ep 27 hobson posture and airway
DESCRIPTION
Dr. Jennifer Hobson on the relationship between Posture and Airway.TRANSCRIPT
![Page 1: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/1.jpg)
“Relationship between Restricted Breathing Mechanics on Airway and
Posture”
Dr. Jennifer Flage Hobson, PT, DPT, MTC, CMTPT
[email protected] ptrenaissance.com
25 E Washington, Suite 1319 Chicago, IL 60602
![Page 2: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/2.jpg)
Airway
Neck Posture
![Page 3: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/3.jpg)
Evaluate Posture in standing and sitting Beighton scale systemic hypermobility Evaluate mouth opening mechanics for disc displacement and
muscular control Assess ROM; rotation to translation ratio, (should be 4:1:1 and
50/50). Centric Relation Provocation Test Palpation test: Using the Rocabado 8 point pain provocation map. Perform intra-oral joint/muscle and facial assessment. Hyoid Mobility test. Cervical spine ROM, joint testing, strength and stability Myofunctional Assessment (tongue tie, mallampati, swallow, chew) Breathing assessment; capnometer: CO2 levels, breath rate Review of C. S. X-rays: Lateral Ceph, flexion/extension, Open
mouth
Evaluation of the CS/TMJ and breathing dysfunction
![Page 4: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/4.jpg)
Centric Relation Provocation Test Palpation test: Using the Rocabado 8 point
pain provocation map
Evaluate the TMJ for dysfunction.
![Page 5: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/5.jpg)
Beighton Scale of Systemic Hypermobility 9 out of 9 points
![Page 6: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/6.jpg)
![Page 7: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/7.jpg)
Normal Atlas-Axis position
![Page 8: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/8.jpg)
Right rotation of Atlas, R inclined occlusal plane.
![Page 9: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/9.jpg)
Left Rotation of Atlas on Axis, Left inclined occlusal plane
![Page 10: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/10.jpg)
![Page 11: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/11.jpg)
Observe the spine of this patient. Straight neck causing neck pain, headaches, and bruxism
L. Motta, M. Matins, teal Craniocervical posture and bruxism in children, Physiotherapy Research International, Vol 16 Issue 1 pg. 57-61, March 2011 C. Restrepo, Y. Quintero, etal. Effect of Physiotherapy on Bruxism and Head Posture TMD/orofacial pain epidemiology and treatment Instituto de Ciencias de la Salud, Medellín, Colombia Y. Quintero, C. Restrepo, etal. Effects of awareness through movement of the head posture of bruxist children. CES-LPH Research Group, CES University, Medellín, Colombia.
![Page 12: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/12.jpg)
![Page 13: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/13.jpg)
Interactions Between Head and Mandibular Position
Correlations between Posture and Jaw Relations, Danner, Jakstat and Ahlers, Journal of Craniomandibular Function, 2009;1(2):149-163
Forward Head Posture to Military
Cervical Flexion to Cervical Extension
Mandibular Retrusion to Protrusion Teeth contact more post to ant
Mandibular Retrusion to Protrusion Teeth contact more ant to post
![Page 14: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/14.jpg)
![Page 15: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/15.jpg)
Weakness of the anterior neck flexorsChin tucks, Chin tuck and lift exercise.
Jull, G, Kristjansson, E & Dall'alba, P 2004. Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Man Ther, 9, 89-94.
![Page 16: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/16.jpg)
![Page 17: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/17.jpg)
Superior and inferior airway
![Page 18: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/18.jpg)
Effects of neck flexion and extension on airway. Cervical flexion decreases airway
Cervical extension increases airway
![Page 19: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/19.jpg)
Capnometer: ETCO2 40-45mmHG, Breath rate: 8-10 at rest
![Page 20: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/20.jpg)
Dysfunctional shallow chest breathing found in 90% of my head and neck patients, including myself!
(CO2: 26mmHG, Breath rate 22bpm)
![Page 21: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/21.jpg)
Dr. Kevin Boyd, Pediatric cases effects of posture and airway.
![Page 22: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/22.jpg)
Is it a coincidence that the majority of my head and neck patients have dysfunctional breathing?
!• In my practice, all of my patients are getting
tested and treated for breathing dysfunction. • They are now also getting Myofunctional
therapy along with the manual therapy/dry needling/postural strengthening to restore proper joint mechanics of the upper quarter/spine balanced stance.
• Buteyko breathing method. (Proper breathing mechanics, volume, breath rate)
![Page 23: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/23.jpg)
Dr. John Mew
![Page 24: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/24.jpg)
Crooked or Straight Front Teeth
Crowding caused by incorrect tongue position and function
![Page 25: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/25.jpg)
Crooked or Straight Front Teeth
Correct tongue position and function gives correct arch form
![Page 26: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/26.jpg)
Permission by Dr. Boyd
![Page 27: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/27.jpg)
Patient I.H 4.yo
• Nursed for 6 months, milk supply faded. Mom return to work.
• Swollen adenoids and tonsils. • Snoring at night. • Mouth breathing during the day and night. • Forward head posture. • Hyperactivity. • Nail biter.
![Page 28: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/28.jpg)
Physical Therapy Examination
• Mallampati score: Between 3-4, • Hyoid bone moderate restriction of mobility • Tongue evaluation: short anterior frenulum;
mouth breather; high narrow palate. • Scapular weakness. • Sub-cranial stiffness, posterior rotation of the
cranium. Increased tone posterior cervical muscles. Forward head posture.
• Decreased diaphragmatic breathing
![Page 29: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/29.jpg)
Female 4 year old patient, ponticulus posticus grade 2; Small bridge of bone resulting from complete ossification of the Atlanto-Occipital
membrane reaching the posterior notch of C1.
![Page 30: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/30.jpg)
Enlarged Adenoids & TonsilsLimited airway
![Page 31: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/31.jpg)
I. H. Front view pics
Note facial asymmetry
![Page 32: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/32.jpg)
Retro-inclined Profile
![Page 33: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/33.jpg)
Weakness of the scapular stabilizers and upper quarter; winging noted.
![Page 34: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/34.jpg)
Mandible to the Left
![Page 35: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/35.jpg)
Frontal view occlusion mandibular midline 2 mm to left
![Page 36: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/36.jpg)
Tongue thrust swallow, poor position of tongue
• Tongue thrust swallow
![Page 37: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/37.jpg)
I.H. frenulum anterior and lateral view
Suction upward of the tongue Cave exercise
![Page 38: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/38.jpg)
Jenny’s anterior and lateral view of lingual frenulum
![Page 39: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/39.jpg)
Swollen tonsils and adenoids Pediatric ENT recommend
Tonsilloadenoidectomy
![Page 40: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/40.jpg)
Importance of proper nutrition
• Met with Dr. Lois Laynee, Developmental airway specialist. Recommended the following…
• Eliminate gluten and dairy (well known foods to cause inflammation to the body)
• Eliminate process foods. Anything packaged.
• Reduce sugar intake.
![Page 41: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/41.jpg)
Biobloc palatal expander, Dr.Mew/Dr. K. Boyd, began Sept.2013
![Page 42: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/42.jpg)
Intraoral swelling reduced to normal 12/2013 to present 6/2014
• No need for a adenoidectomy or tonsillectomy • No longer hyperactive. • No longer had dark circles under her eyes. • She is still in Myofunctional/speech therapy. • We 3M Micropore tape on lips every night. • She is in swimming for scapular strengthening. • Still in phase 1 of the Biobloc expander with Dr. Kevin
Boyd. • Capnometer: CO2: 40mmHG, Breath rate 14bpm. • In each of my Children’s Buteyko clinics I offer. • Scheduled to have anterior tongue tie frenectomy with Dr. Larry Kotlow 7/22/14
![Page 43: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/43.jpg)
C.H. 3-year old boy
• Delivered 5 weeks early VBAC • Difficulty with milk supply from mom. Nursed yet
had to supplement after 2 months. • Weaker immune system, longer to recover from
illness’. • Hospitalized for pneumonia at Children’s Hospital
at age 1; 2nd 3day hospitalization Corona virus effecting breathing (CO2 levels in hospital 18mmHG).
• Swollen adenoids and tonsils, recommended SX • Speech delay, speech therapy 1 year.
![Page 44: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/44.jpg)
Examination: C. H.
• Mallampati score: Between 3-4. • Hyoid bone moderate restriction of mobility. • Tongue evaluation: short posterior frenulum;
mouth breather; high narrow palate. • Firm, tight floor of mouth under mandibular
symphysis. • Decreased diaphragmatic breathing, over-
breathing. • Mouth breathing.
![Page 45: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/45.jpg)
C.H. Frontal View Pics
No smile smile
![Page 46: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/46.jpg)
C.H. profile
![Page 47: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/47.jpg)
C.H.posterior tongue tie4 opinions First 3 said no to tongue tie
Last opinion, Dr. Larry Kotlow
Performed Posterior tongue tie frenectomy on 1/29/14
Albany, NY.
![Page 48: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/48.jpg)
C.H. Post frenectomy tongue flexibility
![Page 49: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/49.jpg)
CH Intraoral swelling reduced to normal 2/2014 to present 6/2014
• No need for a adenoidectomy or tonsillectomy • No longer hyperactive. • She is still in Myofunctional/speech therapy/PT
manual therapy. • We 3M Micropore tape on lips every night. • He is in swimming for scapular strengthening. • Planning to start Biobloc expander with Dr. Kevin
Boyd at age 4 (Oct 2014). • Capnometer: CO2: 30mmHG, Breath rate 27bpm.
Still needs more work. Can’t do Children’s Buteyko breathing clinics due to attention span yet.
• Lingual posterior tongue tie revision Frenectomy scheduled 7/22/14 with Dr. Larry Kotlow
![Page 50: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/50.jpg)
Why is OMT Important?
• Lack of a Lip Seal may lead to Occlusal dysfunction (Harari, et al,2010)
• Low, forward tongue rest may be linked to psychological, cosmetic, structural issues, (Peltomaki, 2007)
• Failure to masticate food properly (Straub, 1962)
• Incorrect swallowing may be linked to GERD, (Phua, et al., 2005)
• OSA: Mouth Exercises May Reduce AHI numbers by 39% (Guimaraes, 2010)
![Page 51: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/51.jpg)
![Page 52: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/52.jpg)
Mallampati scores 1-4
![Page 53: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/53.jpg)
Throat musculature1. Tensor veli palatini 2. Levator veli palatini 3. Salpingopharyngeus
4. Musculus uvulae
5. Aponeurosis of tensor veli palatini
6. Pterygoid hamulus
7. Palatopharyngeus
8. Palatoglossus
9. Tonsil 10.Tongue
![Page 54: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/54.jpg)
References• Danner H., Jakstat H., Ahlers M. Correlations between posture and jaw
relations Zeitschrift fu kraniomandibulare Funktion 2009; 1(2):149-163. • Cesar G. Tosato J, et al. Correlation between Occlusion and Cervical Posture in
Patients with Bruxism. Parkell Online Learning Center. • Ciancaglini R, Testa M, Radaelli G. Association of Neck Pain with symptoms of
Temporomandibular Dysfunction in the general adult population. Sand J Rehab Med 31, pg. 17-22, 1999
• Visscher C. , Lobbezoo R, et al. Clinical test in distinguishing between persons with or without craniomandibular or cervical spinal pain complaints. Eur J Oral Sciences
• McNeely M, Olivo A., Magee D. A systematic Review of the Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders. Physical Therapy J o APTA 2006; 86:710-725
• Armijo-Olivo A., Jara X. et al. A Comparison of the head and cervical posture between the self-balanced position and the Frankfurt Method.
• Carra M., Huynh N. , Lavigne G. Sleep bruxism and sleep-disordered breathing in pediatrics: an overview for clinicians. Zeitschrift fur Kraniomandibulare Funktion 2011; 3(3):205-220
![Page 55: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/55.jpg)
References• Olivo, S.A., Bravo, J et al. The Association Between Head and Cervical Posture and
Temporomandibular Disorders: A Systematic Review. J Orofac Pain Vol 20, Number 1, pg 9-23, 2006
• Olivo, S. A., Mages, D. et al. The Association Between the Cervical Spine, the Stomatognathic System, and Craniofacial Pain: A Critical Review. J Orofac Pain Vol 20, Number 4, 2006 Pg. 271-287
• Lee, W. Y., Okeson, J. et al. The Relationship Between Forward Head Posture and Temporomandibular Disorders. J Orofac Pain Vol Number 2, 1995 Pg. 161-167
• Moniaco, A., Cozzolino. V. et al. Osteopathic manipulative treatment (OMT) effects on mandibular kinetics: kinesiographic study. Euro J or Paediatric Dentistry 1/2008, pt. 37-42.
• Olmos. S, Kritz-Silverstein. D, et al. Effect of Condyle Fossa Relationships on Head posture. J of Craniomandibular practice Jan 2005 Vol 23., No. 1 pg. 48-52
• Pradham. N, White, G. et al. Mandibular deviations in TMD and non-TMD groups related to eye dominance and head posture. J of Clinical Pediatric Dentistry Vol 25, Number 2/200 pg. 147-154
• Wright. E, North. S. Management and Treatment of Temporomandibular Disorders: A Clinical Perspective. J of Manual & Manip Therapy Vol 17 Number 4pg 247-254.
![Page 56: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/56.jpg)
References continued
• L. Motta, M. Matins, teal Craniocervical posture and bruxism in children, Physiotherapy Research International, Vol 16 Issue 1 pg. 57-61, March 2011
• C. Restrepo, Y. Quintero, etal. Effect of Physiotherapy on Bruxism and Head Posture TMD/orofacial pain epidemiology and treatment Instituto de Ciencias de la Salud, Medellín, Colombia
• Y. Quintero, C. Restrepo, etal. Effects of awareness through movement of the head posture of bruxism children. CES-LPH Research Group, CES University, Medellín, Colombia.
• Jull, G, Kristjansson, E & Dall'alba, P 2004. Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Man Ther, 9, 89-94.
![Page 57: Ep 27 Hobson posture and airway](https://reader037.vdocuments.us/reader037/viewer/2022102722/555868e3d8b42aaa7e8b4a39/html5/thumbnails/57.jpg)
!• Dr. Mariano Rocabado, PT, DPT, CFC, MTC • Michael Karegeannes, PT, MHSc, LAT, MTC,
CFC, CCTT, CMTPT • Dr. Larry Kotlow • Dr. Kevin Boyd • Joy Moeller, RDH, • Patrick McKeown, Buteyko Mentor
Special Thanks