parameters on balance maintenance. PloS one, 13(12), e0208697-e0208697. https://doi.org/10.1371/journal.pone.0208697
4. Duvall, S. E. (2017). Postpartum Corrective Exercise Specialist [online training programme] [Audiovisual]. Core Exercise Solutions LLC. www.coreexercisesolutions.com​

Research has shown that there is great variation in the nasal cavity and sinus pathways between individuals. Due to natural anatomical variation some of us are more prone to sinus conditions than others. Anatomical variations can influence how out sinuses drain whether it is due to narrow nasal pathways or a mechanical restriction between two or more bones. Factors contributing to disrupted drainage pathways may be congenital (since birth) or traumatic (such as a neck or head injury).

An osteopathic treatment will diagnose your unique condition and look to address the underlying anatomical cause.

Sinus infection is most often viral rather than bacterial. Symptoms of a viral sinus infection do not require antibiotics and can ease on their own. Alongside osteopathic treatment, there are a few things you can do at home to help:

• Rest and slowing down
• Drinking plenty of fluids
• Elevating your head with an extra pillow when lying down
• Steam
• Humming
• Irrigation techniques (neti pot)

Indications for a bacterial sinus infection include fever, tenderness of the face and changes in the colour of mucosa.

​Whether it's a long term thing, or fluctuating seasonal symptoms, osteopathy can help relieve your sinus symptoms by addressing the underlying cause contributing to your unique condition.

Bibliography

• Cappello, Z. and Dublin, A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): January 2020. Anatomy, Head and Neck, Nose Paranasal Sinuses
• Lafci Fahrioglu S, Andaloro C. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Nov 14, 2018. Anatomy, Head and Neck, Sinus Function and Development.
• Gach P, Tuchtan-Torrents L, Delteil C, Adalian P, Piercecchi MD, Ebert LC, Gorincour G. Virtual reconstruction of paranasal sinuses from CT data: A feasibility study for forensic application. Diagn Interv Imaging. 2019 Mar;100(3):163-168.
• Mahmood HT, Shaikh A, Fida M. Reliability and validity of maxillary and sphenoid Sinus morphological variations in the assessment of Skeletal maturity. J Ayub Med Coll Abbottabad. 2018 Jul-Sep;30(3):360-365.
• Villarreal R, Wrobel BB, Macias-Valle LF, Davis GE, Prihoda TJ, Luong AU, McMains KC, Weitzel EK, Yao WC, Brunworth J, Clark DW, Nair S, Valdés CJ, Halderman A, Jang DW, Sivasubramaniam R, Zhang Z, Chen PG. International assessment of inter- and intrarater reliability of the International Frontal Sinus Anatomy Classification system. Int Forum Allergy Rhinol. 2019 Jan;9(1):39-45
• Weitzberg E, Lundberg J. American Journal of Respiratory and Critical Care Medicine; 2002. Humming Greatly Increases Nasal Nitric Oxide. Vol 166(2), pp.144-145

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What is amazing about the human body, is it's ability to adapt to a given situation or task.  Problems can occur though, when we spend to long in a fixed position, such as being sat at a work station.  The body does it's best to adapt to the sustained posture, but even then can end up fatigued.  So, we end up with restricted spine and ribs, with sore muscles and joints. Then when we want to be active or exercise, our bodies are less able to move, so we may under-perform or become injured.

This thoracic stretch can help relieve the stiffness and restriction that builds up when your work requires you to sit or stand at a desk all day.  You can do this stretch at your desk, so give it a go. Worried you'll look a bit funny in the office? Then, get you work colleagues involved! ​

Lewis Jenner M.Ost., FAFS, Reg Osteopath MONZ 
​​Lewis graduated from the British School of Osteopathy, the biggest and oldest osteopathic school in Europe. Before training to be an osteopath, he had a successful career in engineering. 
 
Lewis is the only osteopath in New Zealand to have completed the prestigious GIFT program, at the Gray Institute (USA), working with some of the world's leading experts in rehabilitation. He is also a certified Nike Golf Performance 'Specialstandworks' with golfers to prevent and rehabilitate injuries and also improve their power, strength, flexibility and balance. 
 
By combining osteopathy with principles from the GIFT program, Lewis can perform functional movement based assessments and treatments, which can be tailored to the patients relevant sport or activity.  Lewis has a particular interest in treating injuries relating to running, golf and racquet sports, although his approach is effective for anybody that moves.
 
Lewis’s philosophy is about helping patients get better, quicker, so that they can overcome pain, feel like themselves again and get back to doing what they love to do. He also educates patients in how to self-manage their complaints using personalised exercise prescription and ergonomic advice
 
Lewis moved to Wellington from the UK, with his Kiwi wife and their two young boys 

See Lewis for:

• Sporting injuries and exercise advice
• Foot, ankle, knee and hip injuries
• Shoulder injuries
• Restrictions and mobility problems

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In this day and age, time is precious and so is our health.

​Many more people are realising the downsides of excessive alcohol or sugar intake to try to mask the feelings of stress and are looking for  healthy options to help them relax and feel good. Gentle hands on treatment has been shown to be very effective in improving the parasympathetic nervous system response (ie the vagus nerve) and reducing the 'fright/fight and flight' response. This makes you feel grounded, relaxed, calm and happier than usual.

At City Osteopaths Healthcare we have osteopaths, acupuncturists, massage therapists, naturopaths and counselling available. We have many ways of approaching stress and helping your body back to health.

Our patients report feeling happier, more relaxed, better sleep and relief from pain.

For more information check out our website www.cityosteopaths.co.nz or give us a call on 04 4991439. Plus if you have any questions one of our practitioners can call you back as soon as they are able.