title: A CLINICAL GUIDE TO THE ASSESSMENT AND TREATMENT OF BREATHING PATTERN DISORDERS IN THE PHYSICALLY ACTIVE: PART 2, A CASE SERIES.
abstract: BACKGROUND
  Breathing pattern disorders (BPDs) are characterized by persistent, suboptimal breathing strategies that may result in additional musculoskeletal pain and/or dysfunction. The purpose of this case series was to examine the effects of Primal Reflex Release Technique (PRRT) and breathing exercise interventions in physically active individuals that presented with a primary complaint of musculoskeletal pain, a BPD, and startle reflexes.
  
  
  METHODS
  The assessment techniques described in Part 1 of this series were used to identify three student athletes (aged 16-22) who presented with musculoskeletal pain of the low back, mid back, and knee, BPDs, and startle reflexes. The subjects were unable to identify an apparent source of their pain.
  
  
  METHODS
  The clinician's classification of the subject's breathing patterns guided intervention(s). Each subject was treated once with PRRT and/or a breathing reflex triggering exercise.
  
  
  RESULTS
  Each of the three subjects demonstrated clinically important improvements on the numerical pain rating scale specific to their tender areas and/or with their primary musculoskeletal complaint.
  
  
  CONCLUSIONS
  These findings suggest that it may be useful to assess for a BPD and startle reflexes along with a standard orthopedic evaluation in the physically active athlete. Treatment of BPD's may positively impact musculoskeletal pain and/or dysfunction. Further research is needed to understand the effects of treatment of BPD's and how these effects relate to musculoskeletal dysfunction.
  
  
  CONCLUSIONS
  The prevalence of BPD with startle reflexes is unknown and implications regarding the assessment for and treatment of BPD has limited research; however, positive results were demonstrated for the three subjects after normalizing breathing patterns.
  
  
  METHODS
  4.
authors.forename: Jena
authors.initials: J
authors.lastname: Hansen-Honeycutt
authors.forename: Erin B
authors.initials: EB
authors.lastname: Chapman
authors.affiliation: The University of Idaho, Moscow, ID, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Nasypany
authors.affiliation: The University of Idaho, Moscow, ID, USA.
authors.forename: Russell T
authors.initials: RT
authors.lastname: Baker
authors.affiliation: The University of Idaho, Moscow, ID, USA.
authors.forename: Jim
authors.initials: J
authors.lastname: May
keywords: Primal Reflex Release Technique; musculoskeletal pain; startle reflex