Introduction: Flu: Respiratory Assist

About: Hi, I'm Dr. Bob Canida. I've practiced dentistry in Madison, IN for over 30 years. My daughter Christy runs this site.

Respiratory assist techniques can help improve lung function and lymphatic drainage, and are good for any respiratory ailment.  They are especially valuable for treating the respiratory effects of the flu, and to diminish the transition into pneumonia.  The techniques are quite simple, and can be an easy way to help friends and family who have the flu.

The respiratory assist techniques described in this Instructable have been described by Dr. Paul Lee, a practicing osteopathic physician.  He teaches these techniques to family members so they can help treat a flu patient at home several times a day, improving lung function and speeding recovery.

Note that these techniques are usually performed on fully-clothed patients.  These pictures are intended to help demonstrate hand and finger placement.

Step 1: Rib Raising: Finger Placement

This picture demonstrates the finger placement on the subject's back.  Your finger tips should be about 3 or 4 inches in from the spine on the height of contour of the ribs.

  (Please note that this is several inches lateral toward the outside of the chest wall from what is shown in the picture.   Actually the finger tips should be about at the base of the finger webbing.  I will put on a new picture before too long.  Dr Paul Lee reviewed this Instructable, and this was one of the refinements that he suggested.)

My hand position will be reversed (pinkies adjacent, thumbs out) when the patient is lying flat on the table.  You will then resume the finger position, finding it by feel.

Step 2: Rib Raising

When the patient is lying down, slip your hands under his back and place your fingertips in the rib/vertebra junction as shown in step one.  Gently lift the ribs with your fingers about 1/2 to 1 inch up off the table toward the ceiling, to gently stretch the fascia connecting the ribs to the vertebrae. 

Raise the ribs as the patient exhales, hold for several seconds as the patient finishes the deep breath, then relax the pressure as the breath comes back in.  Have the patient breathe deeply, making a bit of noise to help guide you.  Use feedback from the patient to be sure that the pressure on their ribs remains at a comfortable level. 

Repeat the rib raising about 5 times, coordinating with the patient's breath, then move to the other side and repeat the same process.  (The rib raises are still beneficial even if you cannot coordinate them with the patient's breath.)

Step 3: Diaphragm Release Through the Falciform Ligament

Place the fingers in the midline of the stomach as shown, starting at the end of the sternum (Xiphoid process), and continuing down past the navel.  Press gently inward to take up slack in the tissue.

Have the patient exhale, and follow the tissue deeper with the fingers as they exhale.  When they inhale, hold your fingers in the new deeper position and resist being pushed upward by the new inhalation.  Do this for 3 breaths, and then hold for another 10-20 seconds.  

This area may be tender as you go deeper, so moderate the pressure according to feedback from the patient.  The intent is gentle release, and to be gentle to the patient.  

Step 4: Lung and Lymphatic Release

This enhances the full inhalation and exhalation of the lungs, and aids the release of the thoracic inlet and the rich lymphatics in the chest area under the sternum. 

Place your hands on the rib cage over each lung, with the base of the hands directly under the clavicle (collar bone).  Finger position is less relevant; working on women simply shift your hands and fingers to avoid the breasts.

Again ask the patient to enhance the sound of their breathing so you can follow along.  As the patient exhales, follow the deflation of the chest  and rib area with pressure with your hands.  Hold that position as they inhale, and resist being pushed upward by the new inhalation.  Repeat this 3 times, holding the exhaled position each time. 

After the third breath ask them to hold the breath out as long as possible. When they need to breathe in, instruct them to give you an audible signal with their mouth as they breathe.  As they take that big breath in, you release your hands suddenly and definitively as they breathe in so the new inspiration is enhanced.  Many times this is accompanied with a good cough. 

With all these techniques, work within the comfort zone of the patient.  Ask them frequently if the pressure is OK, and adjust as necessary.  

Step 5: Diaphragm Breathing

All of the breathing during these techniques should be diaphragm breathing. 

To check whether you are breathing with your diaphragm, try to curl your fingers under your ribs on each side.  Take a big breath in.  Proper diaphragm breathing will push your fingers out as the diaphragm descends and the stomach seems to get bigger. 

Paradoxical (or chest breathing) will allow your fingers to go farther up into the rib area on inspiration as the diaphragm ascends, the stomach gets smaller, the chest gets larger and the whole rib cage is drawn upwards toward the head while breathing in. 

Side note: in chest breathing, the neck muscles must help lift the rib cage.  As these neck muscles become over worked they develop "trigger points" that refer pain to the head.  Some people find that correcting their breathing patterns have an added benefit of lessening some headaches.  We are a society that likes big chests in both men and women, so some people habitually breathe paradoxically.  When you breathe in using your diaphragm, your rib cage does expand, but not quite as much as when you breathe mainly from your chest and not from your diaphragm.  Check yourself.  It is very important to your body functioning well and to your health to breathe using your diaphragm correctly.

Step 6: Lymphatic Pump

This technique stimulates circulation throughout the body, with emphasis on the lymphatic system, and is also helpful to the lungs. 

Let the patients feet protrude over the end of the bed or table, and place the balls of the feet against your thighs.  (You can also do this with your hands on the balls of the feet.)  Gently press against the balls of the feet in a rhythmic fashion, jiggling/pulsing the feet upwards into the body.  You're aiming for a little over a pulse per second.  

Imagine that you have a big container of jello, and want to set up a nice jiggle or wave pattern through the abdomen which is effecting the diaphragm to pump up and down.  The diaphragm acts as an important pump for the lymphatics.  Do this for several minutes. 

Step 7: Review

All of these procedures should be very gentle, and not done aggressively. 

These techniques are designed to enhance the body's range of motion, especially the lungs and breathing apparatus.   They can be done multiple times each day, and are extremely useful for respiratory problems, including flu and pneumonia. 

Respond to the patient's directives and feedback.  The human touch can be an excellent mechanism of healing, compassion, and care, but be aware some people may not be comfortable with hands-on techniques.  Be sure to look for and respect any such physical boundaries.

With a bit of practice, this simple set of techniques will allow anyone to help friends or family members suffering from the flu, or any other respiratory ailment.