The respiratory muscles The respiratory muscles consist of two main groups: the primaries

(consisting mostly of the diaphragm and intercostals) and the accessories (comprising mostly of
the scaleni, abdominals and sternocleidomastoids). It is also important to remember the effects
upon the oxygenation status and the balance of the blood pH with increasing metabolic
demands should the recruitment of other additional muscles, for example the facial muscles with
pursedlip breathing, and the shoulder girdle and arm fixators, be required during times of
respiratory distress/dysfunction. The primaries’ main role is that of ventilation. The accessories
have other functions, but are recruited to facilitate ventilation when required. Normally, the
respiratory muscles have both ventilatory and non-ventilatory motor functions, for example the
diaphragm acts as the primary respiratory muscle, responsible for generating approximately 60–
70% of the tidal volume while also being responsible for raising intra-abdominal pressure for
postural stabilisation of the torso, parturition and micturition. Such considerations must be
appreciated by the therapist: when the respiratory muscles are required for both motor and
ventilatory functions, their ability to assist ventilation is reduced. This is of particular importance
when ventilatory support has recently been reduced and motor activity is being encouraged
during daytime hours, i.e. during the weaning and rehabilitative phases of recovery. Upper limb
strengthening exercises may be a primary aim at this stage so increasing ventilatory support
overnight may be appropriate (Table 7.1). 130 Tidy’s physiotherapy Table 7.1 Comparison of
skeletal muscle fibre types Characteristics Type I Type IIa Type IIb Contractile Contraction
velocity Slow Fast Fast Myosin adenosine triphosphatase Slow Fast Fast Twitch duration Long
Short Short Calcium ion sequestration Slow Rapid Rapid Metabolic Capillaries Abundant
Intermediate Sparse Glycolitic capacity Low Intermediate High Oxidative capacity High High
Low Glycogen content Low Intermediate High Myoglobin content High Intermediate Low Fibre
diameter Small Intermediate Large Motor unit size Small Intermediate Large Recruitment order
Early Intermediate Late (Reproduced from Schauf et al. (1990), with permission.) The
respiratory muscles share the common features of other skeletal muscles and consist of a
mixture of fibre types (Johnson et al. 1973). The proportions of fibre types and the metabolic
constituents (e.g. capillaries; glycolytic and oxidative capacities; and time of recruitment in
contraction) determine a muscle’s strength and endurance properties (Schauf et al. 1990). Type
I fibres are important for endurance (slow twitch, high oxidative capacity are recruited first and
are most resistant to fatigue). Type IIa fibres have a higher oxidative capacity, fast twitch and
produce an intermediate level of force, and so are relatively resistant to fatigue, while Type IIb
fibres have a low oxidative capacity, fast twitch, produce the greatest force on activation, are the
last to be recruited for motor efforts and are easily fatigued when used repeatedly. Greater
knowledge of muscle physiology is required if the aim is to train the respiratory muscles, rather
than rest them (via ventilatory support). Muscle training may be an appropriate physiotherapy
intervention to facilitate the weaning episode of the prolonged ventilatory supported individual,
where muscle wasting and disuse atrophy are evident, though more research is required in this
area.