Browse > Article

A Study of the Role and Treatment of Scalene Muscle in Breathing Pattern Disorder  

Byun, Dong-Wook (Chuna Manual Medicine Research Group, College of Korean Medicine, Won-Kwang University)
You, Hong-Chang (Chuna Manual Medicine Research Group, College of Korean Medicine, Won-Kwang University)
Ha, Won-Bae (ImSil-Gun Health Care Center)
Lee, Jung-Han (Department of Rehabilitation Medicine of Korean Medicine, College of Korean Medicine, Won-Kwang University)
Publication Information
Journal of TMJ Balancing Medicine / v.10, no.1, 2020 , pp. 1-11 More about this Journal
Abstract
There are studies on breathing pattern disorder (BPD), but the causes of BPD are still complex, and various studies are ongoing. This study reviewed several studies to investigate the possibility that pathological changes in the scalene muscles may be one of the causes of dyspnea, and that treatment of them may improve respiratory disorders. Anatomically, the scalene muscles are located between the cervical vertebrae and the transverse process of the ribs and act as a respiratory muscle. If there is a problem or excessive in its role, it can cause chest breathing or oral breathing. These problems may further affect respiratory diseases such as hyperventilation syndrome, obstructive disease, restrictive disease, and respiratory disorders. According to the results of previous studies, it seems that manual therapy or exercise therapy for the scalene muscles can contribute to the treatment of BPD.
Keywords
Scalene muscle; Breathing pattern disorder (BPD); Manual therapy; Exercising;
Citations & Related Records
Times Cited By KSCI : 8  (Citation Analysis)
연도 인용수 순위
1 Baarends EM, Schols AM, Slebos DJ. Metabolic and ventilatory response pattern to arm elevation in patients with COPD and healthy age-matched subjects. Eur. Respir. J. 1995;8:1345-51.   DOI
2 Tanaka T, Basoudan N, Melo LT, Wickerson L, Brochard LJ, Goligher EC, Reid WD, Deoxygenation of inspiratory muscles during cycling, hyperpnoea and loaded breathing in health and disease: a systematic review. Clinical Physiology and Functional Imagining. 2018.
3 Janda V. Muscle fuction testing. London:Butterworths. 1983.
4 Cleland JA, Childs JD, Fritz JM. Interater reliability of the history and physical examination in patients with mechanical neck pain. Arch. Phys. Med. Rehabil. 2006;87(10):1388-95.   DOI
5 Heiderscheit B, Boissonnualt W. Reliability of joint mobility and pain assessment of the thoracic spine and rib cage in asymtomatic individuals. J. Man. Manip. Ther. 2008;16(4): 210-16.   DOI
6 Simons D. Understanding effective treatments of myofascial trigger points. Journal of Bodywork and Movement Therapies. 2002;6(2):81-8.   DOI
7 Simons D. New Aspects of Myofascial Trigger points-etiological and clinical. Journal of Musculoskeletal Pain. 2004;12(3/4):15-21.   DOI
8 Tulaimat A, Trick WE. Diaphragm: A mnemonic to describe the work of breathing in patients with respiratory failure. PLoS One, 2017;12(7):e0179641. doi: 10.1371/journal.pone.0179641. eCollection 2017.   DOI
9 Tulaimat A, Patel A, Wisniewski M, Gueret R. The validity and reliability of the clinical assessment of increased work of breathing in acutely ill patients. Journal of Critical care. 2016;34:111-5. doi: 10.1016/j.jcrc.2016.04.013.   DOI
10 Johnson BD, Babcock MA, Suman OE. Exercise-induced diaphragmatic fatigue in healthy humans. J. Physiol. 1993;460:385-405.   DOI
11 Sheel AW. Respiratory muscle training in healthy individuals: physiological rationale and implications for exercise performance. Sports Med. 2002;32:567-81.   DOI
12 Gibert C. Emotional sources of dysfunctional breathing. Journal of Bodywork & Movement therapies. 1998;2:224-30.   DOI
13 Richardson C, Jull G, Hodges P. therapeutic exercise for spinal segmental stabilisation in low back pain. Edinburgh:Churchill Livingstone. 1999.
14 Reid DC, Bowden J, Lynne-Davies P. Role of selected muscles of respiration as influenced by posture and tidal volume. Chest. 1976;70:636-40.   DOI
15 Reid WD, Dechman G. Considerations when testing and training the respiratory muscles. Phys. Ther. 1995;75:971-82.   DOI
16 Cerqueira EP, Garbellini D. Electromyographic study of the pectoralis major, serratus anterior and external oblique muscles during respiratory activity in humans. Electromyogr. Clin. Neurophysiol. 1999;39:131-37.
17 Wilson TA, Legrand A, Gevenois PA. Respiratory effects of the external and internal intercostal muscles in humans. J. Physiol. 2001;530:319-30.   DOI
18 Legrand A, Schneider E, Gevenois PA. Respiratory effects of the scalene and sternomastoid muscles in humans. J. Appl. Physiol. 2003;94:1467-72.   DOI
19 Campbell E. The role of the scalene and sternomastoid muscles in breathing in normal subjects - an electromyographic study. J. Anat. 1955;89(3):378-86.
20 Grimby G, Goldman M, Mead J. Respiratory muscle action inferred from rib cage and abdominal V-P partitioning. J. Appl. Physiol. 1976;41(5/1):739-51.   DOI
21 Washino S, Kanehisa H, Yoshitake Y. Neck inspiratory muscle activation patterns during well-controlled inspiration. Eur. J. Appl. Physiol. 2017;117(10):2085-97.   DOI
22 Travell J, Simons D. Myofascial Pain & Dysfunction. Vol. 2 Lower Body. Baltimore:Williams & wilkins. 1992.
23 Kolnes LJ. Embodying the body in anorexia nervosa-a physiotherapeutic approach. Journal of Bodywork and Movement Therapies. 2012;16(3):281-88.   DOI
24 Gardner W. The pathophysiology of hyperventilation disorders. Chest. 1996;109(2):516-54.   DOI
25 Swift A, Campbell I, McKown T. Oronasal obstruction, lung volumes, and arterial oxygenation. Lancet 1. 1998:73-5.
26 Cottin V, Richeldi L. Neglected evidence in idiopathic pulmonary fibrosis and the importance of early diagnosis and treatment. Eur. Respire Rev. 2014;23(131):106-10.   DOI
27 Maltais F, LeBlanc P, Jobin J. Peripheral muscle dysfunction in chronic obstructive pulmonary disease. Clinics in Chest Medicine. 2000;21(4):665-77.   DOI
28 Ottenheijm CA, Heunks LM, Sieck GC. Diaphragm dysfunction in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical care Medicine. 2005;172(2):200-5.   DOI
29 Bohadana Abraham, Izbicki Gabriel, Kraman Steve S. Fundamentals of lung auscultation. N. Engl. J. Med. 2014;370(8):744-51.   DOI
30 Ricketss RM. Respiratory obstructions and their relation to tongue posture. Cleft Palate Bull. 1958;8:3-6.
31 Mcnamara JA. Influence of respiratory pattern on craniofacial growth. Angle. Orthod. 1981;51:269-300.
32 Jung SR, Lee SE, Choi HY. The Effects of Inspiratory Kinesio Taping for Achievement of Respiratory Activity and Pulmonary Function. Journal of Sport and Leisure Studies. 2012;48:849-57.   DOI
33 Koppers RJ, Vos PJ, Boot CR. Exe endurance training. Chest. 2006;129(4):886-92.   DOI
34 Huang YS, Guilleminault C. Pediatric obstructive sleep apnea and the critical role of orofacial growth: evidences. Front Neurol. 2013;3:1-7.
35 Linder-Aronson S. Dimensions of face and palate in nose breathers and habitual mouth breathers. Odontol. Revy. 1969;14:187-200.
36 Linder-Aronson S. Adenoids. Their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the denition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids. Acta. Otolaryngol. Suppl. 1970;265:1-132.
37 Segizbaeva MO, Aleksandrova NP. Inspiratory muscle resistance to fatigue during exercise and simulated airway obstruction. Fiziol. Cheloveka. 2014;40(6):114-22.
38 Lime M. Orthognathic and orthodontic consequences of mouth breathing. Acta. Otorhinolaryngol. Belg. 1993;47:145-55.
39 Lee SY, Guilleminault C., Chiu HY, Sullivan SS. Mouth breathing, "nasal disuse," and pediatric sleep-disordered breathing. Sleep Breath. 2015;19(4):1257-64.   DOI
40 Fitzpatrick M, Driver H, Chata N, Vodue N, Girard A. Partitioning of inhale ventilation during sleep in normal subjects. J, Appl. Physiol. 2003;91:883-90.
41 Raskin S., Limme M., Poirrier R. Could mouth breathing lead to obstructive sleep apnea syndromes. A preliminary study. Orthord. Fr. 2000;71(1):27-35.   DOI
42 Guilleminault C, Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH. Critical role of myofunctional reeducation in sleep-disordered-breathing. Sleep Med. 2013;14:518-25.   DOI
43 Ko MA, Darling GE. Acquired paralysis of the diaphragm. Thorac. Surg. Clin. 2009;19:501-10.   DOI
44 Janda V. Muscles and motor control in low back pain-assessment and management. Physical therapy of the low back, First Ed. Churchill Livingstone. 1987:253-78.
45 Sanders RJ, Jackson CG, Banchero N, Pearce WH. Scalene muscle abnormalities in traumatic thoracic outlet syndrome. American Journal of Surgery. 1990;159(2):231-6.   DOI
46 Hoshide R, Brown J. Phrenic nerve decompression for the management of unilateral diaphragmatic paralysis - preoperative evaluation and operative technique. Surgical Neurology International. 2017;8:254.   DOI
47 Newton E. Hyperventiltion from the emergency department. 2012. http://bit.ly/In8sDf (Accessed June 2013)
48 Saltzman HA, Heyman A, Sieker HO. Correlation of clinical and physiologic manifestations of sustained hyperventilation. New England Journal of Medicine. 1963;268:1431-6.   DOI
49 Enzer NB, Walker PA. Hyperventilation syndrome in childhood. A review of 44 cases. 1967;70(4):521-32.   DOI
50 Thomas M, McKinley RK, Freeman E. The prevalence of dysfunctional breathing in adults in the community with and without asthm. Prim. Care Respir. J. 2005;14:78-82.   DOI
51 Dunnett A. The diagnosis of fibromyalgia in women may be influenced by menstrual cycle phase. Journal of Bodywork and Movement Therapies. 2007;11:99-105.   DOI
52 Jensen D. Wolfe LA, Slatkovska L. Effects of human pregnancy on the ventilatory chemoreflex response to carbon dioxide. American Hournal of Physiology - Regulatory Integrtive and Comparative Physiology. 2005;288(5):57-65.
53 Gosselink R. Controlled breathing and dyspnea in patients with chronic obstructive pulmonary disease (COPD). Journal of Rehabilitation Research & Development. 2003;40:25-33.   DOI
54 Tabak M, Akker H, Hermens H. Motivational cues as real-time feedback for changing daily activity behavior of patients with COPD. Patient education and counseling, 2014;94(3):372-8.   DOI
55 Kang JI, Jeong DK, Choi H. The effects of breathing exercise types on respiratory muscle activity and body function in patients with mild chronic obstructive pulmonary disease. Journal of Physical Therapy Science. 2016;28(2):500-5.   DOI
56 Bott J, Blumenthal S, Buxton M, Ellum S, Falconer C, Garrod R, British Thoracic Society Physiotherapy Guideline Development, G. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax. 2009;64(1):i1-51.   DOI
57 O'Neill, S., & McCarthy, D. S. Postural relief of dyspnoea in severe chronic airflow limitation: Relationship to respiratory muscle strength. Thorax. 1983;38:595-600.   DOI
58 Mesquita Montes A, Tam C, Crasto C, Argel de Melo C, Carvalho P, Santos R, Vilarinho R, Vilas-Boas JP. Forward trunk lean with arm support affects the activity of accessory respiratory muscles and thoracoabdominal movement in healthy individuals. Human Movement science. 2018;61:167-76.   DOI
59 Cools AM, Dewitte V, Lanszweert F, Notebaert D, Roets A, Soetens B, Cagnie B, Witvrouw EE. Rehabilitation of scapular muscle balance: which exercises to prescribe?. Am. J. Sports Med. 2007;35(10):1744-51.   DOI
60 Gouzi F, Maury J, Molinari N, Pomies P, Mercier J, Prefaut C, Hayot M. Reference values for vastus lateralis fiber size and type in healthy subjects over 40 years old: a systematic review and metaanalysis. Journal of Applied Physiology. 2013;115(3):346-54.   DOI
61 Dominelli PB, Ripoll JG, Cross TJ, Baker SE, Wiggins CC, Welch BT, Joyner MJ. Sex differences in large conducting airway anatomy. J. Appl. Physiol. 2018;125(3):960-5.   DOI
62 Molgat-Seon Y, Dominelli PB, Ramsook AH, Schaeffer MR, Molgat Sereacki S, Foster GE. The effects of age and sex on mechanical ventilatory constraint and dyspnea during exercise in healthy humans. J. Appl. Physiol. 2018;124(4):1092-106.   DOI
63 Mitchell RA, Schaeffer MR, Ramsook AH, Wilkie SS, Guenette JA. Sex differences in respiratory muscle activation patterns during high-intensity exercise in healthy humans. Respir. Physiol. Neurobiol. 2017;247:57-60.   DOI
64 Guenette JA, Romer LM, Querido JS, Chua R, Eves ND, Road JD, McKenzie DC, Sheel AW. Sex differences in exercise-induced diaphragmatic fatigue in endurance-trained athletes. J. Appl. Physiol. 2010;109:35-46.   DOI
65 Molgat-Seon Y, Dominelli PB, Ramsook AH, Schaeffer MR, Romer LM, Road JD, Guenette JA, Sheel AW. Effects of Age and Sex on Inspiratory Muscle Activation Patterns during Exercise. Med. Sci. Sports Exerc. 2018;50(9):1882-91.   DOI
66 Barelli PA. Nasopulmonary Physiology. In: Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. Boston, MA:Springer. 1994:47-57.
67 Cottle, MH. The work, ways, positions and patterns of nasal breathing (relevance in heart and lung illness). Proceedings of the American Rhinologic Society. 1972.
68 Kendall FP, Provance PG, McCreary EK. Muscle: testing and function with posture and pain, 4th ed. Baltimore:Lippincott Williams & Wilkins. 1993:36-7.
69 Yoon HG. Effect of push up plus on sling and stable surface on muscle activity and lung function in adults with forward head posture. Journal of the Korea Academia-Industrial cooperation Society. 2017;18(4);624-31.   DOI
70 Ellenbecker TS, and Davies GJ. Closed kinetic chain exercise:a comprehensive guide to multiple joint exercise. Champaign, Human Kinetics. 2001:53-8.
71 Yoo WG. Effect of the Neck Retraction Taping (NRT) on forward head posture and the upper trapezius muscle during computer work. J. Phys. Ther. Sci. 2013;25:581-2.   DOI
72 Kolnes LJ. Embodying the body in anorexia nervosa-a physiotherapeutic approach. Journal of Bodywork and Movement Therapies. 2012;16(3):281-8.   DOI
73 Correa E, Berzin F. Mouth Breathing syndrome: cervical muscles recruitment during nasal inspiration before and after respiration befroe and after repiratory and postural exercises on Swiss Ball. International Journal of Pediatric Otorhinolaryngology. 2008;72:1335-43.   DOI
74 Kapreli E, Vourazanis E, Strimpakos N. Neck pain causes respiratory dysfunction. Med Hypotheses. 2008;70:1009-13.   DOI
75 Kim SY, Kim NS, Jung JH, et al. Effect of forward head posture on respiratory function in young adults. J. Korean Soc. Phys. Ther. 2013;25:311-5.
76 Lee MH, Chu M. Correlations between Craniovertebral Angle (CVA) and cardiorespiratory function in young adults. J Korean Soc Phys Med. 2014;9:107-113.   DOI
77 Kang JI, Jeong DK, Choi H. Correlation between pulmonary functions and respiratory muscle activity in patients with forward head posture. J. Phys. Ther. Sci. 2018;30(1):132-5.   DOI
78 Bartely J. Nasal congestion and hyperventilation syndrome. American Journal of Rhinology. 2006;19:607-11.   DOI
79 Lima LC, Barauna MA, Sologurem MJ, Canto RS, Gastaldi AC. Postural alterations in children with mouth breathing assessed by computerized biophotormmetry. J. Appl. Oral Sci. 2004;12(3):232-7.   DOI
80 Janda V., Frank C., Liebenson, Craig. Evaluation of muscle imbalance. Rehabilitation of the Spine. 2007:203-25.
81 Yun JH, Kim TS, Lee BK. The Effects of Combined Complex Exercise with Abdominal Drawing-in Maneuver on Expiratory Abdominal Muscles Activation and Forced Pulmonary Function for Post Stroke Patients. Journal of The Korean Society of Physical Medicine. 2013;8(4):513-23.   DOI
82 Shin MK, Kwon HC, Kim HS, Lee YD, Choi HS. (The)physiology of the joints volume 3: the phusiology of the joints. Seoul:Hyunmoon. 1998:142,144,158.
83 Donald A Neumann. Kinesiology of the Musculoskeletal system. Seoul:Jeongdam. 2004:404,406-7.
84 Kim EG, Cha YY. Effect of Myofacial Releasing of Abdominal Muscles on Chronic Cough by Oriental Medical Treatment ; 2 Cases Report. J. Oriental Rehab. Med. 2009;19(3):123-34.
85 Hostettler S, Illi SK, Mohler E, Aliverti A, Spengler CM. Chest wall volume changes during inspiratory loaded breathing. Respir. Physiol. Neurobiol. 2011;175:130-39.   DOI
86 Sasaki M. The effect of expiratory muscle training on pulmonary function in normal subjects. J. Phys. Ther. Sci. 2007;19:197-203.   DOI
87 McConnell A. Inspiratory muscle training improves lung function and reduced exertional dyspnoea in mild/moderate asthmatics. Proceeding of the Medical Research Society. Clinical Science. 1998;95:4.
88 Molgat-Seon Y, Dominelli PB, Ramsook AH, Schaeffer MR, Romer LM, Road JD, Guenette JA, Sheel AW. Effects of Age and Sex on Inspiratory Muscle Activation Patterns during Exercise. Med. Sci. Sports Exerc. 2018;50(9):1882-91.   DOI
89 Enright PL, Kronmal RA, Manolio TA, Schenker MB, Hyatt RE. Respiratory muscle strength in the elderly. Correlates and reference values. Am. J. Respir. Crit. Care Med. 1994;149(2/1):430-8.   DOI
90 Elliott JE, Greising SM, Mantilla CB, Sieck GC. Functional impact of sarcopenia in respiratory muscles. Respir. Physiol. Neurobiol. 2016;226:137-46.   DOI
91 Gouzi F1, Maury J, Molinari N, Pomies P, Mercier J, Prefaut C, Hayot M. Reference values for vastus lateralis fiber size and type in healthy subjects over 40 years old: a systematic review and metaanalysis. Journal of Applied Physiology. 2013;115(3):346-54.   DOI
92 Timmons BH, Ley R. Behavioral and psychological approaches to breathing disorders. New York:Plenum Press. 1994.
93 Van den Bergh O, Stegen K, Van de Woestijne KP. Learning to have psychosomatic complaints: conditioning of respiratory behavior and somatic complaints in psychosomatic patients. Psychosomatic Medicine. 1997;59:13-23.   DOI
94 Hill K, East wood P. Effects of loading on upper airway and respiratory pump muscle motoneurons. Respiratory Physiology & Neurobiology. 2011;179(1):64-70.   DOI
95 Bordoni B, Varacallo M. Anatomy, Head and Neck, Scalenus Muscle. [Updated 2018 Nov 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519058/.
96 Lum LC. Breathing exercises in the treatment of hyperventilation and chronic anxiety states. Chest Heart and Stroke Journal. 1977;2:6-11.
97 Ramsook AH, Molgat-Seon Y, Schaeffer MR, Wilkie SS, Camp PG, Reid WD, Romer LM, Guenette JA. Effects of inspiratory muscle training on respiratory muscle electromyography and dyspnea during exercise in healthy men. J. Appl. Physiol. 2017;122(5):1267-75.   DOI
98 Held PA, Castro WM, Silva TLP, Silva KR, Lorenzo VAPD. Treinamento muscular e da respiracao nasal em crianças respiradoras orais. Fisioter. Mov. 2008;21:119-27.
99 Ramsook A.H., Koo R., Molgat-Seon Y., Dominelli P.B., Syed N., Ryerson C.J., Sheel A.W., Guenette J.A. Diaphragm Recruitment Increases during a Bout of Targeted Inspiratory Muscle Training. Med Sci Sports Exerc. 2016 Jun;48(6):1179-86.   DOI
100 Keibel F, Mall FP. Manual of Human Embryology. The Development of the Central Nervous System. Philadelphia:JB Lippincott. 1910;1-59.
101 Hornsveld H, Garsson B. Hyperventilation syndrome: an elegant but scientifically untenable concept. The Netherlands Journal of Medicine. 1997;50(1):13-20.   DOI
102 Keibel F, Mall FP, Manual of Human Embryology. The Peripheral Nervous System. Philadelphia:JB Lippincott. 1912;1-47.
103 Moore K, Dalley A, Agur A. Clinically oriented anatomy, 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins. 2010;1012-3.
104 Hudson A, Grandevoa S, Butler J. The effect of lung volume on the co-ordiated recruitment of scalene and sternomastoid muscles in humans. J. Physiol. 2007;584(1): 261-70.   DOI
105 Cornwall J, Kennedy E. Fiber types of the anterior and lateral cervical muscles in elderly males. Eur. Spine J. 2015;24(9):1986-91.   DOI
106 Kapreli E, Vourazanis E, Strimpakos N. Neck pain causes respiratory dysfunction. Med. Hypotheses. 2008;70(5):1009-13.   DOI
107 Wang JS, Cho KH, Park SJ. The immediate effect of diaphragm taping with breathing exercise on muscle tone and stiffness of respiratory muscles and SpO2 in stroke patient. Journal of Physical Therapy Science, 2017;29(6):970-3.   DOI
108 Murphy PR, Hanmmond GR. Reversal of fusimotor reflex respones during locomotion in the decerebrate cat. Exper. Physiol. 1997;82(5):837-58.   DOI
109 Ward RC, Hruby RJ, Jerome JZ. Foundations for osteopathic medicine, Third Ed. Baltimore:Lippincott Williams & Wilkins. 2002.
110 Byun SH, Han DW. The Effects of passive stretching exercise of the scalene muscles on forced vital capacity. J. Korean Soc. Phys. Med,. 2016;11(1):35-43.   DOI
111 Dommerholt J., Huijbregts P.A. Mysofascial trigger points: pathophysiology and evidence-informed diagnosis and management, Boston:Jones & Bartlett. 2011.
112 Flynn T, Whiteman J, Magel J. Orthopaedic manual physical therapy management of the cervical-thoracic spine & ribcage. Louisville, KY:Evidence in Motion. 2001.
113 De Troyer A, Estenne M. Coordination between rib cage muscles and diaphragm during quiet breathing in humans. J. Appl. Physiol. Respir. Environ. Exerc. Physiol. 1984;57(3):899-906.
114 Simons D, Travell J, Simons L. Myofascial pain and dysfunction: the trigger point Manual, Second Ed. Baltimore:Williams and Wikins. 1998.
115 Hudson A, Grandevoa S, Butler J. The effect of lung volume on the co-ordiated recruitment of scalene and sternomastoid muscles in humans. J. Physiol. 2007;584(1):261-70.   DOI
116 Masubuchi Y, Abe T, Yokoba M. Relation between neck accessory inspiratory muscle electromyographic activity and lung volume. Journal Japanese Respiratory Society. 2001;39(4):244-49.
117 Ha MS. The effects Stretching Exercise of Breathing Accessory Muscle on Respiratory Function in healthy subjects. Korea of Health care Asso. in community. 2018;15(1):1-10.
118 Lewit K. Manipulative Therapy: Musculoskeletal Medicine. Edinburgh:Churchill Livingstone. 2009.
119 Reardon, J, Awad, E, Normandin,E,. The Effect of comprehensive outpatient pulmonary rehabilitation in dyspnea. Chest. 1994;105(4):1046-52.   DOI
120 Casciari R, Fairsher RD, Harrison A. Effects of breathing retraining in patients with chronic obstructive pulmonary disease. Chest. 1981;79(4):393-8.   DOI
121 De Toyer A. Do canine scalene and sternomastoid muscles play a role in breathing? J. Appl. Physiol. 1994;76:242-52.   DOI
122 De Troyer A, Estenne M. Functional anatomy of the respiratory muscles. Clin. Chest Med. 1988;175-93.
123 Saboisky JP, Gorman RB, De Troyer A. Differential activation among five human inspiratory motoneuron pools during tidal breathing. J. Appl. Physiol. 2007;102:772-80.   DOI
124 De Troyer A, Sampson M.G. Activation of the parasternal intercostals during breathing efforts in human subjects. J. Appl. Physiol. Respir. Environ. Exerc. Physiol. 1982;52:524-29.
125 Kisner C, Colby LA. Therapeutic exercise: foundation and techniques, 4th ed. Philadelphia:FA Davis. 2002.
126 Cramer G, Darby S. Basic and clinical anatomy of the spine, spinal cord and ANS. St Louis, MO: Mosby, Inc. 2005;204.
127 Jull G, Kristjansson E, Dall'Alba P. Impairment in the cervical flexor: A comparison of whiplash and insidious onset neck pain patients. Man. Ther. 2004;9(2):89-94.   DOI
128 Cho HR. Change of Craniovertebral Angle(CVA) and Respiration on Application Correction Method of Posture and Breathing Accessory Muscle Exercise in Forward Head Posture(FHP). Journal of The Korean Society of Integrative Medicine. 2015;3(3):89-94.   DOI
129 Segizbaeva MO, Aleksandrova NP, Donina ZA, Baranova EV, Katuntsev VP, Tarasenkov GG, Baranov VM. Effect of Simulated Microgravity and Lunar Gravity on Human Inspiratory Muscle Function: 'Selena-T' 2015 Study. Adv. Exp. Med. Biol. 2016;934:31-40.   DOI
130 Hudson AL, Joulia F, Butler AA, Fitzpatrick RC, Gandevia SC, Butler JE. Activation of human inspiratory muscles in an upside-down posture. Respir. Physiol. Neurobiol. 2016;226:152-9.   DOI
131 Da Fonseca JDM, Resqueti VR, Benicio K, Fregonezi G, Aliverti A. Acute Effects of Inspiratory Loads and Interfaces on Breathing Pattern and Activity of Respiratory Muscles in Healthy Subjects. Front Physiol. 2019;2(10):993.
132 Drake R, Vogl W, Mitchell A. Gray's anatomy for students. St Louis, MO: Elsevier, Inc. 2005;921.
133 Musculino J. The muscular system manual: the skeletal muscles of the human body, 2nd ed. St Louis, MO: Elsevier, Inc. 2005:170.
134 Fella D. Unraveling the complexity of muscle impairment in chronic neck pain. Man. Ther. 2004;9:125-33.   DOI
135 Liebenson C. Re-education of faulty respiration. Journal of Bodywork and Movement Therapies. 1999;3(4):225-28.   DOI
136 Courtney R. The functions of breathing and its dysfunctions and their relationship to breathing therapy. International Journal of Osteopathic Medicine. 2009;12:78.   DOI
137 De Troyer A, Peche R, Yernault JC. Neck muscle activity in patients with severe chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care. Med. 1994;150:41-7.   DOI
138 Lee MH, Hawng-bo G. Effects of the Neck Stabilizing Exercise Combined With the Respiratory Reeducation Exercise on Deep Neck Flexor Thickness, Forced Vital Capacity and Peak Cough Flow in Patients With Stroke. Phys. Ther. Korea. 2015;22(1):19-29.   DOI
139 Lee D, Lee LJ, McLaughlin L. Stability, continence and breathing: the role of fascia following pregnancy and delivery. Journal of Bodywork and Movement Therapies. 2008;12:333-48.   DOI
140 David P, Laval D, Terrien J. Postural control and ventilatory drive during voluntary hyperventilation and carbon dioxide rebreathing. Eur. J. Appl. Physiol. 2012;112(1):145-54.   DOI
141 Tanaka T, Basoudan N, Melo LT, Wickerson L, Brochard LJ, Goligher EC, Reid WD. Deoxygenation of inspiratory muscles during cycling, hyperpnoea and loaded breathing in health and disease: a systematic review. Clinical Physiology and Functional Imagining. 2018;38(4):554-65.   DOI
142 Greenman P. Principles of manual medicine. Baltimore:Williams and Wilkins. 1996.
143 Courtney R, Van Dixhoom J, Cohen M. Evaluation of breathing pattern. Comparision of a manual assessment of respiratory motion (MARM) and respiratory induction plethysmography. Applied Psychophysiology and Biofeedback. 2008;33:91-100.   DOI
144 Lewit K. Manipulative Therapy: Musculoskeletal Medicine. Edinburgh:Churchill Livingstone. 2009.
145 Kuchera M, Goodridge J. Lower extremity. In: Ward, R.(Ed.), American Osteopathic Association: Foundations for Osteopathic Medicine. Baltimore:Williams and Wilkins. 1997.