This weekend I took a class on myofascial release for dysphagia. I hoped to better understand how the superior segment of the core works. I think I achieved that goal this weekend, but also in the progress realized how much I need to learn. The course instructor John Kelly directed me to Orofacial Myologists as a resource to continue my education in this direction for the future. Between this and the pelvic floor continuing education I am pursuing, I still feel like there is so much more for me to learn about core stability.
In a previous post, I discussed how the core ran from the pelvic floor to the throat/neck. I now might reconsider that description. I think I would amend this to say core stability starts at the very beginning of the upper airway. Core stability is complex system of pressure regulation, likened to stability in a soda can. When learning about the kinesiology of swallowing, it became clear that pressure regulation played an important role in this process. Differences in pressure from the oral cavity to the esophagus drive swallowing.
Following mastication, positive pressure in the oral cavity is created in part by forming a seal with a closed mouth with buccinator and orbicularis oris contraction. This positive pressure assists the tongue in moving the bolus to the pharynx. Pressure is raised again by elevating the soft palate, thus closing off the nasopharynx, and by retracting the tongue into the back of the mouth. As pressure builds in this part of the pharynx, the inferior pharynx expands due to anterior and superior elevation of the hyoid. The bolus then goes from an area of high pressure to low pressure down the pharynx. 1
Pharyngeal constrictors continues this wave of contraction and relaxation to drive the bolus down to a lower pressure area from a higher pressure area. Then epiglottis and vocal folds seal off the trachea forcing the bolus to travel down towards the lower pressure esophagus. When the upper esophageal sphincter relaxes, the peristaltic motion of food continues. Throughout this whole process, the body creates positive pressure to drive the bolus down to an area of lower pressure. 1
I know this focused more on swallowing than breathing, but these two processes are very closed related as the gastrointestinal and respiratory systems always are. As previously discussed the mechanics of respiration create core stability. To further my education in this realm, I really think I need to learn how breathing works in this upper airway. I know this is probably going to be more complex than I initially would have thought. Even after a brief search of the literature, it seems articles exist on oronasal rehab for breathing. 2 I think I will start referring to this interesting region as the upper core for now one, for organization’s sake in future posts. It should be a fun new world to explore.
Hope this helps,
- Kelly J. Myofascial Release and Other Manual Techniques in Dysphagia Management. [Powerpoint]. Charlotte, NC. 2015.
- Levrini L, Lorusso P, Caprioglio A, Magnani A, Diaféria G, Bittencourt L, Bommarito S. Model of oronasal rehabilitation in children with obstructive sleep apnea syndrome undergoing rapid maxillary expansion: Research review. Sleep Sci. 2014;7(4):225-33.