Tom Pinder

The purpose of this dissertation was to explore the relevance of dysfunctional breathing (DB) in musculoskeletal (MSK) practice. As exposure to breathing practices become increasingly more prevalent across healthcare professionals and the public, and progressively more treatment modalities related to breathing mechanics are emerging, it is important to explore whether breathing mechanics are a relevant consideration within MSK practice. Initially, a critical review was conducted to explore the term ‘dysfunctional breathing’, its definition and the current evidence around DB in MSK health. One suggested formal definition of DB was identified, by Barker and Everard (2015), but there remains no consensus on what DB is within the reviewed literature. One model of DB was also identified (Barker and Everard, 2015), but it needs further modification and adaptation to meet the requirements of the most recent research published on DB. In addition, a literature review of the potential effects that DB can have on the MSK system was conducted. Anatomical, biomechanical, physiological and neurological effects of DB on the MSK system were identified, some grounded in research and others more narrative in nature and needing further exploration. Finally, an explorative focus group interview and one individual interview were conducted to acquire the beliefs and opinions of current MSK practitioners on the relevance of DB, their assessment methods, interventions and their beliefs on what effects DB can have on the MSK system. Thematic analysis was used to develop themes and classifications. This study revealed that DB assessment methods can be classified into three categories: observational assessment, manual assessment, and subjective assessment. Three types of breathing intervention were identified: breathing re-education, breathing exercises, and manual therapy. In total, fourteen potential effects of DB on the MSK system were identified by the participants. Unlike previous research exploring DB this dissertation has only focused on the implications within MSK health as opposed to exploring DB within respiratory and cardiovascular medicine. It adds to the debate of the need for a formal definition of DB and has identified areas for further research that are needed around the perceived effects of DB on the MSK system. In the absence of an overarching and accurate definition a new model of DB has been produced as a result of this dissertation to provide a suggested framework of what DB could potentially look like, when divided into three subcategories. These subcategories are biomechanical DB, biochemical DB and psychophysiological DB It is proposed by this author that the work produced in this study enables a future consensus to be reached on the formal definition, model and signs and symptoms of DB.

Dysfunctional breathing (DB) refers to various abnormalities breathing patterns. Whilst a formal definition exists, subsequent research has inconsistently applied or omitted it. As interest in breathing techniques grows among both healthcare professionals and the public, it is important to reach a consensus on DB's definition to ensure effective assessment and treatment. This critical review explores how DB is currently defined and applied within respiratory and musculoskeletal health. A lack of consistency in the literature identified the need for a more comprehensive framework of DB. To address this, a new model of DB is proposed that includes three subcategories: biomechanical, biochemical and psychophysiological DB. This revised model offers a foundation for future research and clinical application.