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.

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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.  

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    18 Discussions

    Bob Canidaroebm

    Reply 8 years ago on Introduction

    Roebm, I love osteopathic treatment. I have been part of a study group consisting of dentists that has been meeting west of Chicago for over 25 years. We have a guest osteopath such as Dr. Paul Lee, come in as a presenter/teacher 3-4 times/year. We apply the osteopathic principles in the cranial field as they relate to dental orthopedics and craniofacial pain. Hope that you are enjoying your osteopathic practice! You have a great tradition! Bob


    9 years ago on Introduction

    Thanks for this posting.  I had read a description of this years ago, but had a hard time actually figuring out how to do it.  The pics are very helpful.


    9 years ago on Introduction

      Wow... It's nice to find something like this. I have a consistent respiratory infection caused from my allergies. When my boyfriend gets home next week I am definately going to try this with him. It would be nice if something actually helped! ... lol. >.<

    3 replies
    Bob Canidakomecake

    Reply 9 years ago on Introduction

    Thanks, komecake.  Even if I were feeling good, and had no respiratory problems I would feel better in general having received this treatment.  In addition, I would appreciate the assist if I had respiratory problems.  Of course this set is not an instant cure, but like it says, a respiratory assist.  The osteopaths say that doing this frequently will reduce the conditions that lead to pneumonia, or mitigate the seriousness of pneumonia if it has already set in.   My wife is prone to respiratory/pneumonia problems and she feels that this is very helpful.  She also feels that the regular use of Listerine mouthwash decreases the frequency of occurrence of  her respiratory problems.
    For allergies, the lymphatic pump from the feet would be useful to keep the lymphatic system working against the allergens.  Hope that this helps.

    komecakeBob Canida

    Reply 9 years ago on Introduction

      Great! I'll have to try that mouthwash. Anything that will help would be great. Some days are a lot worse than others and if there are things to reduce the causes, the more information I know the better. Thank you very much. :)

    Bob Canidakomecake

    Reply 9 years ago on Introduction

    Studies (Abrahamsen) have shown that the notching wear of the root areas of the teeth next to the gums are a result of the abrasives in the toothpaste. 
    Since my wife was developing these, after I had seen the presentation of Dr. Abrahamsen's studies, both she and I have stopped using toothpaste and only use a wet toothbrush.  We follow that by rinsing with Cool Mint Listerine with fluoride.  Probably other mouthwashes might have the same effect, but Cool
    Mint Listerine is the only mouthwash that has been documented in studies to reduce microorganisms in the mouth that contribute to gingivitis and that actually reduces gingivitis by mouthwash alone.  My wife is convinced that she has had dramatically less respiratory problems since she has gone to the frequent daily mouthwash. 


    9 years ago on Step 6

    If I'm understanding it right, then once a second you have to move with your hips, like they do on Discovery channel.... Some would not understand your intentions.

    1 reply
    Bob Canidauldics

    Reply 9 years ago on Introduction

    Good point to bring up intentions!  It is always good to check your intentions before beginning to treat others.  The intention of the heart should be a loving intent to assist that person to enhance their own healing and health. 


    Reply 9 years ago on Introduction

    OK, that is exactly what I thought. I thought he was stuffing a turkey and wondered what that had to do with the flu.


    9 years ago on Introduction

    Well done, Dr. Lee.  As an osteopathic medical student, it excites me to see others in the profession using technology to teach patients how to find their health.  Might I suggest the Galbreath maneuver as a second installment?

    It should also be noted that almost anyone can benefit from this technique (not just those with respiratory "problems") as it opens up the lymphatic system and promotes fluid movement throughout the body.  I'm pretty sure this technique is contraindicated in folks with cancer (i.e. it should not be used).  Care to comment on contraindications, Dr. Lee?

    1 reply
    Bob Canidastuboo

    Reply 9 years ago on Introduction

    I am a dentist in a dental study group, focusing on head pain, that invites various osteopathic physicians to teach us 3 or 4 times a year.  Dr Paul Lee is one that we had teach our group recently, and he presented this as a good set of techniques that we could share with others in this time of concern about the flu.  As you have well stated, this type of body work is very profound treatment.  I love being treated by osteopaths who treat with the cranial model, and it excites me to hear that you are an osteopathic student that appreciates the osteopathic principles.  My heartfelt encouragement to you!

    I am not familiar with the Galbreath maneuver, but would love to have you share it!  Best wishes in your studies.  Bob Canida