Testing For The Accessory Muscles Of Respiration

Testing Whether The Diaphragm Is Used

Lying on your back, draw in as large a breath as you can using your diaphragm, that is draw in as large a breath as you can into your abdomen. Now place your two hands on the belly. One hand at the top near the ribs. The other hand at the bottom between the two wings of the pelvis (about the place where the bladder is) as shown in Figure 36.

Having done that, now draw in as large a breath as you can into the chest. You should feel NO movement below either hand; that is, your belly should not collapse or tighten. If you can not do this — if you find the belly contracting or the belly tensing — then you are using the diaphragm to push the chest up.

Figure 36

Checking The Muscles In The Front Of The Chest

To see if the muscle in the front of the chest is being used during the inhale, start at the complete exhale state. Either pinch the muscle at your armpit (the pectoral), see the left panel in Figure 37 on page 131 or press into the muscle (the right panel). Then do a complete inhale including the chest. If the muscle tenses (the increase in tension is very easy to feel) during the inhale, then it is being used to raise the chest (incorrect) instead of the chest expanding (correct).

The Muscles In The Front Of The Neck

There is one major muscle in the front of the neck. This muscle is the sternocleidomastoid muscle. When you are lying down, this muscle should not be tight, it should be soft. If you know this muscle, you can just pinch it even before a breath to see if it is tense.

Figure 37

If you are not familiar with this muscle, here is how to find it. First place your index finger in about the middle of the side of your neck (Figure 38, left). Now, with the finger curved in and down, move your had toward the front until you feel it bump up against some resistance to the forward motion (Figure 38, right). If, in your case, this muscle is very relaxed before an inhale, the resistance to the forward movement is subtle.

Figure 38

Now that you have located the border of this muscle, you can change and pinch it between your thumb (at the front side of the neck) and your first finger (at the breast bone). What I mean by that is that the muscles lie from where your finger is to a point almost in the middle of your breast bone. While the photos above show the model laying down in working position to feel for the muscle, you should practice locating this muscle while you are here reading the book. It is much easier to locate this muscle when you are sitting up since it then has a postural function and is usually tighter than when you lay down. Once you get the feel for locating this muscle, it will be no trouble to do that while you are in the working position.

The left panel of Figure 39 has some arrows drawn on it to show you the middle and outside border of this muscle.

Returning to the issue of whether this muscle is used in breathing, as before, start with a complete exhale. Now pinch the muscle. Next do a complete inhale including the chest. If this muscle tenses during the inhale it means that you are using it to raise the chest. It is easy to feel if it tenses during the inhale or stays relaxed (or is tense before the inhale even starts).

There is one slight caveat here. If you are totally unable to breathe at all into the chest, then obviously this muscle is not going to change in its tension. If your chest is so stuck in an up (chronic inhale) position that you can not use it at all for breathing, then this is a false test. All testing for use of the accessory muscle of respiration assumes that you are able in some degree to breathe into the chest.

Another way to test whether you are using this muscle is to put pillows under your head so that your chin is forced onto your breastbone. You can also move next to a wall or bed board to force your chin onto your breastbone. Now do a complete breath into the belly and the chest. Is there any difference in your ability to breathe into the chest? If so, then you are using the muscles at the front of your neck to breathe into the chest.

Figure 39

Above, on the left of Figure 39, the photo and the arrows show that in this model the sternocleidomastoid (SCM) muscle is prominent even when he has not yet taken a breath to the chest.

The Muscles On The Side Of The Neck

Now we get to some muscles that are more difficult to test. It is not uncommon that these muscles are so tense at all times that the difference between tension after a complete exhale and increase of tension during a complete inhale is difficult to feel. You may have to try the complete exhale followed by the complete inhale (to the chest) several times before you get any impression of whether the tension does or does not increase.

As with the muscle at the front of the neck, we are not concerned here with the degree of tension present at the complete exhale point, we are concerned only with the change during the inhale.

I also would not be fair if I did not mention here another variable. Some people have long necks, some short. One can have a long neck with comparatively short muscles. That tends to result in a state of constant tension because the muscles are simply not able to relax given the muscle's length compared to the neck length. Similarly, one can have long muscles with a short neck so the muscles tend to be relaxed most of the time.

To check the use of these muscles, first place your second finger against the middle of your clavicle. Press your finger down against the bone and backward toward the bed and then move it forward until you locate the border of the same SCM muscles that I talked of above (in the discussion of Figure 38 and Figure 39).

Now rotate your hand and arm so that your finger is pressing into the side of your neck and downward. This is shown in Figure 40 on page 134. Be aware that only a little bit of this muscle can be felt so it is important that you press deeply into and down in the neck right next to the previously located SCM muscle. For the purist, this is the scalenus anticus (anterior scalene) muscle.

Now do your deep breath (belly then chest) and see if this muscle tenses. You will find a discussion of the anatomy of the neck starting on page 164.

It can be difficult to feel if this muscle tightens with the breath. This is especially the case if this muscle is very tense before the breath even begins.

If this muscle in the front side of the neck tenses, it is so likely that the other muscles on the side of the neck also tense that there is no reason to test for them. If it does not tense, then we test the other muscles on the side of the neck.

Figure 40

Before you were pressing in and down as shown in Figure 40. Now move your arm so that you are only pressing inward and move your finger back about an inch so that your finger is about in the middle of the side of your neck. The arm position is shown in Figure 41 left and the finger pushing in is seen in Figure 41 right panel. Here you are testing the medial scalene muscle.

Figure 41

Now, again, take a couple of deep breaths to the chest to feel if this muscle tightens. As before the tightening, if it occurs, can be subtle so take as many breaths as needed to allow you to feel if this muscle tightens. Keep in mind that you are breathing as deeply as you can into the chest.

Finally you are going to test the third muscle at the side of the neck. Again you move your finger back Your finger will now be just in front of the muscle which is commonly called the shoulder muscle. Press straight into the neck and slightly down as shown in Figure 42. You are feeling the posterior scalene.

Figure 42

Now while pressing on that muscle, take your full breath. Again it may be difficult to feel if this muscle tenses during the chest part of the inhale, so take several breaths into the chest until you are sure that it either does or does not tense