Chest Exercises; chest moblizing techniques

 

EXERCISES TO MOBILIZE THE CHEST

Chest mobilization exercises are any exercises that combine active movements of the trunk or extremities with deep breathing. They are designed to maintain or improve mobility of the chest wall, trunk, and shoulder girdles when it affects ventilation or postural alignment. For example, a patient with hypomobility of the trunk muscles on one side of the body does not expand that part of the chest fully during inspiration. Exercises that combine stretching of these muscles with deep breathing improve ventilation on that side of the chest. Chest mobilization exercises also are used to reinforce or emphasize the depth of inspiration or controlled expiration. A patient can reinforce expiration, for example, by leaning forward at the hips or flexing the spine as he or she breathes out. This pushes the viscera superiorly into the diaphragm.

chest moblizing


Specific Techniques

To Mobilize One Side of the Chest

While sitting, have the patient bend away from the tight side to lengthen hypomobile structures and expand that side of the chest during inspiration Then, have the patient push the fisted hand into the lateral aspect of the chest, bend toward the tight side, and breathe out. Progress by having the patient raise the arm overhead on the tight side of the chest and side-bend away from the tight side. This places an additional stretch on hypomobile tissues.

To Mobilize the Upper Chest and

Stretch the Pectoralis Muscles

While the patient is sitting in a chair with hands clasped behind the head, have him or her horizontally abduct the arms (elongating the pectoralis major) during a deep inspiration. Then instruct the patient to bring the elbows together and bend forward during expiration.

To Mobilize the Upper Chest and Shoulders

While sitting in a chair, have the patient reach with both arms overhead (180_ bilateral shoulder flexion and slight abduction) during inspiration and then bend forward at the hips and reach for the floor during expiration

 

 

Respiratory Resistance Training

The process of improving the strength or endurance of the muscles of ventilation is known as respiratory resistance training (RRT). Other descriptions used to denote this form of breathing exercises are ventilatory muscle training, inspiratory (or expiratory) muscle training, inspiratory resistance training, and flow-controlled endurance training.

These techniques typically focus on training the muscles

of inspiration, although expiratory muscle training also has been described RRT is advocated to improve ventilation in patients with pulmonary dysfunction associated with weakness, atrophy, or inefficiency of the muscles of inspiration or to improve the effectiveness of the cough mechanism in patients with weakness of the abdominal muscles or other expiratory muscles

Inspiratory Resistance Training

Inspiratory resistance training, using pressure- or flowbased devices to provide resistance to airflow, is designed to improve the strength and endurance of the muscles of inspiration and decrease the occurrence of inspiratory muscle fatigue. This technique has been studied in patients with acute and chronic, primary and secondary pulmonary disorders, including COPD,cystic fibrosis,26 respiratory failure and ventilator dependence (weaning failure), chronic heart failure,14 and chronic neuromuscular disease. Although reviews of the literature have demonstrated that outcomes of inspiratory muscle training programs in patients with pathologies are inconsistent, some positive changes reported after training are increased vital capacity, increased exercise capacity, and fewer episodes of dyspnea. Inspiratory muscle training also has be a decreased respiratory rate) in patients with cervical-level spinal cord lesions.

Procedure

The patient inhales through a resistive training device placed in the mouth. These devices are narrow tubes of varying diameters or a mouthpiece and adapter with an adjustable aperture that provide resistance to airflow during inspiration and therefore place resistance on inspiratory muscles. The smaller the diameter of the aperture and the faster the rate of airflow, the greater is the resistance. The patient inhales through the device for a specified period of time several times each day. The time is gradually increased to 20 to 30 minutes at each training session to increase inspiratory muscle endurance.

Incentive Respiratory Spirometry

Incentive spirometry is a form of ventilatory training that emphasizes sustained maximum inspirations. The patient inhales as deeply as possible through a small, handheld spirometer that provides visual or auditory feedback about whether a target maximum inspiration was reached. Typically, this breathing technique is performed while using a spirometer, but it also may be performed without the equipment.

The purpose of incentive spirometry is to increase the volume of air inspired. It is used primarily to prevent alveolar collapse and atelectasis in postoperative patients. Despite the widespread use of incentive spirometry for

patients after surgery, the effectiveness of this technique alone or in addition to general deep breathing and coughing for the prevention of postoperative pulmonary complications is not clear.

chest moblizing


Procedure

Have the patient assume a comfortable position (semireclining, if possible) and inhale and exhale three to four times and then exhale maximally with the fourth breath. Then have the patient place the spirometer in the mouth, inhale maximally through the mouthpiece to a target setting and hold the inspiration for several seconds. This sequence is repeated five to ten times several times per day and it is founf effective.

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