BIOMECHANICS AND

PATHOMECHANICS OF
RESPIRATION

By :Akanksha Chauhan (MPT 1)

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CONTENTS

 Mechanism of Respiration

 Kinematics of Respiration

 Kinetics of Respiration

 Pathomechanics of Respiration

 References

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INTRODUCTION
 The thoracic cage is conical at both its superior and
inferior aspects.
 The Skeletal boundaries of the thorax are the 12 thoracic
vertebrae dorsally, the ribs laterally and the sternum
ventrally.
 The bony thorax provides a skeletal framework for the
attachment of the muscles of respiration.
 It covers and protects the major organs of the
cardiopulmonary systems.

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Sternum
 The sternum or breastbone is a flat bone with 3 major
parts : 1.manubrium
2.body
3.xiphoid process.
 A palpable jugular notch or suprasternal notch is found at
the superior border of the manubrium of the sternum.
 A sternal angle or angle of louis is the anterior angle
formed by the junction of the manubrium and the body of
the sternum.
 It marks the level of bifurcation of the trachea into the right
and left main stem bronchi and provides for pump- handle
action of the sternal body during inspiration.
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Ribs
 The rib cage is a closed chain that involves many joints
and muscles.
 The anterior border of the rib cage is the sternum, lateral
borders of the ribs, and the posterior border is formed by
the thoracic vertebrae.

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JOINTS OF RIBCAGE ARTICULATIONS

MANUBRIOSTERNAL Manubrium and body of sternum.

JOINT/STERNAL ANGLE/ANGLE OF
LOUIS
XIPHISTERNAL JOINT Manubrium and xiphoid process

COSTOVERTEBRAL JOINT Head of rib ,2 adjacent vertebral

bodies and interposed ivd.

COSTOTRANSVERSE JOINT Rib and transverse process of

vertebra. All ribs except R11 &12.
COSTOCHONDRAL JOINT R1- R10 with costal cartilages.

CHONDROSTERNAL JOINT R1-R7 costal cartilages with

sternum
 Ribs 1 through 7 are classified as vertebrosternal
(“true”)ribs because each rib through its costocartilage,
attaches directly to the sternum.
 The costcartilage of ribs 8 through 10 articulates with the
costocartilage of the superior rib, indirectly articulating
with the sternum via rib 7. These ribs are classified as
vertebrochondral (“false”) ribs.
 The 11th and 12th ribs are called vertebral (“floating”) ribs
because they have no anterior attachment to the
sternum.

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KINEMATICS OF RESPIRATION:
 PUMP HANDLE MOVEMENT
 It is upside down movement closely related to movement of
pump handle.
 It mainly contributes to movement of upper ribs.
 Ribs 2 through 7 are attached to body of sternum so it
increases in length and mobility because of its cadual position.
 In upper ribs, most of movement occurs at anterior aspect of
rib, given the nearly coronal axis at vertebrae. The
costocartilage rotates upward, becoming more horizontal with
inspiration.
 The movement of ribs pushes sternum ventrally and superiorly.
 The manibrium moves less than body of sternum because the
shortest and least mobile rib is attached to manibrium
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 This discrepancy in rib length increases movement of
body of sternum in relation to manibrium.
 The greatest effect of motion of upper ribs and sternum is
increase in A-P diameter of thorax.
 This combined rib and sternal motion that occurs in
predominately sagittal plane is called ”pump-handle
motion” of thorax.

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 BUCKET HANDLE MOVEMENT
 Elevation of ribs 8 through 10 occurs about an axis of
motion lying more towards sagittal plane.
 The lower ribs have more angled shape and indirect
attachment anteriorly to sternum.
 These factors allow lower ribs more motion at lateral
aspect of rib cage.
 The greatest effect of elevation of lower ribs is increase in
transverse diameter of lower thorax.
 This motion that occurs in a more frontal plane is
‘’bucket-handle motion’’ of thorax.
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Piston movement of Diaphragm

 Contraction of diaphragm leads to descent the dome of

diaphragm known as piston movement of diaphragm.
 It increases the verticle diameter.
 It is accompanied by downward displacement of upper
abdominal viscera and forward bulge of anterior
abdominal wall.
 Range of diaphragmatic descent :
 Quiet inspiration = 1.5 cm
 Forced inspiration = 6-10 cm

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Changes in Intrathoracic Volume
during Respiration
 VERTICAL CHANGES
 During inspiration the vertical diameter of the thorax is
increased primarily by contraction and subsequent
lowering of the dome of the diaphragm muscle
 During quiet expiration the diaphragm relaxes, allowing
the dome to recoil upward to its resting position.

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 KINETICS OF RESPIRATION

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Primary muscles of Respiration
 Muscles of respiration are inspiratory muscles and
expiratory muscles.
 Inspiratory muscles are primary muscles and accessory
muscles.
 Diaphragm, the intercostal muscles (particularly the
parasternal muscles), and the scalene muscles.
 These muscles all act on rib cage for inspiration.
 There are no primary muscles for expiration because
expiration at rest is passive.

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 TIDAL BREATHING

Diaphragm FIBRES OF ZONE OF APPOSITION

CONTRACT,CAUSE DESCENT OF
DOME OF DIAPHRAGM
COMPRESSION OF ABDOMINAL
CONTENTS ,INCREASE IN INTRA
ABDOMINAL PRESSURE
STABILISES CENTRAL TENDON OF
DIAPHRAGM
COSTAL FIBRES CONTRACT AGAINST
CENTRAL TENDON ,LOWER RIBS LIFTED
IN BUCKET HANDLE FASHION
CRURAL FIBRES CONTRACT CAUSING
DESCENT OF CENTRAL TENDON
FURTHER INCREASING
INTRAABDOMINAL PRESSURE.
INCREASED PRESSURE TRANSMITTED
TO DIAPHRAGM TO HELP COSTAL
FIBRES EXPAND LOWER RIB CAGE.

INCREASES THORACIC VOLUME AND SIZE

AND ABDOMINAL CONTENTS DISPLACED
ANTERIORLY AND LATERALLY.
 3D view of diaphragm.mp4

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Accessory muscles of Respiration
Superficial- sternocleidomastoid, trapezius, clavicular
portion of pectoralis major, costosternal portion of
pectoralis major, external obliques.
Deep – scalenes, subclavius, pectoralis minor, transverse
thoracis, external intercostals,rectus abdominis, inetranl
obliques.

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 MUSCLES OF EXPIRATION
 The passive recoil of rib cage and lungs provides most of
volume reduction of thorax necessary for quiet breathing.
 Activity of diaphagram, parasternal muscles and scalene
continues into early expiration, contracting eccentricaly
to control recoil of rib cage.
 As respiratory effort increases, during cough, active
muscle contraction facilites volume reduction in thorax.

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 PRIMARY EXPIRATORY
MUSCLE-the internal
intercostals.
 Quiet expiration is due
to passive recoil of
thorax as a result of the
elasticity of its
osteochondral
components and of the
pulmonary parenchyma.
 ACCESSORY
EXPIRATORY MUSCLES-
abdominals.
 Forced expiration-needs
active muscle
contraction to rapidly
reduce intrathoracic
volume.
 DURING EXPIRATION

DIAPHRAGM RELAXES,CONTRACTION OF
ABDOMINAL MS.

LOWERING OF THORACIC FLOOR,REDUCTION IN AP

AND TRANSVERSE DIAMETER OF THORAX.

INCREASED INTRAABDOMINAL PRESSURE,RAISING OF

CENTRAL TENDON.

DECREASES VERTICAL DIAMETER OF THORAX AND

CLOSURE OF DIAPHRAGMATIC RECESSES

HENCE,ABDOMINAL MUSCLES ACT AS PERFECT ANTAGONIST

OF DIAPHRAGM AS THEY SIMULTANEOUSLY REDUCE ALL 3
DIAMETERS OF THORAX.
 Pathomechanics of Respiration

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 Mechanical difficulties in respiration occur under
following pathological conditions:
1. Obstruction of upper airway passages.
2. Insufficient Respiration due to congenital malformation
of thoracic cage.
3. Deformation caused by abnormal pliability of thorax.
4. Restriction of motion of thoracic cage due to
ligamentous or articular degenerative lesions.
5. Loss of respiratory muscle power.
6. Diseases of organs of thoracic cavity.

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OBSTRUCTIVE CONDITIONS

1. COPD
 Pathology –damage to airways and destruction of alveolar
walls, resulting in loss of elastic recoil of lungs.
 Hence ineffective exhalation-air trapping and hyperinflation.
a. Hyperinflation causes:
 Decrease in the zone of apposition(40%),
 Decrease in the curvature of the diaphragm,
 Change in the mechanical arrangement of costal and crural
components of the diaphragm, and
 Increase in the elastic recoil of the thoracic cage.

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 Barrel shaped chest -Increase in AP diameter of hyperinflated thorax,.
 Flattening of diaphragm at rest-attains shortened length in length
tension curve and functions at lowered position lines of force of costal
fibres move horizontally hence ms is ineffective at elevating ribs
during inspiration.
 According to Laplace’s law, an increase in the radius of curvature
causes an increase in the passive tension of the diaphragm and a
decrease in the efficiency of trans diaphragmatic pressure generation .
 Inspiratory action occurs within upper rib cage.

 Ref-Disorders of the Respiratory Muscles ,Franco Laghi etal, Am J Respir Crit Care Med,2003

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EMPHYSEMA
 Pathology-destruction of elastic fibers in alveoli, reduced
lung recoil.
 With disease progression collapsing forces of
lung<outward expanding forces of lung.
 Hence at end of normal resting exhalation, lungs expand-
overinflated lungs.
 Hyperinflation –flatten diaphragm-further reduction of
breathing.

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 Inspiratory action occurs within upper rib cage.
 Paradoxical breathing seen-due to maintained
effectiveness of upper inspiratory rib cage musculature
and reduced effectiveness of diaphragm.
 Energy cost of breathing increased.
 With diaphragm compromise majority inspiration
performed by accessory inspiratory muscles-SCM
becomes short and less efficient.

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Paradoxical breathing

 It is a condition in which chest moves inward during

inspiration instead of outward.
 This abnormal chest movement affects breathing
pattern and enough utilisation of oxygen is not there.
 This leads to drop in blood oxygen levels and increase
in carbon di-oxide level.
 This is mainly seen in flail chest.

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ASTHAMA
 During acute hyperinflation –the rib cage muscles are
recruited more than the diaphragm during inhalation .
The consequent distortion of the chest wall wastes
energy.
 The greater recruitment of the rib cage muscles places
them at risk of fatigue. Because their threshold for fatigue
is higher than that for the diaphragm however, greater
recruitment of rib cage muscles may help prevent
alveolar hypoventilation during an exacerbation.

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 Patients with asthma have a reduced voluntary drive to
breathe which decreases respiratory muscle recruitment
and the risk of fatigue during an exacerbation– risk of
alveolar hypoventilation. This is due to:-
 Decrease in reflex facilitation during forceful voluntary
contraction.

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 Pectus excavatum/funnel shaped chest:

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 Children with elastic tissue abnormalities (e.g., Marfan
syndrome ).
 A result of abnormal growth, lengthening, and rotation of the
costal cartilages, all leading to a depression of the sternum.
 a classic rotation of the sternum down to the right and the
appearance of the left side of the sternum elevated compared
with the right.
 Symptoms:
 Shortness of breath, lack of endurance, exercise intolerance.
 Chest pain, with or without exercise.
 Frequent respiratory infections.
 Asthma/asthma-like symptoms.

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 Cardiology indicators
 Cardiac compression (by CT, echo)
 Cardiac displacement (by CT, echo)
 Murmur on exam.
 Mitral valve prolapse .
 Other anomalies (BBB, aortic insufficiency, regurgitation,
hypertrophy, malformations)
 Pulmonary indicators
 FVC below 80%
 FEV1% below 80%
 FEF25–75% below 80%
Ref-Chest wall anomalies: pectus excavatum and pectus carinatum Michael J. Goretsky, Adolesc Med 15 (2004)

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 Scoliosis
 In scoliosis the alignment and motion of thorax is altered, so it
affects length-tension relationship and angle of pull of muscles
of Respiration.
 On convex side of scoliotic curve, because of sufficient
curvutare , the intercostal space is widened and intercostal
muscles elongated.
 On concave side of curve, ribs are crowded and intercostal
muscles are shortened.
 Lung volumes and capacities are reduced and it results in
altered biomechanics of scoliotic thorax.

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 Effect on lung growth:
 infantile (juvenile) scoliosis -true lung hypoplasia as the
thoracic deformity is present during the period of rapid lung
growth and development.
 adolescent scoliosis the development and growth of the
lungs has been completed before the onset of the scoliosis.
Thus, the decrease in TLC is due to impaired chest wall
mechanics that prevent the normal inflation of the lungs.
 Cobbs angle between 70 and 100 degrees, patients often
experience dyspnea on exertion.
 When cobbs angle > 100 degrees - chronic respiratory failure.
 reduction in maximal inspiratory and expiratory pressures.
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References
 Fundamentals of respiratory care-Egans 9th edition.
 Eden Hillegas. Essentials of cardiopulmonary system.
 The Physiology of the Joints-KAPANDJI.VOL3
 Disorders of the Respiratory Muscles ,Franco Laghi etal, Am J
Respir Crit Care Med,2003
 Chest wall anomalies: pectus excavatum and pectus carinatum
Michael J. Goretsky, Adolesc Med 15 (2004)

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 THANK YOU

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