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Rehab Update: Diaphragm Strength and Thoracic Scoliosis

By Dr. Don DeFabio, Council on Rehabilitation and Performance Chair

Scoliosis as defined must include vertebral rotation. Therefore, if scoliosis is present in the thoracic spine then rib cage rotation will also be present. The prominent “rib hump” that is commonly seen is a reflection of both rib cage rotation and core weakness.  Greater stabilization of the rib cage can be obtained with exercises to strengthen the diaphragm with abdominal breathing.

Here are the basics for training abdominal breathing:

  1. With inspiration the abdomen pushes out circumferentially (360 degrees) with expansion of the lower ribs and a quiet upper chest.
  2. Hold for 1-2 seconds
  3. Slowly breathe out will a full exhalation drawing the lower ribs down and the abdomen in.
  4. Hold for 1-2 seconds
  5. Start with the patient supine with the knees bent, breathing in with the nose to start with a ratio of 1:2 inhalation to exhalation. Remember to hold for a few seconds as mentioned above.

There are many options for training abdominal breathing such as Crocodile or a DNS Primal Movement pattern which are beyond this update.

In conclusion, for your thoracic scoliosis patients, first teach them basic abdominal breathing, then teach them to do it sitting while visualizing lengthening their spine as if they had a helium balloon on their head to assist in reducing their curve, and then have them do it walking, standing or even on a vibration plate. Here is my video on Breathing Progression for more information.

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