Low back pain and gastroesophageal reflux in patients with COPD: the disease in the breath

Abstract

COPD is a worsening condition that leads to a pathologic degeneration of the respiratory system. It represents one of the most important causes of mortality and morbidity in the world, and it is characterized by the presence of associated comorbidity. This article analyzes gastroesophageal reflux disease (GERD) and low back pain (LBP) in patients with COPD and tries to produce anatomo-clinical considerations on the reasons of the presence of these comorbidities. The considerations of the authors are based on the anatomic functions and characteristics of the respiratory diaphragm that are not always considered, from which elements useful to comprehend the symptomatic status of the patient can be deduced, finally improving the therapeutic approach. The information contained in the article can be of help to the clinician and for physiotherapy, and to all health professionals who gravitate around the patient’s care, improving the approach to the diaphragm muscle.

Ageing of the Diaphragm Muscle

“…The vagus nerve innervates the portion of the esophageal breath, while the intercostal nerves innervate the paracostal and intercostal muscles, which allows better movement of the coasts during the act of breathing [26,27]. The adaptations that the vagus nerve undergoes in the presence of ageing are likely to be related to the thicker (somatomotor) vagal fibers, which thin out [28].…”

The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 2

“…In fact, a chronic physical disorder also leads to dysfunctions in the psychological sphere [41]. There are many chronic pathologies where a disturbance of one of the diaphragms leads to multiple comorbidities, and hence the clinical motivation in manually treating the diaphragm(s) with an osteopathic approach [1-2,7-8, [41][42][43]. We also remember the nervous system, which not only communicates with the whole body but passes through the myofascial system.…”

Lymphatic Pump Manipulation in Patients with Chronic Obstructive Pulmonary Disease

“…Patients with COPD suffer from a range of different comorbidities, including osteoporosis, arthritis, and chronic pain. The cost-sternal and cost-vertebral joints are more rigid and calcified in patients with COPD than people without the disease [4,45]. Due to their respiratory condition, these patients have difficulty remaining on their backs for 20-30 minutes at a time and are often associated with heart failure and dyspnea [46].…”

“…Collectively, these postural and structural changes negatively influence the force expressed by the musculoskeletal system, thus causing a reduced inspiratory pressure [2]. COPD can also cause a range of additional problems, such as cardiac disorders, mood disorders, renal and metabolic diseases, gastroesophageal reflux disease, and intestinal and urogenital disorders [3][4][5]. According to the Global Burden of Disease (GBD) in 2010, chronic respiratory disease was the third leading cause of mortality in the world; in 1990, it was the fourth leading cause of death in the world [6].…”