asthma-massageASTHMA – Chronic inflammatory disorder characterized by bronchospasm ( narrowing of the airways in the lungs), which is reversible over time either spontaneously or following treatment.

 BREATHING: Normal airway vs. Asthma airway

Normal Breathing: Asthma Massage

  • Air in through nose and mouth
  • Goes to trachea, then bronchi ( branching tubes leading away from trachea)
  • The bronchi branch smaller and smaller ending in many small air sacs called alveoli
  • The alveoli is where the oxygen is transferred from air into blood, and the carbon dioxide transferred from blood to air to be exhaled.

Breathing With Asthma: Asthma Massage Therapy

  • People have trouble breathing if around “triggers”
  • Air flow is obstructed as it passes in and out of the lungs
  • The lining of the airway becomes inflamed ( irritated, reddened and swollen), and may produce more mucus.
  •  The more inflammation present, the more sensitive the airway becomes, and the more symptoms appear.
  • If inflammation is not treated, the muscles around the airways become sensitive and start to twitch and tighten causing the airways to narrow
  • The inflammation ( and more mucus )and tightening of the muscles, cause the airways to narrow, making it difficult for air to pass in and out of them

 CAUSES of Asthma: Asthma Massage Treatment

 Airway inflammation and bronchospasm, usually due to triggers. These include:

  • Environmental pollution
  • Dust mites, cat dander, pollens, spores
  • Cigarette smoke
  • Occupational factors ( grain, flour, resins)
  • Food allergies ( peanut, milk, eggs)
  • Exercise – induced asthma
  • Respiratory infections ( viral and bacteria)
  • Psychological factors ( emotional stress, anxiety)
  • Hormonal
  • Genetics
  • Climatic

 TYPES OF ASTHMA:

1. EXTRINSIC Asthma Massage

  •  Irritating substances from outside the body cause an immune system or allergic response. The substance may be pollen, dust, etc. the immune system over-reacts and causes inflammation as a first line of defense

2. INTINSIC Massage for Asthma

  •  Is not allergy-related, it is caused by anything except an allergy. It may be caused by inhalation of smoke or cleaning agents, taking aspirin, chest infection, stress, laughter, exercise, cold air etc.
  •  Antibodies are not produced – this is not an immune response. The cause of attack may be an irritation to the nerves or muscles in the airways

3. EXERCISE INDUCED Massage for Asthma

 Asthma Massage: Muscles involved in Respiration

  • Muscles involved during inhalation:
    • Diaphragm, external intercostals, scalenes assisted by serratus posterior, pectoralis major and minor, levator costarum, subclavius
  • Muscles involved during Exhalation:
    • Intercostals, abdominals, Quadratus Luborum
  • Asthmatic Posture
    • Shoulder girdle Hypertonic – upper trapezius, levator scapula, serratus anterior, rhomboids and cervical spine / neck muscles

Asthma Massage: Signs and Symptoms of Asthma:

  • Wheezing when exhaling
  • Chest tightness
  • Breathlessness, coughing
  • Between attacks – can be asymptomatic
  • Air trapping leads to lung hyperinflation ?? check online
  • Anxious, sweating, distress, rapid shallow breathing, apical ( top part) breathing
  • Exhaustion, confusion, coma

• MILD ASTHMA Massage for Asthma

  • Occasional wheezing or cough
  • No major impairment of activities

MODERATE ASTHMA Massage Treatment for Asthma

  • Daily symptoms, occasional nocturnal S&S( asthma attacks at night)
  • Avoidance of exercise if it is their trigger

• SEVERE ASTHMA Asthma Massage Treatment

  • Daily wheezing, severe nocturnal S&S
  • Absence from work/ school in a year
  • Poor quality of life, occasional hospital stay

Asthma Massage: OBSERVATIONS: Assessment / Palpation

  • Dyspnea ( shortness of breath), tachypnea ( rapid breathing), apical breathing
  • Hyperkyphosis , head- forward, scoliosis
  • Barrel chest ( increased anteroposterior thoracic dimensions)
  • Accessory muscles of respiration including diaphragm, intercostals, scalenes, SCM, pectoralis major and minor and quadratus lumborum are tender and hypertonic
  • presence of trigger points in the muscles of respiration

 Asthma Massage: ROM & Special Testing:

  • AF ROM of C/S, T/S and shoulder
  • PR ROM, static and motion palpation reveal hypomobility
  • AR ROM of shoulder and abdominals for weakness

Asthma Massage: SPECIAL Orthopedic TESTS:

  • Vocal fremitus
  • Mediate percussion
  • Measurement of circumference
  • Rib motion
  • Rib palpation
  • First rib mobility
  • Levator costarum fixation
  • Anterior and lateral spinous challenge
  • Pec maj and minor length

 Considerations & Contraindications for Asthma Massage:

  • Determine patient’s asthma triggers. Remove if present
  • Do not exhaust with over treatment, painful techniques
  • Avoid compression of xyphoid and floating ribs
  • Treatment during acute attack is contraindicated
  • Postural drainage with severe conditions of heart and lungs
  • Tapotement over bony prominences
  • Ask client if osteoporosis is present

Asthma Massage Therapy Treatment:

  •  In chronic cases, spend more time prone than supine. Prone position has been shown to improve ventilation and oxygenation
  • Hydrotherapy: facial steam 5 minutes to loosen mucus; heat to lower posterior intercostals and pectoralis before MFR / fascial work
  • Diaphragmatic Breathing
  • MFR / Fascial work to back. Be sure to focus on areas around respiratory muscles: lats, QL , intercostals
  • General treatment to upper traps, levator scapula, serratus posterior superior, erector spinae, multifidi, posterior intercostals, quadratus lumborum to decrease hypertonicity and trigger points
  • Anterior and Lateral Spinous Challenge
  •  Rib springing to mobilize ribs
  • Levator costarum treatment – These muscles run from transverse process of one vertebrae to the angle of the rib below it, from C7-T11. place one thumb on the rib and other on the spinous process to provide lateral challenge. Have client take deep breaths.
  • Supine, position for kyphosis if necessary
  • MFR to pects, skin rolling on abdomen
  • Warm up abdomen and diaphragm. Diaphragm release from lateral to the xyphoid and moving laterally
  • Massage treatment of pectoralis muscles, subclavius, serratus anterior and intercostals
  • Treat muscles that aid in respiration, cervical spine muscles – scalenes (attaches to ribs), SCM, upper trapz, lev scap, suboccipitals, post cervical muscles.
  • Postural drainage ( done once client is dressed)
    • Lower lobe; prone, hips above head
    • R mid lobe; supine, pillow under (R), roll toward (L)
    • Upper lobe; seated over pillows
    •  Right lung has a middle lobe, both lungs have upper and lower lobes
    • Maintain positions 3-5 min or longer
    • Tapotement
    • Stop to expectorate
    • Continue tapotement or coarse vibrations for 3-5 mins
  •  Treat Kyphosis, lordosis and other conditions with subsequent appointments

 Asthma Massage: SELF CARE

  • Relaxation techniques
  • Breathing exercises
  • Stretching- tight muscles of respiration
  • Steam in hot shower
  • Reduce triggers, see MD for changes in condition