MND Australia

Physiotherapists: a vital part of an MND multidisciplinary care team

Motor Neurone Disease (MND) causes progressive muscle weakness. Since almost all of our body’s functions require muscle activity to enable us to live, move and go about our everyday tasks, the impact of MND is wide-ranging. Depending on the pattern of muscles affected, people with MND experience a range of symptoms1. A multidisciplinary care team will assist you in managing MND symptoms. This integrated, team based care approach improves outcomes for people with MND2.

One of the key members of your multidisciplinary team is a physiotherapist. 

While most people might think of muscles, joints and movement when we think about physiotherapists, they are also key people involved in respiratory care. 

Fundamental to all movement is being able to breathe, which involves the breathing muscles and joints of the ribcage. Much like sports physios focus on the movements involved in sports participation, respiratory physios focus on the movements in breathing and coughing for daily health and activity.

About breathing

There are two main types of respiratory muscles involved in expanding and contracting your chest for breathing; the intercostal muscles, which run between and over the ribs and the diaphragm, which separates the rib cage from the abdomen.

When you breathe in, your diaphragm and intercostal muscles pull tight, air is drawn into your lungs and your ribcage expands. This air includes oxygen that your heart pumps around your body for survival. When you are in deep sleep, your diaphragm muscles keep doing their thing, whilst during wake time you can use additional muscles around your ribcage to take deeper breaths and support more strenuous activity.

When you breathe out your breathing muscles relax and your ribcage moves down (elastic recoil), pushing air out of your lungs. This air includes carbon dioxide that your body no longer needs. A cough is a very forceful breath out. When you cough you draw in a big breath, close your vocal muscles and upper throat, your abdominal muscles contract, you open your throat and air is forced out of your lungs.  Having an effective cough is important because it prevents food from entering your windpipe and helps you clear mucus and secretions.

Breathing with MND

Respiratory muscle weakness from MND results in less air being drawn into the lungs with each breath. This means less oxygen is absorbed into the blood. It is also more difficult to breathe out the carbon dioxide that is produced by the body.

One of the first signs of breathing weakness can be disrupted sleep. Since your diaphragm doesn’t have the extra help of other muscles when you are asleep, breathing weakness can contribute to problems with the balance of oxygen and carbon dioxide in your bloodstream3,4. Keeping the right balance of oxygen and carbon dioxide in the bloodstream is important as it plays an important role in how your body works. Mechanical support of breathing overnight, such as with a Bi-Level Positive Airway Pressure (BiPAP) device, initiated early, can significantly support longevity1,5,6. Your Respiratory doctor will prescribe this when needed, and sleep scientist, nurses and physio’s will help you to use it at home.

Early identification and management of breathing issues is important,  so your respiratory function should be regularly assessed and monitored1,3,4.

How physiotherapists help with breathing in MND

There are many ways in which your physiotherapist may be involved in helping you with your breathing. They can advise you about:

  • techniques to cough more effectively
  • exercises that can help with relaxation and deep, controlled breathing
  • ways to conserve your energy 
  • making your environment more breathing friendly
  • positioning yourself in a more breathing friendly way
  • finding ways to take big breaths, with manual or mechanical tools to practice what we call Lung Volume Recruitment (LVR)
  • machines that can help your breathing as you sleep and settle breathlessness, referred to as non-invasive ventilation (NIV) or Bi-Level Positive Airway Pressure (BiPAP)

Non-invasive ventilation and MND

Managing cough effectiveness

A cough has the important function of keeping your airways clear.

When your cough is weak you are at greater risk of a chest infections and may have difficulty getting rid of excess mucus and secretions.

Some techniques that may help you cough more effectively include:

  • breath stacking using manual or mechanical assistive devices
  • assisted coughing using manual techniques or a mechanical cough assistive device


The way you position your body while sitting or lying down can assist your breathing. Leaning forward through your arms or elbows against a counter or table, electric recliner chairs, adjustable beds, support pillows and wheelchair tilt enable you to experiment with finding comfortable breathing positions. Your physiotherapist can advise you about positioning and sourcing different equipment.

Breathing exercises

Breathing exercises may help your lungs to expand more fully, inhaling fresh air and exhaling ‘used’ air. One simple exercise is to take five to ten deep breaths, with short rests in between each breath, several times a day. Speak with your physiotherapist about the right breathing exercises for you.

Adjusting room airflow and temperature

Having an open window in the room and using a fan to circulate air can also assist your breathing7. Room temperature is important, as being too hot or too cold can make you feel uncomfortable. A humidifier may help increase the moisture in the room air and increase your comfort.

Staying away from coughs and colds

Avoid people with coughs and colds. Have an influenza vaccine before winter to reduce the risk of getting the flu. Your doctor or respiratory physician may also recommend a pneumonia, or other vaccines.

Saving your energy for what you really want to do

Fatigue can be a major problem for people with MND. This is often related to the way MND changes your breathing. There is no advantage in ‘pushing yourself’. Instead, learn to save your energy for activities that are most important for you. Your physiotherapist may offer advice, safe exercise and suggestions that help you to pace yourself and conserve energy for the things you really want to do and offer advice on equipment and labour-saving devices.

Relaxation techniques

Anxiety or worry about breathlessness can affect how well you breathe. Controlled breathing and other techniques can help you to relax and make breathing easier. Your physiotherapist can advise you about the right techniques for you.

Respiratory muscle training and devices

There are devices available to purchase which claim to increase the strength and stamina of the breathing muscles and delay respiratory muscle weakness. The research around these devices generally does not support their use or the claim that they provide any significant benefit8. If you are interested in finding out more, talk to your physiotherapist before spending a lot of money investing in a device that might not be appropriate or helpful for you. Often there are cheaper options available for you to trial first, if appropriate, to see if you would derive benefit from respiratory muscle training with an expensive device.

For more information on breathing and MND you can find our fact sheets in our Information Resources section.