New technology often gives us powerful new improvements in health care. Consider the information made available to us when the X-ray was discovered, followed by computerized tomography, magnetic resonance imaging, and advances in diagnostic ultrasound.
However, such impressive discoveries and inventions are only part of the story. Major innovations in health care can consist of new ways to use the natural gifts of our human senses, minds, and hands.
In a 1990 CNN interview with Larry King, Dr. Henry Heimlich stated, “We believe that you can solve many seemingly complex problems with direct, simple methods.” In the 1950s, Dr. Virginia Apgar’s method of rapidly assessing the newborn did not require the invention of a new device, but a new way to organize the doctor’s observations. The Heimlich maneuver and the Apgar scoring system are classic examples of how low-tech innovation can improve – and sometimes save – lives.
Breathing is a vital function that involves a constellation of musculoskeletal actions. It straddles the somatovisceral interface. In chiropractic clinical assessment, low-tech observation of breathing can give us important insights into a patient’s health and their progress under care.
Single Breath Count as a Valuable Outcome Measure
Classical measurements of breathing capacity such as forced vital capacity are reasonably easy to measure as long as you have a spirometer. If you do not, the single breath count test has been shown to correlate with forced vital capacity and cervical flexor strength.
Ask your patient to take a deep breath in and then count as far as possible in their normal voice, with the approximate rate of two counts per second. The highest number they can say out loud in a normal voice is their single breath count.
If single breath count is less than 15, that typically correlates to a forced vital capacity lower than normal, possibly related to a serious weakness of the respiratory muscles. Single breath count of 50 or greater is often seen with healthy, athletic people.
Real-Life Example: A 17-year-old competitive rower visits periodically for various musculoskeletal pain episodes, often accompanied by subluxation in the mid-thoracic spine. At one visit, she presented with a complaint of an upper trapezius “pinched nerve.” Taking a deep breath provoked a paroxysm of coughing. Pre-adjustment single breath count was 11.
Sacroiliac, thoracic, and cervical subluxations were detected and corrected. Soft-tissue techniques to normalize the function of the psoas, pectoralis minor, and suboccipital muscles were administered. Post-adjustment single breath count was 20. She was able to breathe deeply without distress.
LOREX
During inspiration, diaphragm contraction causes lateral and superior excursion of the lower ribs. This movement can be readily observed.
Ask the patient to stand in front of you, with their back toward you. Place your fingers around the lower ribs (T10-12) while bringing your thumbs as close as possible at the patient’s back. The pressure you apply to these lower ribs is according to patient comfort, of course.
Ask the patient to take a deep breath in while watching your thumbs. This gives you simultaneous input from palpation and visual observation. The lower ribs should move laterally and superiorly on both sides. Notice lack of lower rib excursion (LOREX) or asymmetry in the movement.
Real-Life Example: A 76-year-old retired executive presented with neck and back discomfort with difficulty in taking a deep breath. LOREX tested in the standing position was reduced on the right side. When the patient turned his head to the right, there was no change. However, when he turned his head to the left, LOREX equalized.
Palpation revealed hypomobility at the C1-occ and C1-C2 motion segment on the right side. I had the patient lie on his left side with his right side up, with his head resting on a half-moon pillow. I asked him to press his head firmly down into the pillow as I followed the movement with my thumb on the right lateral mass of the atlas. I then thrusted using a “thumb flick”-type maneuver.
The patient commented that he thought the segment began to move before the thrust. I retested LOREX and found the lower rib cage to be equally mobile on both sides. I asked the patient to take another deep breath and asked him how it felt. He stated his breathing felt easier.
Editor’s Note: Dr. Masarsky has published descriptions of chiropractic assessment pearls, including those related to breathing (see list below). He also offers courses approved for CE credit hours by Northeast College of Chiropractic (formerly NYCC).
Published Materials
- Masarsky CS. More assessment clarifiers [the wide-angle lens]. Asia-Pac Chiropr J, 2024;5.1.
- Masarsky CS. Assessment clarifiers [the wide-angle lens]. Asia-Pac Chiropr J, 2024;4.3.
- Masarsky CS, Todres-Masarsky M. Long COVID pharyngitis, possible glossopharyngeal neuralgia, and subluxation: a case report. Asia-Pac Chiropr J, 2023;4.1.
- Masarsky CS. Alternate uses for the tuning fork: doctor, test thyself [the wide-angle lens]. Asia-Pac Chiropr J, 2023;4.1.
- Masarsky CS. Complex circuitry for complex machinery. Asia-Pac Chiropr J, 2022;3.2.
