2017年6月24日 星期六

(譯文)改善呼吸與表現 Part III：如何於高反覆次數動作過程中在沒有機制結構的喪失情況下呼吸與繃緊(Brace)


Improving Breathing and Performance (Part 3): How to Breathe and Brace Without Loss of Mechanics During High-Rep Movements如何於高反覆次數動作過程中在沒有機制結構的喪失情況下呼吸與繃緊


1/13/2014

In Part 1 of this series, I discussed how mouth breathing can alter head-neck control. In Part 2, we talked breathing during max effort. And as we discussed, holding your breath (with appropriate mechanics) is a natural, physiologic method for maximizing spinal stiffness and force output under very heavy loads.

在此系列文章的Part I中，我討論了嘴巴呼吸是如何改變了頭頸部的控制；在Part II中，我們談到在最大努力過程中的呼吸；且如我們討論的，閉住你的呼吸(透過恰當的機制)是一個在非常重的負荷下最大化脊椎剛度/僵硬(Stiffness)與力量輸出的自然的、生理方法。

However, holding your breath during repetitive movements is not only metabolically costly, it is also mechanically inefficient - and most of our daily movements involve the need to breathe under sub-maximal load and for more than one repetition. So for Part 3, we need to establish how to breathe during high-repetition, serial movements without loss of mechanics.
但是，在反覆性動作中閉住你的呼吸不只代謝代價高，機制上/力學上它也不太有效率，而且我們大多數的日常動作都涉及到需要在次最大負荷下呼吸且多於1下的需求
所以在Part III，我們需要建立如何在高反覆次數、一系列動作過程中呼吸而沒有機制/力學上的損失

Ever see someone take a huge breath of air to pick their shoe up off the ground? Or to rep out pull-ups - only to gasp for air midway thru and totally over-extend their spine? We see it all the time but, assuming the weight of the shoe isn't their one-rep max, this is not normal. 
有沒有看過人吸了一大口氣來將自己鞋子從地上撿起來？
或是吸了一大口氣一次做完全部的引體向上，卻只有在動作中途喘口氣而且完全過度伸展他們的脊椎？
我們無時無刻都看到，但假設那雙鞋子的重量並不是他們的1RM，這就是不正常的。

As I mentioned last week, those with low back pain have been found to hold more air in their lungs during sub-maximal lifting. Why? It's likely they are unable to dissociate diaphragmatic breathing (belly breathing in which the diaphragm descends into the abdominal cavity) with movement thus making every movement a max effort one as they lack a proper global bracing strategy.
如前面文章所述，那些有著下背疼痛的人已經被發現會在次最大舉重過程中保留更多空氣在他們肺部裡，為什麼？
這很有可能是因為他們無法把橫膈膜呼吸(腹式呼吸，吸氣時橫膈膜會下降進入腹腔)與動作分開，因此把每一個動作都變成了最大努力(因為他們缺乏了恰當的全面繃緊策略)

The diaphragm has a dual role during movement as it not only drives respiration, but also assists in spinal control. In movements that require breathing while still under load, the diaphragm is often underused as a stabilizer due to it's mechanical attachments to the thoracolumbar spine and by increasing intra-abdominal pressure. 
橫膈膜在動作過程中有著雙重功能，它不只驅動了呼吸作用，也協助脊椎的控制
在那些仍在負荷下但需要呼吸的動作中，橫膈膜經常作為一個穩定者而未被充分利用(因為它在胸腰椎的力學連接物與因為要增加腹內壓)

This may work for max efforts but as soon as we have to take a breath, neutral spine position is lost and mechanics break down. Athletes will attempt to combat this when they need to breathe by inconsistently using their diaphragm as a stabilizer and instead gulp air into their chest and neck. 
這樣在最大努力下可能能行，但一到我們必須要喘口氣時，中立的脊椎位置就會丟失、力學/機制/結構也會崩潰
在不同於將橫膈膜作為穩定者而需要使用他們的橫膈膜來呼吸時，運動員們會試圖要與這種情況搏鬥(於是將氣吸進入他們的胸口與頸部)

This is highly inefficient as demonstrated in those with asthma - heavy chest/neck breathers - who have markedly higher levels of work associated with breathing.Some hallmarks of faulty bracing: the athlete inhales with an apical breath → traps the air in the upper chest → performs a few repetitions then gasps for air → loss of neutral spine then occurs while still under load commonly into overextension → unable to reconstitute spinal stiffness while still under load (pathologic neutral)
如同在那些有著氣喘(重度胸口/頸部呼吸者，他們有著與呼吸相關明顯較高的功)的人身上所表明的，這是相當無效率的
錯誤的繃緊的一些特點/標誌：運動員以頂端/向頂的呼吸來吸氣→將空氣困在上胸裡→執行幾次反覆次數然後喘口氣→發生中立脊椎的丟失(仍處於負荷的情況下，通常會進入過度伸展)→無法重新建構脊椎剛度(同時仍處於負荷下-病理的中性)




Proper diaphragmatic breathing. Courtesy: artofmanliness.com (obviously a great site)


To move more efficiently we need to have a global bracing strategy during high-rep movements (which, face it, submax repetitive movements are what make up daily life and most athletic movements) in which spinal control is never lost and efficiency is high. Here's a simple and effective breathing/bracing strategy
為了在高反覆次數的動作過程中更有效率的移動(我們日常生活與多數運動動作是由次最大的反覆性動作所組成)，我們需要有個全面的繃緊策略(Bracing)，在這種狀況下脊椎的控制不會喪失、效率也是高的
以下一個的簡單與有效的呼吸/繃緊策略

Take a diaphragmatic breath (belly breath) - this takes practice (see Part 1) as many athletes, especially those with history of asthma, LBP, etc. really struggle with this.
*Diaphragm is accessed
進行一個橫膈膜呼吸(腹式呼吸)-這是需要練習的(參考Part 1)，尤其是對有著氣喘、下背痛之類病史的人來說
※橫膈膜被使用
Near the end of inspiration, increase abdominal muscle tension.
在接近吸氣的尾聲時，增加腹部肌肉張力
As you exhale, think about squeezing the air out and crushing the toothpick (see Part 2) or wringing out the air with your abs (this is when abdominal and glute tension is the highest).
在你吐氣時，想像透過腹部肌群將空氣擠出與壓碎牙籤或將空氣絞扭出來(此時腹部與臀部的張力是最高的)
*Canister on max tension - this is when the majority of the movement is performed
※處在最高張力的罐子-此時是多數動作被執行的時候
Take one or two small breaths into the diaphragm by slightly reducing abdominal tension, allowing the diaphragm to descend while still in a compressed system.
在我們仍處在一個壓縮的系統中時透過稍微減少腹部張力來進行一或兩個小的呼吸進入橫膈膜，讓橫膈膜能下降
This will increase intra-abdominal pressure and allow the diaphragm to assist in stabilization while the abdominals are at slightly reduced tension. *Spinal stiffness maintained during the next breath
這麼做將會增加腹內壓並讓橫膈膜能在腹部肌群處在一個稍微下降的張力時幫助穩定
※在下一個呼吸過程中脊椎的僵硬/剛度是受到維持的




Note that a correct breathing/bracing strategy maintains spinal stiffness at all times while allowing contributions from abdominal tension and the diaphragm. The abdominals and glutes (canister) never come off tension completely.
注意到正確的呼吸/繃緊策略在所有時候都會維持住脊椎的剛度/僵硬(同時允許來自腹部肌群的張力與橫膈膜的貢獻)
腹部肌群與臀部(罐子)永遠不會完全的脫離張力


Think about breathing into a steel canister - this will allow breathing to occur where it's most effective (the diaphragm) without having to reconstitute spinal stiffness after each breath. The goal is to never lose position nor stiffness, while still being able to breathe under load.
想像將氣吸入一個鋼鐵罐子，這樣將能在不必在每一個呼吸後重新建構脊椎剛度的情況下讓呼吸發生在其最有效率的地方(橫膈膜)
目標是永遠不要失去位置與剛度/僵硬，但仍能在負荷下呼吸
Chest breathing will accompany this when demand requires it - and that's okay to supplement the diaphragmatic breathing - but a proper bracing strategy will always apply. This will take some time and mental energy to master during training but will pay dividends in terms of injury prevention and performance (which are synonymous in my opinion).
在需求需要時，胸式呼吸將會伴隨其中，用來補足橫膈膜呼吸這是沒問題的，但記得總要運用恰當的繃緊策略
這在訓練過程中將會需要花些時間與心理能量來熟練，但對傷害預防與表現將會是個正向的幫助(在作者的觀點中這是同義詞)

There a ton of advanced breathing assessments and techniques out there but we can lop off a lot of dysfunction if we follow this basic principle of an appropriate and reproducible breathing/bracing strategy.
進階呼吸評估與技巧有很多，但若是我們遵循著這個恰當與可重現之呼吸/繃緊策略的基本原則，許多的功能障礙是可以被除去的




- Seth


Tania Clifton-Smithlink


8/26/2014 10:32:45 am



Hi Seth, it is excellent to read your three parts on breathing and performance - having worked in this area clinically for over 25 years - I would like to add that actually the vocal folds are the top of the canister and the diaphragm works as a modulator. It is hyperinflation that causes much of the problem and the loss of the diaphragm movement. Generally in the athletic population this is the result of over working or too much bracing of the abdominal muscles. Most of what you say is great and works well - I have a problem with the words 'bracing' as this is where many of problems originate - when we brace this also braces the thoracic cavity, limiting, diaphragm excursion and limiting ventilation. If someone has correct alignment and muscle balance then bracing should not be needed, as the body will work how it is meant to Obviously under high loads for protection of the spine this is a different story. Thanks for highlighting breathing patterns as this is often overlooked but it is where all movement originates - if breathing patterns are wrong everything else will be wrong.

Tania- Physiotherapist- Breathing Specialist.


REPLY



Seth R. Oberst, DPT, CSCS


8/26/2014 04:13:03 pm



Tania,




Thanks for your thoughtful comments. I completely agree with your points. For me the act of bracing is different than being braced as bracing is the active involvement of a global strategy as I typically see high rectus abdominis activity (braced) with poor IO/TA facilitation which certainly limits thoracic expansion and pelvic control. Certainly being overbraced is not ideal and only adds deleterious compression to the spine. However bracing while breathing behind the shield or into the abdominal brace affords a level of control while not completely eliminating thoracic expansion and diaphragm mobility. Ultimately the task should yield a reflexive bracing strategy with breathing to meet the demand. Let's talk more about this - I'll email you. Thanks!


REPLY
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2017年5月16日 星期二

生命旅程的摯友—呼吸

生命旅程的摯友—呼吸

    呼吸同時是我們人生旅程的第一件(透過哭來擴張肺部以進行呼吸)和最後一件事，不論我們睡著或醒著、坐著或站著、走著或跑著，也不管我們緊張或平靜，只要活著，呼吸都陪著我們…
    但對於這位一輩子都陪著我們的朋友，我們是否曾經好好認識過它？

    偶發的頭暈、想吐、手腳容易冰冷、情緒莫名的緊張、無法釋放的壓力、難以入睡、胸口悶痛、長期的頭痛、肌肉的緊繃痠痛感、無法做出好的動作、運動表現停滯不前、瘦身成果不彰，甚至許多常見的慢性疾病，都可能與「呼吸」有一定程度的關聯，你相信嗎？

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2017年5月8日 星期一

(譯文)把氣吐出來 Part II：如何平衡系統

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(譯文)過度充氣與極度焦慮系統：為何將氣吐出是重要的？





Hyperinflation and the Stressed-Out System: Why It's Important to Get Air Out
過度充氣與極度焦慮系統：為什麼將氣吐出來是重要的？


12/8/2014


8 Comments

As followers of my blog (now in 110 countries — waiting on you, Greenland) have surely begun to appreciate - I have a thing for breathing. Watching clients and athletes breathe, it becomes apparent that one's breathing pattern is just such an important indicator of system readiness and neutrality.
觀察客戶與運動員呼吸，一個人的呼吸模式是系統就緒度與中立性的重要指標這件事變得很明顯

Charlie Weingroff calls breathing a keyhole into the nervous system which I think is perfect. Without a normalized and balanced breathing system, movement variability suffers typically causing loss of adaptability - a rigid system - and movement patterns default to high-tension strategies (more on that later).
Charlie Weingroff稱呼吸為進入神經系統的鑰匙孔(我覺得這形容很棒)
沒有將呼吸系統正常化或平衡化，遭受的動作變異性通常會導致適應能力的喪失-死板/僵硬的系統，動作模式會默認為高張力的策略(待會會提到更多)

One of the most common breathing patterns we see is the hyperinflated pattern. Essentially, the athlete is in a state of excessive inhalation - breathing on top of breathing - with inadequate exhalation. They just can't get air out efficiently. 
其中一種我們最常見的呼吸模式是過度充氣模式
實質上，運動員正處在一個過渡吸氣的狀態-在呼吸的頂端呼吸-帶著不足的吐氣
他們就是無法有效地將氣吐出

This hyperinflated pattern of breathing can be asymmetric (typically see the left rib-cage flared more than the right) or symmetric (both rib cages flared) as described by the Postural Restoration Institute. While these differences are important, particularly to the physio, hyperinflation has consequences regardless of symmetry.
這種呼吸的過度充氣模式可能如PRI所描述的是不對稱(通常會看到左胸廓比右胸廓翻起來更多)或對稱的(兩邊的胸廓都翻起)
雖然這種差異性很重要(尤其是對理療師而言)，不論對稱性怎麼樣，過度充氣都會有後果




This is an asymmetric rib flare. And yes, it happens in jacked up people too - this isn't only a skinny gym noob problem. Courtesy: hruskaclinic.com
這是一個不對稱的肋骨翻起，這不只發生在健身房的新手瘦皮猴身上，在猛將身上也會發生





The picture on the right indicates a flared ribcage and overextended lumbar spine
在右側的圖片顯示了翻起的胸廓與過度伸展的腰椎



Given the anatomic link between the ribcage, diaphragm, and thoracolumbar spine it's important to think of this like an SAT analogy: Inhalation is to lumbar extension as exhalation is to lumbar flexion. In the hyperinflated state inhalation/extension >> exhalation/flexion contributing to system-wide issues in performance and loss of variability. 
考慮到胸廓、橫膈膜與胸腰椎之間解剖結構的關係，把這個像是SAT類比般來思考是很重要的：吸氣連結到腰椎伸展、吐氣連結到腰椎屈曲
在過度充氣狀態中，吸氣/伸展>>吐氣/屈曲，導致整個系統在表現上的問題與變異性的喪失

Without access to the diaphragm (and the pelvic floor), the deep abdominals, and ultimately full spinal range (flexion), movements become rigid and "stuck": the athlete is the classic overextended, powerful but stiff dude who lacks sustainable movement (think spondy, pelvic floor dysfunction, neural tension, the list goes on and on...)
沒有得到橫膈膜(與骨盆底肌)的存取，深層的腹部肌群，以及最終完整的脊椎範圍(屈曲)、動作將會變得僵硬死板、卡住：運動員是經典的過度伸展、力量十足但僵硬、缺乏可持續動作的傢伙(思考一下頸椎病、骨盆底肌功能障礙、神經張力，這個表還可以繼續列下去)

Taking it a step further: inhalation is to excitation and tension (sympathetic-dominance) as exhalation is to relaxation and inhibition (parasympathetic dominance). Inhalation yields excitation - why heart rate increases with inhalation and decreases with exhalation. 
再進一步討論：吸氣會連結到激發/刺激與張力(交感主導)、吐氣則與放鬆和抑制有關(副交感主導)
吸氣產出激發/刺激-這也是為什麼心跳率會隨著吸氣而升高、隨吐氣而下降

The dominance of this fight-or-flight response is essential in short bouts of performance, but is pretty much awful if maintained for long periods of time as it prevents recovery and relaxation - both of which are important for system neutrality.
這種戰或逃反應的主導在短的表現回合中是必須的，但如果長時間維持這種狀況是非常可怕的，因為這會讓我們無法恢復與放鬆(此兩者對系統中立性是非常重要的)

As my dad always said, everything in moderation. With this hyperinflated state inhibition of muscles, particularly the extensors, is difficult and the athlete cannot get into and sustain a variety of movements because the nervous system is under constant threat.
就像我爸總是說做任何事情都要適度，帶著這種過度充氣狀態，肌肉的抑制(尤其是伸直肌群)會非常困難，且運動員也無法進入與維持/支撐各種各樣的動作(因為神經系統處在持續的威脅下)

The increased pH of the blood due to decreased CO2 levels also contributes to a sensitive peripheral nervous system. No wonder people with persistent/chronic pain display this hyperinflated, stressed-out state - a threatened nervous system is often a painful one!
由減少的CO2水平而導致的血液pH升高也會促成敏感的周邊神經系統
難怪那些有這持續/慢性疼痛的人們會展現出這種過度充氣、壓力過重的狀態-一個受到威脅的神經系統通常也是個疼痛的神經系統





This hyperinflated state is a big culprit, in my opinion, for the high tension strategies I see so often in athletes. They just don't know how to dim or inhibit the muscles that aren't necessary for the movement. 
在我的觀點中對我經常在運動員身上看到的高張力策略而言，這種過度充氣的狀態是個罪魁禍首
他們就是不知道要如何去抑制或使那些對該動作而言不必要的肌肉們

Ever walk on ice? Every muscle is tensioned to limit joint motion and decrease the risk you might fall - yeah, it's exhausting. Defaulting to these high tension strategies, when they aren't necessary, is like walking on ice. 
有沒有在冰上走過路呢？全身的肌肉都會張力化來限制關節動作與降低可能會跌倒的風險-沒錯，這讓人筋疲力盡
在他們不需要的時候默認到這種高張力策略就像走在冰上

The system is rigid and movements are more taxing - everything other than max effort is typically a struggle in this state and they fatigue out early. These people always feel tight, though they probably have plenty of muscle excursion.
系統變得僵硬/死板、動作變得更費力-除了最大努力以外的所有事情都在這種狀態中掙扎，於是疲勞產生的更早
這些人們會總覺得緊繃，即使他們可能有著充足的肌肉收縮距離( muscle excursion)

Clearly, exhalation needs to be emphasized for a balanced, efficient system. By emphasizing flexion-biased breathing patterns, the system can approach a balance. pH levels can be normalized and beneficial training effects can be realized without adding rigidity to the system. 
無疑的，為了達到平衡、有效率的系統，吐氣需要被強調
透過強調屈曲為基礎的呼吸模式，系統可以往平衡的方向靠近
pH水平也可以被正常化、有利的訓練效果也可以在沒有施加死板/僵硬於系統上的情況下被實現

By facilitating ribcage over pelvis mechanics, the diaphragm and pelvic floor can return to their normal resting length and function allowing the diaphragm to act like the diaphragm. I think many of our barbell-based strength training systems lend us towards this hyperinflated state so some reset movements likely need to be thrown into programming.
藉由促進胸廓位於骨盆上方的機制，橫膈膜與骨盆底肌可以回到它們正常的休息長度與功能，使得橫膈膜能表現的像橫膈膜
我想，有許多我們以槓鈴為根基的肌力訓練系統導致我們朝向這種過度充氣的狀態，所以一些重製動作很可能是需要貝加進計畫中的



So what to do about this? That's coming in a near future post but - spoiler alert - it involves forced exhalation, flexion and developmental patterns, and some recovery strategies. In the meantime here's my earlier post on diaphragmatic breathing for recovery.
所以該怎麼做呢？ 那是近期文章將會提到的內容，但..劇透警告-它涉及到強迫的吐氣、屈曲、發展性的模式以及一些恢復策略
同時也可以參考以下這篇文章：http://www.sethoberst.com/blog/improving-breathing-and-performance-part-4-breathing-and-stress-how-to-shut-down-and-recover-your-nervous-system

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2017年5月5日 星期五

(譯文)改善呼吸與表現 Part II：在最大努力過程中的呼吸





Improving Breathing and Performance (Part 2): Breathing During Maximum Effort


12/30/2013



In Part 1, I discussed why mouth breathing destabilizes the entire upper body via the loss of packed neck position. In Part 2 of this series on breathing and performance, we need to discuss breathing under max load. There is a growing interest in breathing mechanics and how it relates to human performance. The ultimate goal is to maintain stiffness and spinal control under load and breathing has a huge influence on these variables.

在Part I中，我們討論了為什麼嘴巴呼吸會透過包裝紮實的頸部位置之丟失而使得整個上半身不穩定

在呼吸與表現這系列的Part II，我們需要來討論在最大負荷下的呼吸

人們對呼吸機制/力學與其是如何與人類表現有關聯越來越感興趣


最終目標是在負荷下保持僵硬/堅硬/剛度(Stiffness)與脊椎控制，而呼吸對這些變量有著巨大的影響。


Here's the deal: The abdomen is essentially a canister with the diaphragm as the lid, the pelvic floor as the bottom, and the spine running thru it (think banana with a toothpick stuck thru it). There are 85(!) joints within this canister - all of which need to be appropriately controlled because as soon as we see a shearing or translational movement across these joints, force production is altered - a big problem when going for maximum effort.

是這樣的：腹部/腹腔實質上是一個有著橫膈膜作為蓋子、骨盆底肌作為底部、脊椎從中穿過它的容器/罐子(想像香蕉內有一根牙籤卡穿其中)，在這個罐子中有著85個關節，它們全部都需要被恰當的控制，因為只要我們看到有剪切或平移的動作橫穿過這些關節，力量的產生就會被改變：在最大努力時發生就完蛋了So how do we stabilize under maximum load? We hold our breath.

所以我們要如何在最大負荷下穩定？

我們閉住呼吸。

Ever see someone take a huge breath of air and hold it when trying to push a wagon full of hay (okay that's a reference to me growing up on a farm) or lifting a couch. Of course you have, this is a normal physiologic response to a max effort - I dare you to push a car without this strategy.

有沒有看過人在試圖要推動裝滿乾草的馬車或抬起一個沙發時吸一大口氣閉住？(好吧，這只適用於我這種在農場長大的人)

你當然有看過，這是面對最大努力時正常的生理反應-我打賭你不敢在沒有這種策略下推一輛車：）




With normal descent of the diaphragm, air fills the lungs and intra-abdominal pressure increases outward in all directions.

By tightening down the abdominals, we simultaneously counter these forces with a global abdominal contraction directed inwards. Squeezing the glutes pulls up the floor of the canister - do not forget that the glutes need to be engaged prior to and during max efforts (glute insufficiency is a major culprit in stress incontinence).

伴隨著橫膈膜的正常下降，空氣填滿肺部、腹內壓向外往所有方向增加。

透過收緊(tighten down)腹部，我們同時地用朝內的全面腹部收縮來抗衡這些力量

夾緊臀部(Squeeze)將罐子的地板/底部向上拉，不要忘了「臀部需要在最大努力之前和過程中被徵募」

(臀部機能不全在壓力失禁這件事中是主要/重要的原因)

This dynamic stabilization allows equalized pressure across the spine to actively control and mitigate shear forces across the spine. This system also upregulates the nervous system for increased force output and increases heart rate and blood pressure, keeping tissues perfused and preventing you from passing out - great for that max performance.

這種動態的穩定性使平衡的壓力穿過脊椎來主動的控制與減輕穿過脊椎的剪力

這種系統也向上調節了神經系統來增加力量輸出並增加心跳率與血壓，保持組織灌注並防止你暈倒，這對最大表現是很好的





The canister. Courtesy: bettermovement.org


This is important: you must counter the increased pressure from the held-in air with a STRONG abdominal contraction, otherwise you are only partially stabilized.

這非常重要：你必須要以腹部收縮抗衡來自閉在體內空氣而增加的壓力，否則你只是被部份/局部的穩定

This is probably why those with low back pain hold more air in their lungs during lifts - they lack a proper global bracing strategy with the abdominals and glutes and attempt to rely more on intra-abdominal pressure created from the greater volume of air.

這很可能是為什麼那些有著下背痛的人在舉物過程中會將更多的空氣保留在他們的肺部裡面，他們缺乏一個恰當的腹部與臀部全面繃緊策略，並企圖要更依賴由大量空氣所產生的腹內壓。

As a cue for global bracing, think about crushing the toothpick from all directions or tightening down on your spine. When do we see failed lifts or less than optimal max jumps?

作為全面繃緊的提示，想像要從四面八方壓碎牙籤或收緊脊椎

我們什麼時候看到失敗的舉物或不太理想的最大跳躍？

Often, it's when the athlete has exhaled too quickly prior to finishing the movement, throwing a destabilizing wrench into the system. Ask any accomplished powerlifter and they will tell you it takes considerable practice to brace under load.

時常，那正是運動員在完成動作之前太快吐氣之時，把一個去除穩定的板手丟進系統

可以問問看任何一個優秀的健力選手，他們會告訴你要學會在負荷下繃緊需要很多的練習


Doing heavy abdominal work, like tons of crunches, will NOT improve your ability to sustain and maintain intra-abdominal pressure - it's a completely different motor pattern.

做繁重的腹部訓練(如一堆腹部捲曲)並不會改善你維持腹內壓的能力，它是完全不同的動作模式

Is holding your breath under max loads a good idea for those with a heart or vascular condition? Not so much (and I question whether they should be performing max lifts in the first-place) which is probably why you've heard of the cue to exhale during the concentric phase of a movement.

在最大負荷下閉住呼吸對那些有著心臟或血管狀況的人是個好點子嗎？

可能並不那麼適用(我會懷疑他們是否應該要在一開始就最大負荷的舉重)，而這也可能是為什麼你曾聽過在動作向心階段過程中吐氣的提示

In normal, healthy populations the breath-holding technique actually likely decreases the likelihood of blowing out a blood vessel by reducing the pressure gradient. Thus, holding your breath under max load (Valsalva maneuver) is the best and safest way for healthy athletes to generate maximum stability for competition-level max efforts (vertical jump, Olympic lifts, taking a punch) without the need to take another breath.

在正常、健康的群體身上，閉住氣的技巧實際上很可能藉由減少壓力梯度而減少了衝破血管的可能性

因此，在最大負荷下閉住呼吸(伐式操作)對健康運動員要在不用進行再一次呼吸情況下為競賽水平的最大努力(垂直跳、奧林匹克舉重、承受拳擊)產生最大化的穩定度而言是最佳與最安全的方式




But what about when we do need to take another breath?: While breath-holding is a physiologic response to max effort, what about submaximal efforts - like high-rep or serial movements - the ones we typically use in training and activities of daily living? We can't just hold our breath for these movements, otherwise you'd creep people out with a blue face while standing up from your desk chair - not to mention lose spinal control with each breath.

但如果是在我們真的需要再一次呼吸時該怎麼做？

雖然閉氣是面對最大努力時的生理反應，那麼面對次最大努力時呢？-就像是高反覆次數或一系列的動作，我們通常會在日常生活活動或訓練中使用的那種呢？

我們無法只是閉住呼吸來做這些動作，否則在你從椅子站起來時帶著的紫青臉會讓人們爬著出去，更不用說每次呼吸都會失去脊椎控制這件事了。




These serial, submaximal efforts are where mechanics break down and an effective diaphragmatic breathing and bracing pattern is crucial - we will address this in Part 3!

這一系列，次最大努力是力學、機制打破/分解之處，一個有效率的呼吸與繃緊模式是至關重要的，我們會在Part III 做分享。

-Seth
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(譯文)改善呼吸與表現 Part I：為何嘴巴呼吸會毀壞頭-頸部控制


Improving Breathing and Performance (Part 1): Why Mouth Breathing Ruins Head-Neck Control改善呼吸與表現 Part I：為何嘴巴呼吸會毀壞頭-頸部控制



This is the first in a multi-part series on breathing and performance. I think we can all agree that mouth breathing is not ideal. It ruins your date and makes you dread sitting next to a mouth breather on an airplane. But aesthetics aside, it significantly compromises the ability to maintain a packed neck position which, we discussed in the last post on jaw pain, alters the control of the head and neck.


本篇是針對呼吸與表現系列文章中的第一篇，我想我們都能同意嘴巴呼吸並不理想


它會毀了你的約會、讓你在飛機上懼怕坐在嘴巴呼吸者旁邊，但我們先把美觀擺一旁，嘴巴呼吸會顯著折衷維持包裝紮實的頸部位置之能力，而此部分我們在先前的文章"下巴疼痛"中討論過，嘴巴呼吸會改變頭頸部的控制。






Here's the deal: with chronic mouth breathing (present in >50% (!) of the population in some studies), the body naturally adopts a forward head posture as a compensation to maintain an open airway.


是這樣的：習慣性的嘴巴呼吸(在某些研究中超過50%的人口存在這樣的問題)，身體將會自然的採用向前的頭部姿勢來做為維持暢通呼吸道的代償


This causes a tilt of the rib cage (overextension fault - we've established in previous posts that is a major no-go) to keep the chest upright.


這樣一來會導致胸廓的傾斜(過度伸展的毛病-在先前的文章中已經知道這是件不能做的事)來保持胸口挺直。


What we've seen clinically and in the research, is that once the stacked posture of rib cage over pelvis is lost, the diaphragm is at a mechanical disadvantage (becomes less efficient) and its synergy with the abdominals is lost - they both shut down.


我們在臨床與研究中看到的是，一旦胸廓在骨盆上方的堆疊姿勢丟失了，橫膈膜就會處在一個結構/力學上的劣勢(變得較無效率)且其與腹部肌群的協同作用也會丟失-它們兩個都停工了。


In order to maintain aerobic capacity with decreased diaphragm activity, we adopt a mouth-open upper chest/neck breathing pattern that is both ineffective and costly. This faulty pattern will rob you of performance and exercise capacity because you're increasing the work of the accessory muscles in your neck and upper chest which is metabolically very costly.


為了要在減小的橫膈膜活動下維持有氧能力，我們採用了張嘴的上胸/頸部呼吸模式，而這不但無效率代價還很高，這種錯誤的模式會掠奪我們的表現與運動能力(因為我們正在增加位在頸部與上胸部的輔助肌肉的工作量，而這在代謝上的成本是十分高昂的)


With heavy breathing during training, we further challenge this system which is often exacerbated by the cue to "look up" during squats, deadlifts, etc. reinforcing this faulty mouth-breathing pattern.


在訓練過程中強烈/繁重的呼吸，我們更進一步的挑戰了這個系統，而此系統經常被"向上看"這種在深蹲、硬舉之類的過程中常見的提示給惡化，加強了這種錯誤的嘴巴呼吸模式。


Furthermore, the more you breathe (gulp) with the chest and neck, these muscles (SCM, scalenes, pecs) become quite stiff increasing the forward pull and shear on the cervical vertebrae - especially the scalenes as they attach directly onto the spine.


此外，我們用胸口與頸部呼吸(大口吸氣)越多，這些肌肉(胸鎖乳突肌、斜角肌、胸肌)越變得僵硬、增加施加在頸椎上的剪力與前拉-特別是斜角肌(因為它們直接連接到脊椎上)


It's pretty common to see this neck breathing pattern in those with cervical radiculopathy (impinged nerve roots) and TMJd.


在那些有著頸椎神經根病變(受到夾擠的神經根)與顳下頜關節紊亂綜合症的人們身上看到這種呼吸模式是很常見的


Weird that they often have a forward head posture too, right? (hint - it's not weird at all)


也覺得很奇怪他們為什麼經常有著個向前的頭部姿勢，對吧？(提示-一點都不奇怪)


The 1st rib can get chronically elevated as well, limiting overhead shoulder position. The overall result is a destabilizing effect and faulty mechanics in the entire upper quarter.


第一肋骨也會被慢性的提高，限制了過頭的肩部位置


總體的結果就是在整個上半身的去穩定/不穩定效果與錯誤的力學結構





Courtesy: www.4shared.com


Here's the fix: Remember having tantrums as a kid and your mother would tell you to "breathe in thru the nose, out thru the mouth"? Mother was helping you out because by inhaling thru the nose you automatically adopt a more upright, packed neck position.

修理方法在這：還記得在小時候發脾氣時，媽媽會告訴你要"透過鼻子吸氣、透過嘴巴吐氣"嗎？ 媽媽正在幫助你脫離情緒，因為藉由透過鼻子吸氣，我們自動/無意識地採用了更加直挺、包裝紮實的頸部位置

Try it: take a quick breath in thru your nose. You will automatically sit more upright and bring the diaphragm back into the breathing pattern (which also increases parasympathetic tone - helps you to calm down, your mother knew what she was doing).

試試看：透過你的鼻子做一個快速的吸氣，你將會無意識地坐得更挺並將橫膈膜帶回到呼吸模式中(這麼做也增加的副交感的作用/張力，能幫助我們冷靜下來，你老媽知道她在做什麼)

Now go back to mouth breathing: right away you notice your chest and neck rise instead of belly (diaphragmatic) breathing and your posture drops back into a forward-head, rounded shoulder look - not cool.

現在我們回到嘴巴呼吸：馬上你就會注意到自己的胸口與頸部上升/隆起而非腹部(橫膈膜)呼吸，你的姿勢變回到一個向前的頭部、圓起的肩部樣子...這並不好

Clean up any mobility deficits in the anterior neck and chest (Kelly Starrett of mobilityWOD.com has some great ideas) and start breathing thru your nose.

清除掉任何在前側頸部與胸口的活動度缺損(Kelly Starrett在mobilityWOD有些好點子)並開始透過你的鼻子呼吸

The best part - it's a reinforcing cycle: it's hard to breathe in thru the nose with a forward head so by forcing yourself into this pattern more, you are reinforcing a packed neck position. As we discussed previously, a better head-neck relationship improves jaw position and stability.

而這最好的一部分是：它是個強化的循環，我們很難在向前的頭部姿勢下透過鼻子吸氣，所以我們越是強迫自己進入這種呼吸模式，我們越是強化了包裝紮實的頸部位置

就像我們先前所討論的，一個更好的頭-頸部關係能改善下巴位置與穩定度。




Improving breathing patterns is hard. I recommend lots of practice at nasal (aka belly) breathing first at your desk or lying on your back while in bed - it will help improve your head-neck position with breathing in an unloaded environment first.

改善呼吸模式是困難的，我建議先在桌子前或是躺在床上做很多在鼻子(腹部)的呼吸練習，透過先在無負載的環境/姿勢中呼吸將會幫助改善你的頭-頸部位置

Then, as coaches, we can systematically challenge breathing and head-neck positioning in loaded and stressed positions once the athlete better understands this pattern.

然後，身為教練，一旦運動員更加了解這種模式後，我們可以在負載與有壓力的位置下有系統的挑戰呼吸與頭頸部定位

More to come on breathing and spine control/performance!

將會有著更多呼吸與脊椎的控制/表現到來！

-Seth (take a deep breath bro)
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(譯文)改善呼吸與表現 Part IV：呼吸與壓力-如何關閉並恢復你的神經系統





Improving Breathing and Performance (Part 4): Breathing and Stress - How to Shut Down and Recover Your Nervous System改善呼吸與表現IV：呼吸與壓力-如何關閉並恢復體的神經系統


1/28/2014

We've already discussed how to increase performance with breathing and bracing strategies during movements (I highly recommend checking out Part 1, Part 2, and Part 3 to get the whole picture), but what about when the training, competition, mission, or workday is over?
我們已經討論了在動作過程中如何透過呼吸與繃緊策略來增加表現(我高度建議讀過Part I-III來獲得整體概念)，但在訓練、競賽、任務或工作日結束後又是怎麼樣呢？
An inability to shut down, sleep, and recover is not only frustrating to that individual which further amplifies the stress, but is also untapped potential for performance gains. Recovery may be the most important part of your workout.
無法關閉、睡眠與恢復不僅進一步放大壓力令人沮喪、，也使得未被開發的潛能無法被用於表現的獲得
恢復或許是你的訓練當中最重要的部分

Stress, both physical and emotional, is powerful when appropriate as the heightened state of the sympathetic nervous system (the "Fight or Flight" state that gets your heart pounding) can increase short-term physical performance.
在恰當的時候生理或情緒的壓力是很強大的，因為交感神經系統的增強/升高狀態(使我們心臟怦怦跳的戰或逃狀態)能夠增加短期的生理表現/體能表現
However, those who are in a chronic amped state due to work, rigorous training, competition, or even battle are often unable to efficiently regulate this system and shut it down when necessary. Even chronic pain patients suffer from this.
但是那些因為工作、嚴格訓練、競賽、甚至戰鬥而處在慢性興奮狀態的人們經常無法在必要時有效的調節這個系統並將其關閉
甚至是慢性疼痛的病人也遭受這種困擾
This causes an imbalance between the sympathetic and parasympathetic nervous systems in which athletes are persistently yoked-up and unable to sleep and recover. We have to get out of this reset baseline in which abnormal starts to feel normal. Self-medicating to sleep is NOT normal.
這將會導致交感與副交感神經系統之間的失衡，使運動員持續的在連線狀態且無法睡眠與恢復。
我們必須要從這種異常狀態中出來以重設基準線並開始感覺正常
自行服用藥物來幫助睡眠並不正常





In normal diaphragmatic breathing, the heart rate accelerates when breathing in and decelerates when breathing out. This Heart Rate Variability (HRV) is a glimpse into the balance of the nervous system.
在正常的橫膈膜呼吸中，心跳會在吸氣時加速、在吐氣時減速
心律變異性(HRV)可以一瞥神經系統的平衡性

When athletes are in a constant state of sympathetic dominance, the heart beats like a drum and does not have a normal variability. This is exacerbated by heavy upper chest and neck breathing (discussed in detail in Part 1) and poor diaphragmatic activity resulting in chronic over-breathing.
當運動員處在一個持續不斷的交感神經主導狀態，心臟會就像個鼓般跳動，且不會有著正常的變異性
而這會被重度上胸與頸部呼吸以及不良橫膈膜活動所惡化，導致慢性過度呼吸

Loss of HRV is even found to be predictive of mortality in those with heart conditions.
在那些有著心臟病的人們身上，HRV的喪失甚至被發現是死亡率的預測

The harder we train or stress about work, the less variable this system becomes as the sympathetic state dominates and our athletes and soldiers cannot down-regulate and adapt to these stressful stimuli.
訓練或工作的越是艱苦、壓力越大，這個系統的變異性就會因為交感狀態主導而變得越少，我們的運動員或士兵就無法向下調節與適應這些壓力性的刺激
The result is what you really care about: poor adaptation and recovery, disrupted sleep patterns, fatigue, and ultimately poor performance. By the way, notice how much these symptoms look like (and are likely correlated with) overtraining.
結果正是我們真正關心的：不良的適應與恢復、被破壞的睡眠模式、疲勞、最終是不良的表現
順帶一提，注意這些症狀看起來有多像過度訓練(及其可能的關聯)

One way we can help better balance the nervous system and down-regulate for adaptation is thru better diaphragmatic breathing. In Part 2, I discussed how breath-holding and prioritizing inhalation during max effort can up-regulate the sympathetic nervous system and increase force output. Similarly, prioritizing exhalation via the diaphragm can down-regulate the sympathetic nervous system for better balance.
一個我們可以幫助神經系統間有著更好的平衡與向下調節以產生適應的方法是透過更好的橫膈膜呼吸
在Part II中我討論了在最大努力過程中閉氣與優先化吸氣是如何能向上調節交感神經系統與增加力量輸出
同樣的，藉橫膈膜優先化吐氣能夠向下調節交感神經系統以利更佳的平衡

To help shut down and recover, try this for 5 minutes per day preferably before bed:
為了幫助關閉與恢復，最好每天在睡覺之前試試這個5分鐘：

1. Lay on your back with knees bent, one hand on abdomen at the bottom of the rib cage and one on the upper chest.
1. 膝蓋彎曲仰躺，一手放在位於胸廓底端的腹部上、另一手放在上胸口

2. Take a breath in thru the nose and breathe into the belly, feeling the hand on your abdomen rise. The hand on your upper chest should not rise - only the diaphragm and lower ribs should move. There should be no pause between inhalation and exhalation.
2. 透過鼻子吸氣、並吸進到腹部，感覺在腹部的手升起；在上胸口的手不應該升起-僅有橫膈膜與下胸廓應該有動作；在吸氣與吐氣之間不應該暫停

3. Breathe out in a slow, controlled motion - this should be completely passive. Take twice as long to exhale as it took to inhale.
3. 在一個緩慢、有控制的動作下吐氣，而這應該完全是被動的；吐氣花的時間要是吸氣所花時間的兩倍

4. Time yourself and aim for 8-10 breaths per minute, this may take time to accomplish as the athlete may feel some air hunger indicating a reset system (abnormal is now normal) where they've been chronically over-breathing - which is why this feels weird. Concentrating on the exhalation should help.
4. 為自己計時並以每分鐘8-10次的呼吸為目標，這可能會需要花些時間來達成，因為運動員可能會感覺到一些表明了系統重設(異常現在變得正常)的缺氧(在他們已經長期過度訓練的系統)，而這也是為什麼這感覺起來很怪；專注在吐氣上應該會有幫助

*Obviously breathe if necessary, don't be a knucklehead about this and pass out - breathing should always win.
※ 必要時明顯的呼吸，不要傻傻的然後昏倒-呼吸應該總要是贏的那個

Diaphragmatic breathing takes practice but can be extremely effective at helping down-regulate this sympathetic breathing state and promoting recovery and a balanced baseline. Break the stressed-out loop and start PRing - we need to better manage and maintain homeostasis with the tools that we have.
橫膈膜呼吸需要練習但對幫助向下調節這種交感呼吸狀態與促進恢復、平衡的基準線會是非常有效的
打破壓力過重的迴路並開始PRing-我們需要透過我們有的工具來更好的管理與維持體內平衡

"If breathing is not normalized, no other movement can be" Lewit
"如果呼吸沒有被正常化，也沒有其他的動作能被正常化、Lewit

- Seth




*If you need more than self-management for this, then find a local provider. Breathing always wins.

**Kelly Starrett has some good stuff on this, as do the DNS and PRI groups if you yearn for more.






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2017年4月27日 星期四

(譯文)呼吸-Part II-指標/跡象、評估&介入

Breathing – Part II – Indications, Assessment, & Intervention
呼吸 Part II -指標/跡象、評估&介入
Part I of this series dealt with breathing anatomy and mechanics.  Knowledge and understanding of the anatomy and mechanics of breathing is essential for a proper assessment and intervention.  This post will expand on the previous post and go over some indications, assessment, and intervention for breathing.
此系列文章的Part I討論了呼吸解剖構造與機制，對呼吸機制與解剖構造的認識對適當的評估與介入而言是必要的。
本文將會從前文加以細說/擴展並為呼吸介紹一些指標/跡象、評估與介入。

Indications 指標/跡象

So what type of patients do breathing mechanics apply to?  Pretty much anyone that moves or breathes.
所以哪種類型的病人是呼吸機制適用的？
幾乎所有會移動或呼吸的人都適用。
Seriously though, you should strongly consider breathing mechanics in all of your patients. Even if it isn’t the main culprit of their dysfunction, it might help return them back to optimal functioning.
說真的，你應該要強烈的為每一位病人考慮到其呼吸機制。
即使呼吸不是他們功能障礙的主要罪魁禍首，也可能能幫助他們回到最佳的功能。
Some more specific examples:
一些更明確的例子：
  • Spine, Hip, and Shoulder Dysfunction
    脊椎、髖部與肩部功能障礙
  • Postural Faults
    姿勢錯誤
  • High-Threshold Patterns
    高閾值模式
  • Impaired Neurodynamics
    受損的神經動力學
  • Psychological (apprehension, anxiety, central sensitization)
    心理的(恐懼、焦慮、中樞敏感化)

Assessment 評估

To keep it simple, you want to visually observe their posture and how they mechanically breathe.  Compare this to an ideal breath and look for any signs/symptoms of dysfunctional breathing.  Assess this in various postures (supine, seated, standing) and movements.  The patient doesn’t need to know.  In fact, I find it better if the patient isn’t aware.  If you do find a patient with a breathing dysfunction you can then go into a more detailed assessment with palpation techniques (discussed under dysfunctional breathing).
為了保持簡單，我們需要視覺的觀察他們的姿勢與他們機制上是如何呼吸的。
將其與理想呼吸對比並尋找是否有任何功能障礙呼吸的跡象/徵狀
在不同姿勢(仰臥姿、坐姿、站姿)與動作下評估呼吸；病人並不需要知道我們在評估
事實上，我發現如果病人沒有查覺到的話，評估效果更好。
如果你確實發現一個病人有著呼吸功能障礙，就可以接著前進到結合觸診技巧之更為詳細的評估(在功能障礙呼吸底下討論)
Sure, you can make it more complicated by assessing breath holding times, questionnaires, and spirometry.  However, this puts the patient through unnecessary discomfort and may affect your rapport.  They walked into your clinic because they’re having back pain, not because they want to talk about their breathing patterns and blow into some device.
當然，你也可以透過評估呼吸屏住時間(breath holding times)、問卷與肺量計(spirometry)來讓其變得更複雜。
但是這麼做將會使得病人經歷非必要的不適，且可能會影響到你們的融洽
他們是因為有著背痛才走進你的診所，而不是因為想要討論他們的呼吸模式與吹氣到某些儀器裡面。
It’s important to note that there is a great variance in breathing patterns.  Therefore it is difficult to create a protocol and thorough checklist for an ideal breath.  However, there is alot of evidence for dysfunctional breathing.  So it may be more clinically efficient to look for dysfunctional breathing rather than ideal breathing patterns.
有一點很重要得注意到的是「呼吸模式中有著很大的差異/不同」，因此很難為一個理想呼吸去作出的方案/規程與透徹/絕對的檢查表。
但是目前對於功能障礙的呼吸則有著許多的證據，所以比起尋求理想的呼吸模式來說，去找功能障礙的呼吸可能比較具有臨床效益。

Ideal Breathing 理想的呼吸

The ideal breath is a smooth, segmental, 3-dimensional motion.  During inspiration there is abdominal distension (circumferentially) and a postero-lateral lower ribcage expansion.  During expiration there is contraction of abdominals and pelvic floor that returns the ZOA to an optimal position as evident by a depressed sternum and IR of ribs (no anterior ribflare).
理想的呼吸是一個順暢、分段性、3D的動作。
在吸氣過程中會有著腹部的擴張/膨脹(圓周狀)以及下段胸廓的後-側向擴張。
在吐氣過程中會有著將ZOA(並列區域)返回到最佳位置的腹部肌群與骨盆底肌收縮，而這由壓平的胸骨與肋骨的內旋(沒有朝前的肋骨翻/飛起)得以顯見。
Overall what you’re looking for is the inspiratory cascade of events that leads to controlled increased intra-abdominal pressure and proper muscle activation.  On the exhale you want to see adequate expiration of air with no signs of hyperventilation.
總地說來，我們在尋找的是導致有控制之增加的腹內壓與恰當肌肉活化的吸氣級聯事件。
在吐氣時我們希望看到的則是沒有過度換氣跡象之充分的氣體呼出。

Dysfunctional Breathing 功能障礙呼吸

What you never want to see is excessive accessory muscle activation, disproportionate shoulder movement, T-L junction hinging, or vertical ribcage movement.  Other signs include: mouth breathing, frequent sighs/throat-clearing, rapid and/or shallow breathes, and asynchronous breaths
我們永遠不會想要看到的是過度的附屬肌肉活化、不成比例的(過大)肩部動作、胸腰椎接合點絞鍊或垂直的胸廓動作；其他的跡象包括：嘴巴呼吸、頻繁的嘆息聲/清嗓、急促與/或短淺的呼吸以及不同步的呼吸。
Paradoxical breathing is a common breathing dysfunction.  This is when the patient inhales and there is a vertical and posterior motion of the ribcage and a hollowing of the abdominal cavity.
異位/反常呼吸是一個常見的呼吸功能障礙，此時病人吸氣會有著胸廓的垂直與後向動作以及腹腔的挖空/凹陷

One of the biggest signs of dysfunctional breathing is lack of postero-lateral expansion of the lower ribcage.  This can be assessed using the MARM (Manual Assessment of Respiratory Motion).  
功能障礙呼吸的其中一個最大跡象就是缺乏下段胸廓的後-側向擴張，而這可以使用MARM(徒手呼吸動作評估)來評估。
Research has shown that the MARM can be be a useful assessment for dysfunctional breathing.  This test is simply performed by having the patient seated and facing away from you.  You place your fingers on the lower lateral ribcage and align your thumbs with the spine.  Then have the patient breath naturally while you assess for the postero-lateral expansion of the lower ribcage.  Patrick Ward performs a similar technique in this video around 3:15.
研究已經證明MARM對功能障礙呼吸來說可以是一個很有用的評估，此測試簡單地透過請病人背對我們坐著來執行，我們將手指放置在病人的下段側邊胸廓並將拇指對準病人脊椎，接著請病人自然的呼吸，我們同時評估其下段胸廓的後-側向擴張(Patrick Ward在下列影片的3：15處操作了一個相似的技巧)


High-Threshold Strategy 高閾值策略

This section is purposefully placed between assessment and intervent because it essentially both.  A high-threshold strategy is when an individual performs a task using excessive activity/tone in global musculature in a compensatory or protective manner.  Gray Cook has described it as when “the body is splinting instead of stabilizing”.  One of the major signs of this strategy is dysfunctional breathing patterns.
此區塊有目的的被擺在評估與介入中間，因為其對兩者都是不可少的
高閾值策略是人們以一個代償性或保護性方式在整體肌肉使用過度活動/張力來執行任務之時。
Gray Cook將其描述為"身體正在夾板固定而非穩定的時候"，此種策略其中一個最主要的跡象就是功能障礙的呼吸模式。
An example of this is when you give a patient an exercise that is too difficult for them.  They start to hold their breath and squeeze every muscle they have.  A patient won’t be able to perform a proper breathing pattern if they are using a high-threshold strategy.
關於此種策略的一個例子就是當我們給病人一個對他們而言太困難的運動時，他們開始閉住呼吸然後繃緊他們有的所有肌肉，「如果他們正使用著高閾值策略，是無法執行恰當的呼吸模式的」。
So how do you use this to your advantage?  You can use breathing assessment throughout all of your interventions to verify that the patient is not using a high-threshold strategy to perform the task.
所以我們要如何好好使用這種優勢？
我們可以在所有我們的介入中使用呼吸評估來驗證/檢驗病人並沒有使用高閾值策略來執行任務。

Intervention 介入

There are many ways to treat breathing dysfunctions.  Which rabbit hole you go down depends on your patient and what they need.
有許多的方式可以治療呼吸功能障礙，我們要跳進哪個兔子坑取決於病人所需。
However, the first place to start for everyone should be from an educational stand-point.  It is advantageous to explain to the patient why breathing is important to them specifically (use knowledge from Part I).  
然而，對每個人來說的第一個出發點都應該要從一個教育性的觀點開始，對病人解釋為何呼吸對他們那麼的重要是有利的。(使用Part I的知識)
Then you should teach the patient about dysfunctional breathing and what you expect for a proper breath.  To avoid overcomplicating this, I usually simply give the patient a cue that has them focus on the circumferential lower ribcage and abdominal distension.
然後我們應該要教導病人什麼是功能障礙的呼吸以及你所期待的恰當呼吸，為了避免將此過度複雜化，我通常會單純地給病人一個要他們專注在還狀面/圓頂狀的下段胸廓與腹部膨脹的提示。
Some example cues I’ve heard and used: “breath into your lower ribs and abs”, “breath into an imaginary belt around your stomach”, “breath down and out”, “inhale into a balloon inside your stomach”, “push your breath down”, “expand your ribs out with your breath” etc.  The possibilities are endless.
有些我曾聽過與使用的範例提示：「吸氣進入你的下段肋骨與腹部」、「吸氣進入一個環繞於胃部的想像腰帶」、「向下向外吸氣」、「將氣吸入一個在胃部裡面的氣球」、「將你的吸氣向下推」、「透過你的呼吸擴張肋骨」之類的
可能性是無窮盡的
You can also use tactile cues.  Put your hands or a theraband around their lower ribcage to increase sensory afferent input.  Then have them to breath into the resistance of your hands/theraband.
你也可以使用觸覺提示，將雙手或環圈彈力帶放置在病人的下段胸廓來增加感覺輸入，接著請他們吸氣進入我們雙手/環圈彈力帶的阻力。
For patients who have great difficulty with this or use paradoxical breathing patterns you may need to start simple.  I usually start with a simple progression of hi-lo breathing, lateral expansion breathing, and finally a combination of the two for an “ideal breath”.  
對使用此種方式遭遇相當困難或使用異位呼吸模式的病人來說，我們或許應該要再簡單一點來開始。
我通常由簡單的Hi-Lo呼吸進程、側向擴張的呼吸來開始，最終將兩者結合在一起操作來達成"理想呼吸"。
It’s important to educate them and have them feel the difference in their hands and their body.  As the patient gets comfortable you can cue the patient to breath in through the nose and out through the mouth, exhale longer than the inhale, and try to expire all of their air.
教育病人並讓他們感覺雙手之間的差異和自身身體是很重要的，當病人變得自在舒服，我們就可以提示病人透過鼻子吸氣、透過嘴巴吐氣、吐氣要長於吸氣，並試著呼出體內所有的空氣。
Other biomechanical interventions can be separated into mobility and stability categories.  Part I focused on the stability aspect of the inspiration, but it can also be used for mobility (yoga has been doing this for thousands of years).
其他的生物力學介入可以被分成活動度與穩定度的類別，Part I聚焦在吸氣的穩定度面，但其也可以被用於活動度的改善(瑜珈已經這麼做上千年了)。

Mobility 活動度

Much like ligament locking for joint mobilization/manipulation, the breath can be directed by altering postures and positions.  Leslie Kaminoff describes breathing as the act of “shape changing”.  Using this theory you can alter your posture to direct the where the breath (“shape change”) occurs.  It’s physics.  The shape change from inspiration (expansion) will always go towards the place of least resistance.
很像是關節鬆動術的ligament locking，呼吸可以透過改變姿勢與位置來被導向。
Leslie Kaminoff將呼吸描述為一個"型態變化"的行為，運用這個理論我們可以改變姿勢來引導呼吸(型態變化)發生的位置/地方，這是物理現象。
來自吸氣(擴張)的型態變化總會朝最少阻力的地方前進。
For example, if a patient has a restricted R posterior lumber quadrant, then you would put them in a childs pose reaching contralaterally with their R UE.  Since you closed off the L side by laterally sidebending/flexing and closed off the anterior R rib cage by flexing, the only place for the shape change to occur would be into the R posterior quadrant.  
舉例來說，如果一個病人有著受限的右方後側腰部象限，我們會請他呈現嬰兒姿、並以他的右上肢向其對側延伸。
因為我們透過側向的側彎/屈曲將左側封鎖起來以及透過屈曲將前側的右胸廓封鎖起來，為一個能夠有型態變化發生進入的地方就是右方後側的象限。
You can further increase the expansion (stretch) into this area using tactile or verbal cues to get them to breath into the postero-lateral R rib cage.
我們可以使用觸覺或口語提示讓病人呼吸進入後-側邊的右胸廓以更進一步的將擴張增加進入此區域。
Another mobility aspect of breathing is it’s amplification of the parasympathetic NS.  This can be very advantageous when performing manual techniques or corrective exercises to increase tissue extensibility.  Muscle guarding and reflexive activation can be minimized by focusing on breathing.
呼吸活動度的其他面向是其對副交感神經系統的放大/增幅，在在執行徒手技巧或矯正性運動以增加組織延展性時會非常的有利
透過專注在呼吸，肌肉防衛與反射性活化可以被最小化

Stability 穩定度

As mentioned before with the high-threshold strategies, simply having your patient breath properly during exercises will help establish proper inner core stabilization.  

如前面所提到的高閾值策略，單純讓病人在運動過程中恰當的呼吸將能幫助建立恰當的內部核心穩定性。

One important consideration is that you must simultaneously monitor their posture.  You always want a neutral spine.  Performing a task with an anterior pelvic tilt not only causes compensatory mechanisms, but it prevents proper breathing mechanics (decreased ZOA, decreased eccentric abdominal & PF contraction).

有個重要的考慮事項就是你必須要同時監控他們的姿勢，要他們保持中立的脊椎
帶著前傾的骨盆執行任務不只會造成代償性的機制，也會無法有著恰當的呼吸機制(減小的ZOA、減小的離心腹部肌群&骨盆底肌收縮)
Again, the guy with a positive scour sign, hip impingement, and anterior pelvic tilt doesn’t want to hear about breathing.  He just wants his hip to stop hurting so he can get back to golfing.  So instead of going into too much detail about the mechanics of breathing or working on isolated breathing exercises, simply have your patient breath with a neutral spine during all their exercises.  It’s a great place to start and ensures that the patient is performing the exercise with the correct musculature.

再一次，有著陽性腹瀉跡象、髖部夾擠與骨盆前傾的傢伙不會想要聽關於呼吸的事，他只想要髖部不再痛讓他可以回去繼續打高爾夫球。
所以與其給太多關於呼吸機制的細節(或研究得太細)或致力再孤立的呼吸運動上，不如單純請病人在其所有的運動中以一個中立脊椎呼吸
這是一個確保病人以正確肌肉執行運動與開始的好地方。
Since I have learned about the importance of breathing I no longer time my patients with a stopwatch.  I now have everyone counting their breaths (i.e. holding quadruped diagonals for 7 breathes instead of 30 sec).

因為我已經學到關於呼吸的重要性，我不再使用碼表來為我的病人計時，現在我都請每位病人數他們的呼吸(維持在四足跪姿斜向延伸的動作行7個呼吸來取代30秒)
For advanced patients you can progress to “breathing behind the shield”.  This is a term coined by the great Pavel Tsatouline.  It’s a great way to incorporate breathing with core stability.  It describes the act of maintaining abdominal tension while breathing.  

對進階的病人我們可以進階到"在盾牌後方呼吸"
這是一個由Pavel Tsatouline所創造的詞，它描述的是在呼吸時維持腹部張力的行為。

“Breathing behind the shield” is the balance of controlling intra-abdominal pressure and abdominal & pelvic floor muscle tone.  It displays that the patient is able to use the diaphragm’s dual function: respiration and stabilization.

"在盾牌後方呼吸"是控制腹內壓與腹部&骨盆底肌肌肉張力的平衡，它顯示出該病人可以使用橫膈膜的雙重功能：呼吸與穩定性
Hans Lindgren has an amazing video on assessing and interventions for breathing and core stability.  At about 2:10 into the video he goes over a great technique to help you teach your patients how to “breath behind the shield”.  This is a great place to begin and can be progressed through the developmental sequence.

Hans Lindgren有個很猛的影片(呼吸及核心穩定度的評估與介入)
大約在影片中的2：10處他探討了一些幫助我們教導病人如何"在盾牌後方呼吸"的超棒技巧，而這正是一個好的開始點，且可以透過發展順序來被進程/進階。

Bottom Line 底線

There are many ways to assess and treat dysfunctional breathing patterns.  Hopefully this article will give you a good place to start.  Below are some great articles, videos, and descriptions of breathing patterns.  As with every intervention, it is important to master this yourself before you try to teach your patient.
評估與治療功能障礙呼吸模式的方法很多，希望本文能給讀者們一個好的開始點
下方是一些關於呼吸模式的好文、好影片與描述
和所有的介入一樣，在試著教給病人之前自己先熟練/精通是非常重要的。

Dig Deeper

Simple Exercise – Crocodile Breathing

References

Tom Myers & Leslie Kaminoff.  The Breath in the Pelvis – Seminar (NYC 2012).
Courtney R,Reece J (2009). Comparison of the Manual Assessment of Respiratory Motion (MARM) and the Hi Lo breathing assessment determining a simulated breathing pattern.  International Journal of Osteopathic Medicine.
Courtney R (2009). The functions of breathing and its dysfunctions and their relationship to breathing therapy.  International Journal of Osteopathic Medicine
Courtney R (2011).  Dysfunctional Breathing – It’s paramaters, measurement and relevance.  Thesis RMIT University. (a must read – click here)
Kaminoff L. (2006). “What yoga therapists should know about the anatomy of breathing.” International Journal of Yoga Therapy.
McLaughlin L. (2009). “Breathing evaluation and retraining in manual therapy.” Journal of Bodywork and Movement Therapies.
McGill S , Sharratt M ,Sequin J P. (1995). “Loads on spinal tissues during simultaneous lifting and ventilatory challenge.” Ergononomics.
Janssens L , Brumagne S, Polspoel K, Toosters T, McConnell A. (2010). “The effect of inspiratory muscles fatigue on postural control in people with and without recurrent low back pain.” Spine.
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The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.
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