Diaphragmatic pain- treatment and prevention

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As the diaphramatic pain blog got a fair amount of interest in terms of people looking at it, I re-read it and obviously there is a lot of information about what is happening and why things are hurting, but not so much about how to stop it happening or how to treat the pain.

As alluded to by one of the comments I have been in touch with a couple of people and suggested some stretches, which seems to have stopped the symptoms. I basically sat down and worked out some things which would stretch out the tissues mentioned.

The general key when stretching out psoas/iliacus/abdominals is that you don't just sit there and stretch out one portion of the fibres. Move around within the stretch and get into the different fibres of the muscles. They don't just work in one plane, and have a multitude of minor variation of angles which it is beneficial to stretch into.

Here are a couple of pics of the stretch cycle that I tend to do before a run/race to warm up the torso ready for the miles that lie ahead. These are a series that stretch one hip flexor, you then have to do it all in a mirror image to get to the other.

Make sure the back knee doesn't touch the ground, and look UP to the hand. Move back and forth, into and around the stretch. Apologies for the non-level shot, but Lynne didnt think she'd get me in the frame.

Now look at the other hand, again, the back knee doesn't touch the ground. Move around in the stretch, feel the different fibres of muscles and breathe into them. Don't count the seconds. Do it so that it feels right.

Last one, stretch out over the top, this is stretching the same area as the last 2 stretches, but puts the enphasis on other parts of the tissue and fascia. Again, breathe into it. To stretch the other Hip flexor do it all again but starting with the other leg forward to begin with.

You can follow these if you like, or make up your own, I find they work. If they don't work for you, find something that does.

Another point that is worth making is that if the psoas or iliacus has become chronically shortened through overuse/abuse/misuse, it may be that just stretching might not be enough to loosen the structures out enough to be able to run painfree (hopefully it will be, but maybe not). In that case, all is not lost. It is a treatable condition, and there are a number of things that we might be able to help out with - involving assisted stretching, muscle facilitation and Soft Tissue Release, (much like the well vaunted and much publicised Active Release Therapy- its the same thing, just under a different - and I believe patented- name).

Obviously every situation is different, and each client is individual, but if you do have an issue with this and want to get it looked at to see if we can help you out, please do drop us a line, Lynne or I would be glad to help. (I've had it and self-treated it, and Lynne has treated me and knows what its all about - psoas, iliacus and diaphragmatic release are underused by a lot of soft tissue therapists, but having come to realise just how important they are, we try to implement it in our treatments as much as possible).

abdominal massage and spasming diaphragms

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If you've read the post about the Mount Famine race, you may remember I mentioned a spasming diaphragm. This is a bit of a wierd one which I first felt a good few years ago when I was running in Japan. (just for fun, I must hasten to add... trying to lose weight to get better at climbing)

Sometimes, as I was running, I would get a really really bad pain in the abdomen, on the right side, just below the ribs. I knew it wasn't stitch- I've had that before, and it went pretty much as soon as I stopped running, only to return as soon as I started again. I then didn't run for a few months, and when I went out for a run again, it didn't hurt.
Wierd.
Didn't think much of it until recently.

The most recent time I had that pain was in Mount Famine, when I was really pushing it, and the time before that was in a (fun) winter time trial over 5km with some of the guys down in Greenwich Tritons. I was fine for 4.75km, then I thought I'd up the pace- boom, within about 20metres I had that stabbing pain in the abdomen, and it didn't go until I stopped. Mount Famine- it came, but by then, I figured out what it was.

Looking at the abdomen- the pain I was feeling was just under the ribs, on my right side. When I finished a hard run, it was slightly tender to touch- but the real issue was just to the left of the xiphoid process at the bottom of the sternum. That REALLY hurt, and, pressure there recreated the pain pattern that I was feeling during those all out aerobic efforts.
What could that be? What muscles attach there, and have bearing on breathing? The main one is the diaphragm- hence my suspicions of the spasming diaphragm. One might call this a Breathing Pattern Disorder- not one that is induced necessarily by bad posture, but perhaps one that is induced by breathing too hard(!)

So I sat (well, lay) down today to have a quick check around and see if I could sort it out. We studied abdominal massage during the course at NLSSM, and I have to say that I somewhat under-utilise it with my clients.
Using a soft touch, I worked my way around the area, noting that the area around the xiphoid process was tender and referring pain, especially under the ribs, my main abdominals felt tight, and the tissue between the ribs- the intercostals were really quite tender... all of this is probably because of a long period of exercise, and not getting enough massage to the muscles- hence the problems.
So I worked on the offending areas, working in the correct direction (so as not to disturb the peristaltic rhythms of the gut), feeling where there were adhesions between organs and muscular walls, and doing some Soft Tissue Release, especially on the diaphragm- that was pretty intense, and not without some discomfort.

However. I now feel much freer, more relaxed, and much more at ease with myself. It would seem that the phrase "a knotted stomach" is not just a metaphor, but also a physical condition which can cause anxiety and concern.
So, if you go to a massage therapist, don't just expect a back rub- those soft tissues, organs and the like may well be in desperate need of some care. We are used to having our posterior musculature rubbed and soothed- so why not the anterior? It seems a little wierd, however, it is soothing, relaxing, and when done correctly, most rewarding.
I shall be using abdominal massage as a modality within a modality a lot more from now on.

Breathing Pattern Disorders

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So in view of the fact today is National Asthma Awareness day in the UK, I thought I'd write a little on Breathing Pattern Disorders (BPD) and how they affect people and the human organism.

There are a few misconceptions about oxygen, carbon dioxide and their relationship with the human body. When we breathe, we expel CO2, and breathe in O2. However, this does not necessarily mean that CO2 is poisonous to humans. No, we cannot live from breathing in CO2, but yes, we can have big issues from not having enough of it in our system.

When a person overbreathes - or, at the extreme of this, hyperventilates, the effect on the body is to reduce the amount of CO2 in the system, and the concentration of CO2 in the blood drops. This lowering of concentration of CO2 results in respiratory alkalosis- it causes the bloods pH levels to rise, from an average of about 7.4 up into potentially alkaline levels. (The body will attempt to respond to this by releasing bicarbonate from the kidneys, but this is only a short term buffering attempt).

Symptoms that are generally associated with increased alkalosis are fatigue, increased pain sensitivity, decreased cognitive function, anxiety and so on.

BPD can be seen in people who actually have no specific cause for an issue. There are myriad symptoms ranging from digestive to cardiovascular, emotional and musculoskeletal which can be a result of a disorder associated with breathing. The most common physical symptoms are abdominal pain, chest pain, headache and back pain- these combined are responsible for over half of primary care visits in the UK per year. Only 10-15% are caused by organic illness. Indeed, a patient with chest pain, on average sees at least 10 doctors prior to a diagnosis being made.

The causes of BPD can be wide ranging. Women have shown an historic prevalence for Hyperventilation - and studies have shown this may be due to progesterone in their bodies which is absent from men. As previously mentioned, it may have no obvious specific cause - but it brought on through accumulated stress. It may be biomechanical - the fascia in the body becomes used to sitting and relaxing in a certain manner, which may be comfortable for a person, but it sub-optimal when it comes to breathing.

No matter where you look, there are connections with pain, with dysfunction, with biomechanical issues, with physiology because people are not (for any number of reasons) breathing optimally.

I am not saying don't go to a doctor if you have chest pains. By all means, go! Get it sorted. However, if there appears to be no good reason for an issue you are having - if there has been no discernable cause for pain, for a disorder that may be cropping up or general disaffection and brain fog, think about the way in which you are breathing. Think about your posture. Think about whether you are breathing more or less than you need to.
This may perhaps be the root of it.

(I must acknowledge Leon Chaitow in this post, without whose work, this entry would be significantly shorter, this is not an in depth look at BPD, I am merely scraping the surface with a fingernail, it's a fascinating and deep subject matter - oh, and any mistakes are my own- don't go shouting at Leon).

Tim