Case 37: Long-Standing Breathing Restriction and Rib Movement

Presentation

A female client in her forties came to see me with non-specific lower back discomfort. During history-taking, her speech pattern and pacing suggested a possible breathing restriction. On further discussion, she told me she’d found smooth, unrestricted breathing difficult for over three decades, beginning in childhood. She said this had never been formally identified, and that it had limited her ability to take part in higher-intensity physical activity, so she relied mostly on low-demand or static exercise.

AI-generated illustration of a clinician observing a client's rib cage movement during breathing in a standing assessment
AI-generated illustration. Not the client in this case.

Assessment

My movement assessment observed a localised restriction in rib movement, possibly related to a previous injury. In upright activity, this appeared to limit how her thoracic spine and rib cage moved during breathing. She felt it had shaped how much physical activity she could tolerate for many years.

Approach

Sessions focused on rib mobility, thoracic movement and breathing mechanics.

What the client reported

Over the following months, she reported that breathing felt more comfortable, and she later returned to running and higher-intensity exercise.

Reflection

This case is a reminder that a long-standing, never-identified movement restriction can shape the way a person chooses to move and exercise. Thorough history-taking and a movement assessment that includes breathing mechanics can help bring these factors to light. Ongoing difficulty with breathing should always be assessed by a GP first, so other causes can be ruled out.

Clinical reflection disclaimer: This case documents a clinical observation from my practice as an exercise scientist and remedial massage therapist. It is intended for professional education and reflection only. Individual results vary significantly and cannot be predicted. Outcomes may reflect natural recovery, multidisciplinary care or other factors beyond the care provided. This is not medical advice, diagnosis or treatment recommendation, and complex presentations require medical assessment and clearance. All cases are de-identified and shared with client consent. I do not diagnose, treat or cure medical conditions. For medical concerns, please consult a qualified healthcare practitioner.
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