Who is the course targeted towards, and what can participants expect from attending?

I am excited to present my full four-day lab course for you for the first time. I am very passionate about this topic. Breathing applies to everyone, so the course is ideally presented as a multidisciplined program (physiotherapy, occupational therapy, speech therapy). Educating all clinicians on how to incorporate breathing with movement just makes sense for improved carry-over between our disciplines. AHPRA-registered physiotherapists, occupational therapists and speech therapists are all encouraged to attend.

From a physiotherapy perspective, are there particular patients and conditions that these techniques relate to?

Breathing applies to all patients and is the thread that ties all practitioners together, whether they work in intensive care, neurologic rehabilitation, pediatrics, or sports medicine, to name a few.

The muscles that support respiration are the same muscles that support postural control; therefore, we can not look at posture, movement and balance without looking at breathing. In my very biased opinion, I believe that this course material should be a foundational course in all physiotherapy, occupational therapy, and speech therapy university curricula.

Let me give you a detailed example of how diagnostics and treatment planning can be approached from a multi-systems perspective. Jill, a 16-year-old girl playing competitive volleyball, was seeing a sports physiotherapist for chronic right shoulder pain and dysfunction. Jill’s physiotherapist suspected that the problem was due to incorrect shoulder mechanics and the consequences of those atypical repetitive stresses on her right shoulder during volleyball. However, after addressing Jill’s musculoskeletal problems and her motor plans, she continued to have repeated episodes of chronic pain. Why was this? Jill’s physiotherapist referred her to me for a consultation because he wondered if her cystic fibrosis (CF) might somehow be involved in her poor outcomes.

Look at this case from a multi-systems perspective. Why did she not get better with musculoskeletal interventions alone? Jill’s brain prioritised surviving (breathing) over thriving (volleyball), which was a good decision. Follow this chain.

Cardiopulmonary: because CF causes thick lung secretions, Jill needed daily on-going airway clearance. She coughed aggressively every day (she could have used a better option, but did not).

Neuromuscular: the aggressive cough led to repetitive, excessive, intra-abdominal pressures (IAP), which in turn led to a stressed pelvic floor, which resulted in stress incontinence.

Musculoskeletal: Jill’s shoulder needed dynamic stabilisation during contact with the volleyball. Stress incontinence (leak of pressure) prevented her from generating adequate IAP, which in turn compromised intra-thoracic pressure. Lower proximal pressures resulted in inadequate dynamic stability for her right shoulder during the high impact of volleyball serves and spikes.

Interpretation: Jill’s chronic shoulder condition was a result of poor airway clearance strategies. Crazy, but true.

In order to effectively address her chronic shoulder impairment, I needed to (1) first and foremost, change her airway clearance program to reduce mechanical stresses, (2) change her postural control strategies that lead to stress incontinence, (3) increase her rib cage mobility to support full shoulder range of movement, and (4) change/coordinate her breathing pattern during all volleyball manoeuvres to minimise mechanical conflicts. Jill’s shoulder pain resolved and her stress incontinence was reduced. Without addressing how Jill’s underlying physiologic stress (CF) interacted with her musculoskeletal and neuromuscular systems, her shoulder progress had stagnated. That is the purpose of my course. You can not separate physiology from physical performance.

Why is this information critical for physiotherapists to apply in practice?

In the four-day lab program, we will explore the relationship of the diaphragm’s five major roles: as a respiratory muscle, a postural control muscle, an anti-reflux muscle, a lower gastrointestinal motility muscle, and a major venous return muscle. Then we will look at the diaphragm as the body’s major pressure regulator separates and control pressures in the thoracic and abdominal cavities in conjunction with the top valve (vocal folds) and the bottom valve (pelvic floor). This idea extends the definition of core stability beyond the abdominal muscles. Core stability means controlling proximal pressures throughout the entire trunk to exert effective counter- forces through our limbs regardless if that force is for a simple motor task like sit-to- stand or for a complex motor task like playing professional sports. The concepts from this course apply to everyone who moves, which is why I believe this material is foundational across the lifespan.

Tell your colleagues to come. You will enjoy expanding your ideas of how to integrate breathing and movement. I will present tons of different manual techniques in labs as well as present theoretical models and research to support the ideas. I know four days is a long time, but ask anyone who has taken my courses: I will make sure you have fun while learning, and I will be sure to bring my American accent with me.

Dr Mary Massery has been invited to give over 900 professional presentations in all 50 US states and in 16 countries worldwide, including more than 100 presentations for the American Physical Therapy Association. She received her Bachelor of Science in Physical Therapy from Northwestern University in 1977, her Doctor of Physical Therapy from the University of the Pacific in 2004, and her Doctor of Science from Rocky Mountain University in 2011.