Exercise-induced laryngeal obstruction in athletes: Contributory factors and treatment implications

Abstract

Otherwise healthy adolescent athletes presenting with respiratory symptoms consistent with exercise-induced laryngeal obstruction (EILO) are frequently encountered in clinical practice. The symptoms are often incorrectly considered to result from exercise-induced asthma, and may be wrongly treated as such. Given the potential implications for health and performance if EILO is left untreated, a more comprehensive understanding of contributory mechanisms is essential in order to create appropriate treatment procedures. Informed by knowledge from physical therapy, as well as the fields of voice rehabilitation and vocal pedagogy, this theoretical article presents a novel way of understanding and managing EILO by exploring bodily mechanisms and structures that may disturb laryngeal function during strenuous exercise. Firstly, the status quo of the EILO diagnosis, its aetiology and treatment options are reviewed. Secondly, considerations associated with laryngeal structures and mechanisms, and their potential influence on laryngeal movement and sensitivity are examined. Thirdly, the manner in which postural de-alignment and breathing pattern may interfere with laryngeal functioning will be discussed. Finally, interventions for voice disorders and singing and the relevance of these for EILO are evaluated. It is argued that clients with EILO should undergo a thorough physical examination to identify constrictions in the body as a whole - such as postural de-alignments and a dysfunctional breathing pattern - as these are hypothesized as playing a critical role in laryngeal tightness during exercise. Physical therapists possess particular skills and competence with regard to examining breathing patterns and postural de-alignments, and should be included in the treatment process of EILO.

Physiotherapy improves symptoms of exercise-induced laryngeal obstruction in young elite athletes: a case series

“…Over time, the increased mechanical loading on respiratory muscles may also generate conflicting forces and a sensitisation at the laryngeal level. Compensatory postural adaptations such as dealignment of the cervical spine, changes in thoracic configuration and an FHP (comprising an elevated position of the larynx) may well follow 30. The phrenic nerve, which receives innervation from the C3–C5 and courses within the fascia of the anterior scalene, supplies both motor and sensory nerve fibres to the diaphragm.…”

“…This would offer rich data about breathing pattern and cervical alignment during physical exertion, and could possibly help the athletes to change their breathing patterns by enabling them to study their own bodily habits/adaptations more closely. Given the presumed importance of abdominal breathing for optimal function of the larynx,30 a more comprehensive study of diaphragmatic movements, or the lack of such, in individuals with EILO would also be worthwhile.…”

“…The method differs from traditional physiotherapy in that it understands the body to be a functionally integrated entity, such that (1) constriction in one part of the body influences the steadiness of the entire body and (2) that lived experiences and feelings are embedded within the body 32 40. The assessment of the breathing pattern is of particular interest, as it is assumed that emotional or physical stress over time may constrict the breathing and cause tension in bodily function and movements 30. The approach has therapeutic potential for individuals presenting with complications associated with the respiratory system.…”

“…To date, few studies have examined whether physiotherapy may be an appropriate treatment for EILO. Building on findings from singing and voice therapy and the understanding that divergences in bodily functions and structures are mutually related, it has been suggested that a dysfunctional breathing pattern, postural dealignments and a forward head posture (FHP) may trigger laryngeal tightness during high-intensity exercise 30. In this case series, we examine whether a specialised physiotherapy approach—Norwegian psychomotor physiotherapy (NPMP)—targeting postural dimensions and the breathing pattern, in combination with elements of cognitive behavioural therapy and modification of training intensity, can help reduce laryngeal tightness in athletes presenting with EILO.…”

A multidimensional strategy to managing dysfunctional breathing and exercise-induced laryngeal obstruction in adolescent athletes

“…When the normal relaxed respiratory cycle is replaced with patterns of abnormal breathing, a number of patterns have been identified including hyperventilation syndrome, periodic deep sighing, forced abdominal expiration and a dominant thoracic breathing [ 21 ]. Thoracic breathing has lately been recognized in many adolescent athletes diagnosed with EILO [ 15 , 22 ].…”