Athlete Breathing Problems
Vocal Fold Dysfunction - NOT Asthma!!!


Vocal fold dysfunction (VCD) is a breathing problem affecting patients when they breathe in (inspiration) which is intermittent and can cause variable upper airway obstruction.

It occurs when the vocal folds are abnormally adducted (pulled together). It can co-exist with asthma. It is frequently undiagnosed. Common symptoms include intermittent shortness of breath, wheezing, noisy breathing (stridor), or cough on exertion.Oftentimes, it is treated with asthmatic inhalers, which do not work, and sometimes can make the problem worse.

Causes of VCD are unknown. The larynx (voicebox) is highly innervated by sensory and motor (muscle) fibers. The original purpose of the larynx is protective, that is, to close when any abnormal stimulus (food, water, inhaled material) comes in contact with the laryngeal area so as to prevent aspiration pneumonia , and possibly death. In VCD the larynx is hyper-responsive resulting in hyperfunctioning, or closing of the cords. Irritants include gastro-esophageal reflux (GERD), some medications (ACE inhibitors – a type of blood pressure medication), chronic cough, laryngeal dryness, respiratory infections, and exercise with poor breathing technique. External irritants include inhaled medicines, fumes, allergens, or particulate matter in the air (ie.-aerosolized material from cutting the grass).

Diagnosis is by an Otolaryngologist with flexible or videostroboscopic examination after a good history of the problem.

Treatment is to lower irritation, by proper humidification, antacid medication, removal of topical meds, and limit exposure to particulates in air. Proper breathing control is also important, as discussed below.

Some athletes cannot perform and start to wheeze when they have to exert themselves such as in long hard runs, or sprinting. They mistakenly attempt to breathe in hard during inspiration, using neck muscles which stimulate the larynx to close, and the fast inhalation also pulls the vocal cords IN (Bernoulli phenomenon). The athlete becomes ‘winded’ and stops.

Proper breathing for athletes, as well as for VCD patients is to practice diaphragmatic or belly breathing. The neck muscles, jaw, and larynx should be relaxed, especially during inspiration. It is PASSIVE. Breathing out on expiration is ACTIVE, forcing your umbilicus (belly button) to move toward your spine, causing your diaphragm to raise up. The resultant passive inspiration the diaphragm pulls down and pulls air in with it

Stand in front of a mirror. Put your finger in your belly button. As you slowly blow out to a count of five- your belly button should move toward your spine or back. You can make a noise on expiration and count ‘puffs’ to five if you want. Allow the air to QUIETLY come in through open mouth as your diaphragm goes down, pulling air in. There should never be any tensing of muscles in your neck. RELAX!!!!!

Remember out to a count of 5, in to a count of 3 or 4. Do this 2-3 minutes , 3 x a day. After you have the technique down, go outside and walk while practicing your breathing. For ATHLETES- after mastering the walk, start using technique while running. For all patients, when difficulty breathing, use this technique of breathing. It takes TIME-and work to fix this problem.

Similar breathing techniques can be found online or youtube by searching Kundalini (or breath of fire- a yoga technique).

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