Primary and Secondary Respiration - American Academy of ...

Primary and Secondary RespirationRaymond J. Hruby, DO, MS, FAAO

Objectives• Define:• Primary Respiratory Mechanism (PRM)• Secondary Respiratory Mechanism(SRM)• Discuss Relationships Between PRM andSRM• How are they related?• Where do they meet?• What is the clinical significance ofthis interrelationship?

Primary Respiratory Mechanism• Primary –underlying all other physiologicfunctions• Respiratory –concerned with cellularrespiration• Mechanism –cranial articulations andsacral respiratory motion bt between theilia

Anatomy and Physiology of the PRM• Structural components:• Cranial articular mechanism• Intracranial and intraspinal membranes• Sacrum• Functional components:• CSF• Inherent motion of the CNS• Inherent potency

StructureReciprocalTensionMembraneCSFFluctuationCranialArticularMobilityPrimaryRespiratoryMechanismSacralRespiratoryMotionCNSMotilityOSTEOPATHICSTRUCTURALEXAMFunction

Secondary Respiratory Mechanism(SRM)• SECONDARY – dependent on the PRM• RESPIRATORY –concerned with alveolarrespirationi• MECHANISM – includes anatomic structuresfrom nasal passages to alveoli; li also includesrib cage and diaphragms

Anatomy and Physiology of theSecondary Respiratory Mechanism(SRM)• Structural components– Nasal passages– Pharynx– Larynx– Bronchi– Lungs– Thoracic cage– Diaphragms: throracoabdominal, pelvic,cranial

Anatomy and Physiology of the SecondaryRespiratory Mechanism (SRM)• Functional components:• Concerned with thoracic (alveolar)respiration• O 2 – CO 2 transfer mechanism• Intimately connected to other bodysystems such as cardiovascular,neurological, musculoskeletal

Commonalities Between the Two Systems• Vital to life• Phasic in nature• Respond to metabolicdemands

Some Possible PRM-SRM Relationships• Both have spontaneous excursions• Can be in or out of phase with each other• They can move in an unrelated ltdfashion, withthe PRM typically slower• SRM can enhance PRM or assist withtreatment of PRM – for example, use ofrespiratory cooperation

Some Possible PRM-SRM Relationships• The PRM is constant and stable• The SRM is more prone to modulation andadaptation to the environment• The SRM adjusts to the external atmosphericconditions to meet the needs of the internalmetabolic processes, including the PRM.

Some Possible PRM-SRM Relationships• Restriction of motion of cranial bones,and/or cranial, thoracic and pelvicdiaphragms can alter PRM amplitude andfrequency• SRM can be used to influence PRM

Some Possible PRM-SRM Relationships• The PRM continues as long as life persists• The SRM may be interrupted t or stopped,and resumed through forcefulmanipulation of the temporal bones

An Interesting Analogy?• The PRM may be compared to the riseand fall of the oceanic tide• The SRM may be thought of as the wavesof the ocean water that arise from andrespond to environmental changes

Where do the PRM and SRM meet?• Some examples:– Temporal bones– Occiput and/or Sacrum– Neurological control system for respiration– The core link and the three diaphragms

Where do the PRM and SRM meet?• PRM initiates and maintains activity of CNSrespiratory centers.• These CNS centers then di drive the action of theSRM components.• Provides a “pathway” for the influence andaction of the inherent potency of the PRM.

Temporal Bones

Temporal Bones

Occiput and Sacrum

Connection to the Neurological System

Neural Control of Respiration

Connection to the Musculoskeletal System

The Core Link and the Three Diaphragms

What is a Diaphragm?• A connective tissue septum which divides abody cavity into superior and inferiorcompartments.• This septum is attached at its periphery to amobile part of the bony skeleton and issubject to rhythmic motion related to thephases of respiration.

Cranial DiaphragmSuperior View of the Tentorium Cerebelli

Thoracoabdominal Diaphragm

Pelvic Diaphragm

Connection to the Cardiovascular System

ANOTHER THOUGHT…Consider the extensive nature and function of fascia

Another Thought• H. Langevin. Connective tissue: A body‐widesignaling network? Medical Hypotheses,Volume 66, Issue 6, Pages 1074‐1077.

Another Thought• Unspecialized ‘‘loose’’ connective tissue formsan anatomical network throughout the body.The hypothesis is that, in addition, connectivetissue functions as a body‐widemechanosensitive signaling network.

Another Thought• Three categories of signals are studied:electrical, cellular, and tissue remodeling, eachpotentially responsive to mechanical forcesover different time scales.

Another Thought• It is proposed that these types of signalsgenerate dynamic, evolving patterns thatinteract with one another.• Such connective tissue signaling would beaffected by changes in movement andposture, and may be altered in pathologicalconditions (e.g. local decreased mobility dueto injury or pain).

Another Thought• Connective tissue thus may function as apreviously unrecognized whole bodycommunication system.

Another Thought• Since connective tissue is intimately associatedwith all other tissues (e.g. lung, intestine),connective tissue signaling may coherentlyinfluence (and be influenced by) the normal orpathological function of a wide variety of organsystems.

Another Thought• Demonstrating the existence of a connectivesignaling network therefore may profoundlyinfluence our understanding of health anddisease.

A. T. Still on fascia:• “This connecting substance must be free at all partsto receive and discharge all fluids, and use them insustaining animal life, and eject all impurities, thathealth may not be impaired by dead and poisonousfluids.”• “By its action we live and by its failure we die.”• “The soul of man, with all the streams of pure livingwater, seems to dwell in the fascia of his body.” body”

Clinical Correlations• Deep inhalation (SRM) can enhance the PRM– Newborn first breath• Biomechanical factors –Exercise: try breathing withneck extended vs. flexed• Realignment of core link elements (diaphragms)• Temporal lbone influence on respiration• CV4 technique• Sutherland’s (and others’) experience withrespiratory arrest patient

Breath ofLifePRMSRM

Primary vs. Secondary RespirationPRM• Inherent motility of the brainand spinal cord• Fluctuation of thecerebrospinal fluid (potency)• Mobility of the intracranial andintraspinal membranes• Articular mobility of thecranial bones• Involuntary motion of thesacrum between theinnominatesSRM• Structural components– Nasal passages– Pharynx– Larynx– Bronchi– Lungs– Thoracic cage– Diaphragms: throracoabdominal,pelvic, cranial– Respiratory centers in the brain• Functional components:• Concerned with thoracic (alveolar)respiration• O 2 –CO 2 transfer mechanism• Intimately connected to other bodysystems such as cardiovascular,neurological, musculoskeletal

PHYSIOLOGICFUNCTIONS…

Physiologic Functions• Respiration– Clll Cellular– Tissue• Fluid Exchange– Arterial blood– Venous blood– Lymph– Cerebrospinal fluid

References• Moskalenko, Y. Cerebral pulsation in the closedcranial cavity, Izv Asad Nauk SSSR (Biol) 4:620‐9, 61.• Sears. Investigations on respiratory motoneurones ofthe thoracic spinal cord, Progr Brain Res 12:259‐72,64• Nelson eso KE et al.2001 a. Cranial Ca arhythmic impulserelated to the Traube‐Hering‐Mayer oscillation:comparing laser‐Doppler flowmetry and palpation. p JAm Osteopath Assoc, 101(3): 163‐73