I just wanted to go over what should happen in normal tidal breathing and then how that can change under circumstances where someone's trying to carry a load or someone's trying to increase their oxygen flow in carbon dioxide flow out. Okay, so where do you want to start? So let's start with normal.

I have a question. It should be an easy one.

You always say that. You always say that. And then we talk for 10 minutes.

Well, it should be easy. I wanted to go over what should happen in normal tidal breathing and then how that can change under circumstances where someone's trying to carry a load or someone's trying to increase their oxygen flow and carbon dioxide flow out. So where do you want to start? Let's start with normal.

We want to go over the entire book of respiratory physiology.

Ideally. Right.

So when you say what's going on, give me a frame of reference so we can be targeted in our conversation.

Motions of the bones and muscle activity. I could start by describing these.

OK. You want to do that?

Yeah.

I'd be cool with that.

Sternum pump. Lungs full from the bottom up.

I like that. I like that a lot. OK. And then with the understanding that we're talking about upright standing or that type of behavior.

Or if someone's sidelined, the lowest portion is going to fill.

There you go. This whole gravity thing works.

Yeah. Yeah. Yeah. Yeah. Pump handle has to move this way.

You call that an up pump handle. For those of you born in the last 25 years, a pump handle is in reference to an old water pump. I suggest you watch the movie about Helen Keller. That's how she learned how to spell water with sign language. That was the first word she learned was water.

No.

What kind of an American are you?

Not a very good one, I guess.

Even though he was a communist. Anyway, go ahead.

Bucket handle ribs are moving outward and also upward ever so slightly.

By tradition, there's a division regarding the pump handle and bucket handle concept. Anything associated with the sternum would be associated with the bucket handle behavior, and anything lower than that would be the pump handle. That's the traditional view. I will respectfully disagree with tradition, as I usually do, and offer that bucket handle motion is probably taking place everywhere. It's just less pronounced because of the constraints of the upper part of the thorax. The ribs have a direct connection to the sternum, which creates a constraint that makes the bias a little bit stronger. So from a visual representation, you're going to see it more pronounced there. The way they are typically drawn reinforces this, but they don't give enough credit for diaphragmatic rib expansion, which is happening. Traditionalists say it depends, referring to the changing curvature of the thoracic spine through flexion and extension. However, the reality is that at the top of the thorax, segments would tip backward, while at the bottom, segments would tip forward. Traditional terms don't hold up. If you imagine a balloon inside the thorax blowing up, you can see this principle. We can use some traditional terminology to facilitate conversation, as the way the thorax fills up determines what type of relative motion will be demonstrated.

Because the ribs have a direct connection to the sternum. Yeah.

It just creates a constraint that sort of makes the bias a little bit stronger. So from a visual representation, you're going to see it a little bit more there. And then the way they, it's typically drawn. A certain way. And they certainly don't give enough credit for the diaphragmatic expansion. But it is happening. And what they'll say is, oh, it depends. They'll make reference to the changing curvature of the thoracic spine by traditional means, right? They'll use flexion extension as terms, but the reality is it's like if you look at the shape of the thorax, at the top, the segments would tip backwards, at the bottom, the segments would tip forward, the bottom, the segments would tip backwards. So which one is it? If you're defining it by traditional terms? You see why I hate traditional terms because they don't hold. But yeah, just if you took a balloon inside the thorax and blew it up, just look at it from that perspective. And then, like I said, we can use some of the traditional terminology to help us have a conversation, because the way the thorax fills up depends on or is a determining factor as to what type of a relative motion will be able to demonstrate.

They say thoracic flexion because the entire portion of the upper back is.

Yes, they'll imply like a bigger curve is going to be reflection, right?

Yeah.

But if you look at it from a segmental standpoint, if you take T2 and then look at T9, and take a breath, they're moving in different directions. One is tipping forward—T2 is tipping forward—while T9 is tipping backward to make a bigger curve. Can you picture that? So to blindly call it one thing doesn't seem fair to me.

Yeah, they're moving away from each other.