Cross Country Runner with Shortness of Breath: A Vocal Cord Dysfunction Case Study

I had the opportunity to work with a 15-year-old male cross country runner in the fall of 2019 who was experiencing pre-syncope toward the end of his races.

Pre-syncope is the medical term for being on the verge of fainting.

With less than a half mile to go, he described his vision becoming blurry and tunneled, difficulty breathing, and losing control of his body. He only experienced these symptoms during competition, when going at max effort.

After this happened in a few consecutive cross country meets, his parents had him evaluated by his pediatrician. Thankfully, his full workup for his heart, lungs, and brain came back negative. His pediatrician referred him to be assessed from a postural and breathing standpoint, to see if anything was physically limiting his performance and causing him to feel like he was going to faint.

What we found at his initial evaluation

The results indicated a common pattern known as the left AIC/right BC pattern (Postural Restoration Institute). The hallmarks of this postural asymmetry are difficulty expanding the right upper chest and left posterior chest, getting into left stance during walking or running gait, and being unable to touch one’s toes because of an inability to retract the ribcage well. This can happen because the chains of muscles that drive this pattern are chronically lengthened or shortened. Repetitive activity, such as running, can exacerbate this pattern, which can limit diaphragm and rib mobility and impair airflow, particularly the ability to exhale fully on the left.

Recommended exercise sequence

At his initial visit, he was given three exercises to help inhibit the muscles driving this pattern. The goal was to restore his left diaphragm’s ability to fully lengthen, restoring the length-tension relationship of his abdominals so he could perform a full exhale followed by a full inhale.

• Exercise 1: 90-90 hip lift with a balloon (Postural Restoration Institute©)
• Exercise 2: Sidelying Swiss ball with right apical expansion (Postural Restoration Institute©)
• Exercise 3: Stair, short seated balloon (Postural Restoration Institute©)

The patient was seen for three visits over five weeks. His exercises progressed each visit to get him comfortable in a left stance position, maintain a good relationship between his pelvis and ribcage, and then breathe well while alternating from his left leg to his right leg to mimic the demands of running.

The symptoms he experienced during cross country meets decreased with each subsequent visit, and at his last visit he was able to compete 100% symptom-free.

Since he was symptom-free and the season was over, he was discharged from physical therapy with a set of exercises to help him keep moving in an alternating, reciprocal fashion while breathing well, so he could continue to improve his running performance.