ASTHMA – 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