Dr. Jennifer Hobson on the relationship between Posture and Airway.

1. “Relationship between Restricted
Breathing Mechanics on Airway and
Posture”
Dr. Jennifer Flage Hobson,
PT, DPT, MTC, CMTPT
jhobson@ptrenaissance.com
ptrenaissance.com
25 E Washington, Suite 1319 Chicago, IL 60602

2. Airway
Neck
Posture

3. Evaluate Posture in standing and sitting
Beighton scale systemic hypermobility
Evaluate mouth opening mechanics for disc displacement and
muscular control
Assess ROM; rotation to translation ratio, (should be 4:1:1 and
50/50).
Centric Relation Provocation Test
Palpation test: Using the Rocabado 8 point pain provocation map.
Perform intra-oral joint/muscle and facial assessment.
Hyoid Mobility test.
Cervical spine ROM, joint testing, strength and stability
Myofunctional Assessment (tongue tie, mallampati, swallow, chew)
Breathing assessment; capnometer: CO2 levels, breath rate
Review of C. S. X-rays: Lateral Ceph, flexion/extension, Open
mouth
Evaluation of the CS/TMJ and breathing
dysfunction

4. Centric Relation Provocation Test
Palpation test: Using the Rocabado 8 point
pain provocation map
Evaluate the TMJ for dysfunction.

5. Beighton Scale of Systemic Hypermobility
9 out of 9 points

7. Normal Atlas-Axis position

8. Right rotation of Atlas, R inclined
occlusal plane.

9. Left Rotation of Atlas on Axis, Left
inclined occlusal plane

11. Observe the spine of this patient.
Straight neck causing neck pain, headaches, and
bruxism
L. Motta, M. Matins, teal Craniocervical posture and bruxism in children, Physiotherapy Research International,
Vol 16 Issue 1 pg. 57-61, March 2011
C. Restrepo, Y. Quintero, etal. Effect of Physiotherapy on Bruxism and Head Posture TMD/orofacial pain
epidemiology and treatment Instituto de Ciencias de la Salud, Medellín, Colombia
Y. Quintero, C. Restrepo, etal. Effects of awareness through movement of the head posture of bruxist
children. CES-LPH Research Group, CES University, Medellín, Colombia.

13. Interactions Between Head and Mandibular Position
Correlations between Posture and Jaw Relations, Danner, Jakstat and Ahlers, Journal of
Craniomandibular Function, 2009;1(2):149-163
Forward Head Posture to Military
Cervical Flexion to Cervical
Extension
Mandibular Retrusion to Protrusion
Teeth contact more post to ant
Mandibular Retrusion to Protrusion
Teeth contact more ant to post

15. Weakness of the anterior neck flexors
Chin tucks, Chin tuck and lift exercise.
Jull, G, Kristjansson, E & Dall'alba, P 2004. Impairment in the
cervical flexors: a comparison of whiplash and insidious onset neck
pain patients. Man Ther, 9, 89-94.

17. Superior and inferior airway

18. Effects of neck flexion and extension on airway.
Cervical flexion decreases airway
Cervical extension increases airway

19. Capnometer: ETCO2 40-45mmHG, Breath rate: 8-10
at rest

20. Dysfunctional shallow chest breathing found in 90% of my
head and neck patients, including myself!
(CO2: 26mmHG, Breath rate 22bpm)

21. Dr. Kevin Boyd, Pediatric cases effects
of posture and airway.

22. Is it a coincidence that the majority of my head
and neck patients have dysfunctional breathing?
!
• In my practice, all of my patients are getting
tested and treated for breathing dysfunction.
• They are now also getting Myofunctional
therapy along with the manual therapy/dry
needling/postural strengthening to restore
proper joint mechanics of the upper quarter/
spine balanced stance.
• Buteyko breathing method. (Proper breathing
mechanics, volume, breath rate)

23. Dr. John Mew

24. Crooked or Straight Front Teeth
Crowding caused by incorrect tongue position
and function

25. Crooked or Straight Front Teeth
Correct tongue position and function gives
correct arch form

26. Permission by Dr. Boyd

27. Patient I.H 4.yo
• Nursed for 6 months, milk supply faded.
Mom return to work.
• Swollen adenoids and tonsils.
• Snoring at night.
• Mouth breathing during the day and night.
• Forward head posture.
• Hyperactivity.
• Nail biter.

28. Physical Therapy Examination
• Mallampati score: Between 3-4,
• Hyoid bone moderate restriction of mobility
• Tongue evaluation: short anterior frenulum;
mouth breather; high narrow palate.
• Scapular weakness.
• Sub-cranial stiffness, posterior rotation of the
cranium. Increased tone posterior cervical
muscles. Forward head posture.
• Decreased diaphragmatic breathing

29. Female 4 year old patient, ponticulus posticus grade 2; Small bridge of
bone resulting from complete ossification of the Atlanto-Occipital
membrane reaching the posterior notch of C1.

30. Enlarged Adenoids & Tonsils
Limited airway

31. I. H. Front view pics
Note facial asymmetry

32. Retro-inclined Profile

33. Weakness of the scapular stabilizers and
upper quarter; winging noted.

34. Mandible to the Left

35. Frontal view occlusion mandibular midline 2
mm to left

36. Tongue thrust swallow, poor position of
tongue
• Tongue thrust swallow

37. I.H. frenulum anterior and lateral view
Suction upward of the tongue Cave exercise

38. Jenny’s anterior and lateral view of
lingual frenulum

39. Swollen tonsils and adenoids
Pediatric ENT recommend
Tonsilloadenoidectomy

40. Importance of proper nutrition
• Met with Dr. Lois Laynee, Developmental
airway specialist. Recommended the
following…
• Eliminate gluten and dairy (well known
foods to cause inflammation to the body)
• Eliminate process foods. Anything
packaged.
• Reduce sugar intake.

41. Biobloc palatal expander, Dr.Mew/Dr. K.
Boyd, began Sept.2013

42. Intraoral swelling reduced to normal
12/2013 to present 6/2014
• No need for a adenoidectomy or tonsillectomy
• No longer hyperactive.
• No longer had dark circles under her eyes.
• She is still in Myofunctional/speech therapy.
• We 3M Micropore tape on lips every night.
• She is in swimming for scapular strengthening.
• Still in phase 1 of the Biobloc expander with Dr. Kevin
Boyd.
• Capnometer: CO2: 40mmHG, Breath rate 14bpm.
• In each of my Children’s Buteyko clinics I offer.
• Scheduled to have anterior tongue tie frenectomy with
Dr. Larry Kotlow 7/22/14

43. C.H. 3-year old boy
• Delivered 5 weeks early VBAC
• Difficulty with milk supply from mom. Nursed yet
had to supplement after 2 months.
• Weaker immune system, longer to recover from
illness’.
• Hospitalized for pneumonia at Children’s Hospital
at age 1; 2nd 3day hospitalization Corona virus
effecting breathing (CO2 levels in hospital
18mmHG).
• Swollen adenoids and tonsils, recommended SX
• Speech delay, speech therapy 1 year.

44. Examination: C. H.
• Mallampati score: Between 3-4.
• Hyoid bone moderate restriction of mobility.
• Tongue evaluation: short posterior frenulum;
mouth breather; high narrow palate.
• Firm, tight floor of mouth under mandibular
symphysis.
• Decreased diaphragmatic breathing, over-
breathing.
• Mouth breathing.

45. C.H. Frontal View Pics
No smile smile

46. C.H. profile

47. C.H.posterior
tongue tie
4 opinions
First 3 said no to tongue
tie
Last opinion, Dr. Larry
Kotlow
Performed Posterior
tongue tie frenectomy on
1/29/14
Albany, NY.

48. C.H. Post frenectomy tongue flexibility

49. CH Intraoral swelling reduced to normal
2/2014 to present 6/2014
• No need for a adenoidectomy or tonsillectomy
• No longer hyperactive.
• She is still in Myofunctional/speech therapy/PT
manual therapy.
• We 3M Micropore tape on lips every night.
• He is in swimming for scapular strengthening.
• Planning to start Biobloc expander with Dr. Kevin
Boyd at age 4 (Oct 2014).
• Capnometer: CO2: 30mmHG, Breath rate 27bpm.
Still needs more work. Can’t do Children’s Buteyko
breathing clinics due to attention span yet.
• Lingual posterior tongue tie revision Frenectomy
scheduled 7/22/14 with Dr. Larry Kotlow

50. Why is OMT Important?
• Lack of a Lip Seal may lead to Occlusal
dysfunction (Harari, et al,2010)
• Low, forward tongue rest may be linked to
psychological, cosmetic, structural issues,
(Peltomaki, 2007)
• Failure to masticate food properly (Straub,
1962)
• Incorrect swallowing may be linked to GERD,
(Phua, et al., 2005)
• OSA: Mouth Exercises May Reduce AHI numbers
by 39% (Guimaraes, 2010)

52. Mallampati scores 1-4

53. Throat musculature
1. Tensor veli palatini
2. Levator veli palatini
3. Salpingopharyngeus
4. Musculus uvulae
5. Aponeurosis of tensor
veli palatini
6. Pterygoid hamulus
7. Palatopharyngeus
8. Palatoglossus
9. Tonsil
10.Tongue

54. References
• Danner H., Jakstat H., Ahlers M. Correlations between posture and jaw
relations Zeitschrift fu kraniomandibulare Funktion 2009; 1(2):149-163.
• Cesar G. Tosato J, et al. Correlation between Occlusion and Cervical Posture in
Patients with Bruxism. Parkell Online Learning Center.
• Ciancaglini R, Testa M, Radaelli G. Association of Neck Pain with symptoms of
Temporomandibular Dysfunction in the general adult population. Sand J Rehab
Med 31, pg. 17-22, 1999
• Visscher C. , Lobbezoo R, et al. Clinical test in distinguishing between persons
with or without craniomandibular or cervical spinal pain complaints. Eur J Oral
Sciences
• McNeely M, Olivo A., Magee D. A systematic Review of the Effectiveness of
Physical Therapy Interventions for Temporomandibular Disorders. Physical
Therapy J o APTA 2006; 86:710-725
• Armijo-Olivo A., Jara X. et al. A Comparison of the head and cervical posture
between the self-balanced position and the Frankfurt Method.
• Carra M., Huynh N. , Lavigne G. Sleep bruxism and sleep-disordered breathing
in pediatrics: an overview for clinicians. Zeitschrift fur Kraniomandibulare
Funktion 2011; 3(3):205-220

55. References
• Olivo, S.A., Bravo, J et al. The Association Between Head and Cervical Posture and
Temporomandibular Disorders: A Systematic Review. J Orofac Pain Vol 20, Number 1, pg
9-23, 2006
• Olivo, S. A., Mages, D. et al. The Association Between the Cervical Spine, the
Stomatognathic System, and Craniofacial Pain: A Critical Review. J Orofac Pain Vol 20,
Number 4, 2006 Pg. 271-287
• Lee, W. Y., Okeson, J. et al. The Relationship Between Forward Head Posture and
Temporomandibular Disorders. J Orofac Pain Vol Number 2, 1995 Pg. 161-167
• Moniaco, A., Cozzolino. V. et al. Osteopathic manipulative treatment (OMT) effects on
mandibular kinetics: kinesiographic study. Euro J or Paediatric Dentistry 1/2008, pt. 37-42.
• Olmos. S, Kritz-Silverstein. D, et al. Effect of Condyle Fossa Relationships on Head
posture. J of Craniomandibular practice Jan 2005 Vol 23., No. 1 pg. 48-52
• Pradham. N, White, G. et al. Mandibular deviations in TMD and non-TMD groups related to
eye dominance and head posture. J of Clinical Pediatric Dentistry Vol 25, Number 2/200
pg. 147-154
• Wright. E, North. S. Management and Treatment of Temporomandibular Disorders: A
Clinical Perspective. J of Manual & Manip Therapy Vol 17 Number 4pg 247-254.

56. References continued
• L. Motta, M. Matins, teal Craniocervical posture and bruxism
in children, Physiotherapy Research International, Vol 16
Issue 1 pg. 57-61, March 2011
• C. Restrepo, Y. Quintero, etal. Effect of Physiotherapy on
Bruxism and Head Posture TMD/orofacial pain epidemiology
and treatment Instituto de Ciencias de la Salud, Medellín,
Colombia
• Y. Quintero, C. Restrepo, etal. Effects of awareness through
movement of the head posture of bruxism children. CES-LPH
Research Group, CES University, Medellín, Colombia.
• Jull, G, Kristjansson, E & Dall'alba, P 2004. Impairment in the
cervical flexors: a comparison of whiplash and insidious onset
neck pain patients. Man Ther, 9, 89-94.

57. !
• Dr. Mariano Rocabado, PT, DPT, CFC, MTC
• Michael Karegeannes, PT, MHSc, LAT, MTC,
CFC, CCTT, CMTPT
• Dr. Larry Kotlow
• Dr. Kevin Boyd
• Joy Moeller, RDH,
• Patrick McKeown, Buteyko Mentor
Special Thanks