Have you ever wondered how your AS is affecting your breathing? Unless your climbing up a flight of stairs, or a marathon runner you really don’t know what deep breathing really is. How many times in a day do you run out of air? Have you ever thought of that?
As a speech language pathologist, I understand how the lungs function for humans to speak, but I never thought the information I possessed could be used to help someone increase their breathing capacity. It wasn’t until I started working at the rehabilitation hospital and had many patients on supplement oxygen that I realized I could use this knowledge to help them get off this dependency. When I say dependency, I’m talking about the body’s need to have this oxygen when in fact if the lungs just did their job they wouldn’t need it. Now don’t get me wrong, maintaining proper oxygen saturation levels is imperative, but some people can maintain these safe levels without the need of supplemental oxygen if they would just breathe right. However, not everyone on oxygen can get off that need for it due to poor saturation of the body’s system. A person’s lungs can function very well but their body cannot absorb the oxygen it needs. So you can have excellent lung capacity but your body cannot absorb the oxygen it needs to function properly.
I wasn’t always so aware of how our pulmonary function was impacted by AS until I had a patient who had this diagnosis. This wonderfully funny woman was unable to open her mouth fully, had difficulty swallowing and couldn’t get a full breath of air into her lungs. These complications were a result of her having AS and not knowing about it until it was too late. The muscles in her cheeks, tongue and throat had become weakened with lack of movement making it difficulty for her to chew and swallow. As I began working with her, having her do oral motor (mouth) and swallowing exercises to address chewing and eating, I then needed to address her breathing. I noticed her thoracic cavity (rib cage) did not move! Well no wonder she couldn’t breathe. I used voicing measurements to determine vital capacity (maximum amount of air a person can expel from the lungs after a maximum inhalation) and mean phonation time (how much air is needed for speaking). I found she had virtually no vital capacity and little if any mean phonation time. Fortunately her saturation levels were normal, which is strange because her vital capacity was pitiful. When she tried to talk she would run out of air after 3 words. The AS had literally decreased her ability to breathe properly, and without knowledge of her disease and it’s effects, she just thought it was due to old age. By the way she was only 72!
As I worked with her I developed a breathing program, using techniques that divers use to help increase lung capacity and function. I found that in order for this patient to increase her vital capacity she needed to increase the movement in her her thoracic cavity. This is not easy after years of AS! I began having her use yoga arm movements along with the breathing techniques. After the first week she increased her vital capacity by 4 seconds, which is a huge accomplishment. By the end of her treatment she was by no means breathing easier, but better. I sent her off to complete these exercises on her own, but it really got me to thinking how my own pulmonary function will be affected by my AS.
A study published in January, 2012 discussed the pulmonary involvement in patients with AS. The study showed significantly impaired pulmonary function in patients with AS compared to previous data and the control group. They found a relationship between pulmonary function and the typical features of AS: reduced spinal-and chest-wall mobility.
This study showed that patients with AS were more likely to have “restrictive respiratory impairment” compared to non-AS sufferers. Researchers found reduced pulmonary function was closely related to reduced spinal and chest wall mobility. However, researchers could not find how pulmonary function was impacted by “measures of disease activity, physical function, smoking and cardio-respiratory fitness”. The researchers concluded that maintaining spinal flexibility is extremely important in the management of AS. “However, the effects of mobility and aerobic exercise on pulmonary function in AS patients remain to be explored. The study exposed a need for further examination of the relationships between the disease specific changes and pulmonary function in AS. Furthermore, patients with severely reduced spinal mobility should be referred for a pulmonary function examination and relevant follow-up treatment” Berdal, G., Halvorsen, S., van der Heijde, D., Mowe, M., Dagfinrud, H. (2012). Restrictive pulmonary function is more prevalent in patients with ankylosing spondylitis than in matched population controls and is associated with impaired spinal mobility: a comparative study. Arthritis Research & Therapy , 14(1), R19. Retrieved from http://arthritis-research.com/content/14/1/R19.
I know your not a researcher, and you just want me to get to the meat of what I am trying to say…. Right? So if you have AS your spine begins to move less and less as the disease progresses right? I know I cannot bend to my left and sure as heck have a hard time touching my toes, how about you? Anyway, so as your spine begins to stiffen, your thoracic cavity stops expanding in and out. They become stiff as well. So if all of this is stiff and hard to move what do you think your lungs are doing? They sure aint moving honey! Your lungs begin to take in less and less air with each breath because they cannot stretch enough to fill up.
Think of a balloon as you blow to fill it up. Now close your fingers around the balloon and try to blow it up. Doesn’t fill up very well does it? The one thing I do know is that the ribs are interwoven by muscles and as the AS progresses those muscles don’t stretch as much as they use to. So when your spine doesn’t move it keeps the thoracic cavity from moving which means the muscles between the ribs don’t move, ergo the lungs cannot expand and then you cannot get enough air to breathe…. Which leads you to a life carrying around an oxygen tank with a very, very long tube!
Well I don’t know about you but I refuse to succumb to that lifestyle, plus I don’t do well with extra baggage. As of today I can count to 53 on one breath, produce an /a/ for 45 seconds and hold my breath for 90 seconds, which is actually pretty good. So how do I keep my lungs in shape? Simple daily breathing exercises which I do on the way to work, in the shower and I am lucky to have lots of patients who need to these as well.
So what can you do? Begin by measuring your vital capacity by producing an /a/ for as long as you can after a deep breath. Measure the time it takes before running out of air. Do this 3x. Take the three measurements and divide by 3. This will give you your vital capacity. If you are anywhere around 20 seconds, then your good. Then take your vital capacity score divide it by 100 and then multiply by .59 for women and .67 for men. This score will give you your mean phonation time. If this score is around 14 for women and 16 for men your good. Next take in a deep breath and see how far you can count to on a snap beat (snap fingers together) that is the tempo you should count to. Once you have all these measurements then you have something to base your progress on.
Breathing exercises are really easy. You can do them anywhere, seriously. First rule is breathe in through your nose and out through your mouth “smell the roses, blow out the candles”. Secondly, always breathe in as much as you can and blow out as much as you can. Finally always blow out slowly and suck in your gut. A lot of people ask me “why suck my gut in?” Well when you suck your gut in you are pushing your diaphragm up into your lungs pushing all the negative air out. It helps to clean out what’s bad in the lungs.
Begin by breathing in through your nose, filling up lungs. Hold for a count of 5 (in your head of course). After the 5 if you can breathe in some more and hold for another 5. This stretches the pleura (lining) of your lungs. Now begin to slowly blow out through pursed lips, sucking in your gut, until you have no more air to breathe out. Note: while blowing out your brain will try to make you breathe when it “thinks” it’s running out of air, but if you ignore the impulse you will see how much air you really do have in your lungs.
I tell my patients to do theses exercises 10x, 3x per day for a couple of weeks and then once a day. For extra movement when you breathe in raise your arms above your head and hold and when blowing out lower arms slowly.
We all know AS is not a fun disease, but we have to do what we can to maintain our flexibility and keeping our lungs functioning is just as important as exercising an arm or a leg. Oxygen is our life-force and without proper lung function we would be forcing life!
And don’t forget…… Just Breathe