Physiotherapy Rehabilitation for Phrenic Neuropathy at Breathing Works

Phrenic neuropathy is a condition characterized by damage or dysfunction of the phrenic nerve, which activates the diaphragm - the primary muscle of respiration. Other associated conditions and terms are Diaphragm Eventration, Diaphragm Hernias, Diaphragm Paralysis, or Stroke related Diaphragm Dysfunction.  At Breathing Works we are leaders in the physiotherapy rehabilitation of these conditions.

Impairments to the nerve and muscle result in diaphragmatic weakness, or diaphragm paralysis, which can lead to lead to difficulty breathing, reduced lung volumes, difficulty sleeping  and shortness of breath on exercise and at rest.

Physiotherapy Rehabilitation plays a crucial role in optimizing lung function, minimizing other complications, and improving quality of life. Physiotherapists provide targeted interventions to support breathing muscle strength and mechanics, enhance overall cardiovascular conditioning, and can help facilitate compensatory strategies.  Furthermore in some cases recovery of the nerve function can be achieved, especially when the original nerve injury was not complete.

Assessment and Baseline Evaluation
Rehabilitation begins with a thorough assessment. Our Breathing Works  physiotherapists evaluate respiratory function, including chest expansion, diaphragmatic excursion, breathing pattern, and technical results such as spirometry, CT and MRI results.

Our physiotherapists will then undertake to measure the function of the diaphragm with  ultrasound including diaphragm thickness and excursion on the Left and Right sides.  Our physios are experts in this measurement. Our physios will also measure Maximal Inspiratory Pressure which is often reduced in phrenic neuropathy or diaphragm dysfunction conditions.

Postural analysis and musculoskeletal assessment are also essential since chest wall mobility, spinal alignment, and accessory muscle activity significantly influence breathing efficiency in patients with diaphragmatic weakness.

Breathing Retraining
A cornerstone of physiotherapy management is retraining breathing patterns. Diaphragmatic breathing techniques are introduced to encourage the patient to recruit any remaining diaphragmatic activity while reducing excessive reliance on accessory muscles. Patients are taught to focus on abdominal expansion during inspiration as able, but for some patients this can be a significant challenge and other breathing patterns can be encouraged. Over-time, these exercises are progressed into upright postures and incorporated into functional tasks.

Inspiratory Muscle Training
Our Physiotherapists are experts in Inspiratory muscle training (IMT) and use these devices every day with our patients.  IMT works to strengthen the diaphragm and accessory respiratory muscles, and can “wake up“ the diaphragm in some cases, and in other cases it can aid the other accessory muscles and other half of the diaphragm to help compensate in a functional way.  Our IMT devices that provide resistance or adjustable inspiratory loads can be used to progressively overload the inspiratory muscles, thereby improving endurance and reducing shortness of breath.

 Expiratory muscle training may also be beneficial, especially for patients with weak cough, to aid in airway clearance. Regular practice, typically twice daily, has shown positive outcomes in improving inspiratory pressures and functional capacity.

Airway Clearance and Secretion Management
Some patients with phrenic neuropathy are at risk of impaired secretion clearance due to ineffective coughing. Physiotherapists may teach huffing, assisted coughing techniques, or recommend mechanical insufflation-exsufflation devices in severe cases. Chest physiotherapy, including percussion and vibrations, may also be incorporated when indicated.

Exercise training and Postural Training
Aerobic conditioning, such as low-intensity cycling or walking, is carefully introduced to prevent deconditioning, while strengthening exercises maintain musculoskeletal support for breathing.  Optimizing posture can significantly ease breathing. Physiotherapists also guide patients through energy conservation techniques during daily activities, pacing strategies, and graded functional exercises to improve endurance. Strength training can be appropriate in many patients.

Get in touch

Get in touch with our expert team today to help you make a recovery and stay strong with our Phrenic Neuropathy rehabilitation program today.