Spinal cord injury (SCI) often leads to impaired breathing. Many factors in SCI can contribute to poor lung function with obesity, smoking and the connection between posture and lung performance having been proved significant. For many SCI (level dependent) the muscles responsible for breathing are often weakened. This weakness reduces the volume of the lungs (lung capacity), the ability to take a deep breath and cough, and puts them at greater risk of lung infection. Just like other muscles of the body, it’s is possible to train the breathing (respiratory) muscles to be stronger.

Not all spinal cord injuries will result in impaired breathing. The level of your spinal cord injury plays a huge part in determining whether your ability to breathe will be compromised. Following damage to the spinal cord, the following muscles of respiration (breathing) may be affected if you have a spinal cord injury above T10:

Diaphragm – It is supplied by C3, 4 and 5. It is the main muscle responsible for inspiration (breathing in).

Intercostals – They are supplied by T1 – T11. These are small muscles that are attached to the ribs and help stabilise the rib cage and assist in inspiration (breathing in) and expiration (breathing out).

Abdominals – They are supplied by T6 – T12. They assist in expiration (breathing out). They work most during forced expiration such as coughing, sneezing, blowing your nose, shouting and choking.

Accessory – They are supplied by C1 – C8 and a cranial nerve. These are muscles in the neck. They normally only work to assist breathing during exercise or stress. In high tetraplegics they may become the main inspiratory muscles.

You can help prevent the collection of secretions in the following ways:

1. Deep Breathing Exercises

When deep breathing, you expand more of your lungs than when breathing normally. This extra expansion helps prevent the airways from being blocked with secretions/-mucus or from collapse. To help clear secretions take 4 to 6 deep breaths at a time. Try to hold each breath for 2 or 3 seconds. For maximum benefit do the exercises in a variety of positions such as sitting, sitting upright (will help with abs strength also) or alternate lying on your right and left side.

2. Pursed lip breathing

This simple breathing technique makes you slow down your pace of breathing by having you apply deliberate effort in each breath. Practice using this breath 4 to 5 times a day when you begin in order to correctly learn the breathing pattern.

To do it:

1. Relax your neck and shoulders.
2. Keeping your mouth closed, inhale slowly through your nose for 2 counts.
3. Pucker or purse your lips as though you were going to whistle.
4. Exhale slowly by blowing air through your pursed lips for a count of 4.

3. Diaphragmatic breathing

Belly breathing can help you use your diaphragm properly. Do belly breathing exercises when you’re feeling relaxed and rested. Practice diaphragmatic breathing for 5 to 10 minutes 3 to 4 times per day. When you begin you may feel tired, but over time the technique should become easier and should feel more natural.

To do it:

1. Lie on your back with your knees slightly bent and your head on a pillow.
2. You may place a pillow under your knees for support.
3. Place one hand on your upper chest and one hand below your rib cage, allowing you to feel the movement of your diaphragm.
4. Slowly inhale through your nose, feeling your stomach pressing into your hand.
5. Keep your other hand as still as possible.
6. Exhale using pursed lips as you tighten your stomach muscles, keeping your upper hand completely still.

You can place a book or small weight on your abdomen to make the exercise more difficult. Once you learn how to do belly breathing lying down you can increase the difficulty by trying it while sitting in a chair.

During Covid-19 it is especially important to keep your lungs clear and healthy. Should you require further information please email me at stephen@nobarriers.ie