Breathing evaluation and retraining in manual therapy.

Patients with back and neck pain commonly seek body work yet there are some who do not experience full recovery with the typical tool kit of manual therapy, education and exercise, suggesting the need for additional clinical approaches. Epidemiological literature linking back pain with breathing difficulties suggests one possibility. Altered motor control associated with back and neck pain appears to negatively impact breathing mechanics, which may have negative consequences on respiratory chemistry. Changes in respiratory chemistry can have profound effects on body system function. Altered breathing has been recognized for many years as a potential source of a wide variety of unexplained symptoms. There has been controversy around accurate diagnosis with symptoms and questionnaires often being the only methods used. Capnography, which is routinely used in critical care settings, offers an objective measure of respiratory chemistry providing physiological data on which to base a diagnosis of poor breathing. Capnography can also be used as biofeedback to guide breathing retraining.