Exercise-induced laryngeal obstruction in athletes: Contributory factors and treatment implications

ABSTRACT

Otherwise healthy adolescent athletes presenting with respiratory symptoms consistent with exercise-induced laryngeal obstruction (EILO) are frequently encountered in clinical practice. The symptoms are often incorrectly considered to result from exercise-induced asthma, and may be wrongly treated as such. Given the potential implications for health and performance if EILO is left untreated, a more comprehensive understanding of contributory mechanisms is essential in order to create appropriate treatment procedures. Informed by knowledge from physical therapy, as well as the fields of voice rehabilitation and vocal pedagogy, this theoretical article presents a novel way of understanding and managing EILO by exploring bodily mechanisms and structures that may disturb laryngeal function during strenuous exercise. Firstly, the status quo of the EILO diagnosis, its aetiology and treatment options are reviewed. Secondly, considerations associated with laryngeal structures and mechanisms, and their potential influence on laryngeal movement and sensitivity are examined. Thirdly, the manner in which postural de-alignment and breathing pattern may interfere with laryngeal functioning will be discussed. Finally, interventions for voice disorders and singing and the relevance of these for EILO are evaluated. It is argued that clients with EILO should undergo a thorough physical examination to identify constrictions in the body as a whole – such as postural de-alignments and a dysfunctional breathing pattern – as these are hypothesized as playing a critical role in laryngeal tightness during exercise. Physical therapists possess particular skills and competence with regard to examining breathing patterns and postural de-alignments, and should be included in the treatment process of EILO.

KEYWORDS:

• Breathing pattern
• physical therapy
• posture
• whole body approach

Declaration of interest

The authors report no declaration of interests

Notes

¹ The physical therapy was conducted by the first author, a specialist in Norwegian psychomotor physiotherapy (NPMP). In NPMP, the body is considered a functional entity and respiration is assigned significant meaning; it not only mirrors emotional states in the person, but also has a key role in maintaining optimal posture and balanced tension in muscles of the whole body. Treatment aims to normalize posture and dysfunctional breathing patterns.

² These are the single thyroid, cricoid, and epiglottic cartilages, while the paired cartilages are the arytenoid, cuneiform, corniculate, and tritiate.

³ The cricothyroids, aryepiglotticus, thyroarytenoids, thyroepiglotticus, cricoarytenoids, and arytenoids.

⁴ A pilot study has recently been initiated, in which subjective clinical symptoms, measures of lung function, bronchial hyperresponsiveness (BHR), and parasympathetic activity and movements of the larynx during exercise will be investigated in clients newly diagnosed with EILO. The data will be gathered before and after 5 months of physical therapy addressing the whole body.