The Role of Manual Therapy in Patients with COPD

Abstract

Chronic obstructive pulmonary disease (COPD) is a respiratory condition associated with altered chest wall mechanics and musculoskeletal changes. In this narrative review, we describe the underlying musculoskeletal abnormalities in COPD, the reasons for applying manual therapy techniques, their method of application and clinical effects. A variety of manual therapy techniques have been applied in individuals with COPD, including soft tissue therapy, spinal and joint manipulation and mobilisation, and diaphragmatic release techniques. These have been prescribed in isolation and in conjunction with other treatments, including exercise therapy. When applied in isolation, transient benefits in respiratory rate, heart rate and symptoms have been reported. Combined with exercise therapy, including within pulmonary rehabilitation, benefits and their corresponding clinical relevance have been mixed, the extent to which may be dependent on the type of technique applied. The current practical considerations of applying these techniques, including intense therapist–patient contact and the unclear effects in the long term, may limit the broad use of manual therapy in the COPD population. Further high quality research, with adequate sample sizes, that identifies the characteristic features of those with COPD who will most benefit, the optimal choice of treatment approach and the longevity of effects of manual therapy is required.

Comparative Effectiveness of Western and Eastern Manual Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis

“…COPD is a pathological condition associated with altered chest wall mechanics and musculoskeletal changes, and various manual therapies have been used as adjuvant therapy in combination with conventional medicine [ 5 ]. Although manual therapy is frequently used in clinical practice, some systematic reviews have pointed out that there is not enough evidence to support its therapeutic effect [ 6 , 7 ].…”

“…Various manual therapies take a common approach when the practitioner’s body comes in contact with the patient’s body; therefore, they will have a common expected effect along with the unique effect of each therapy, which leads to unique results for multiple outcomes of COPD. For example, advocators of Western manual therapy may explain that by improving musculoskeletal changes of altered chest wall mechanics, manual therapy can affect chest wall compliance of patients with COPD [ 5 ]. On the other hand, Eastern manual therapies are regarded as manual therapy combined with the traditional concept of meridian massage, and in this medical system, there is a view that both function and structure are systematically correlated [ 10 ].…”

Efeitos da abordagem osteopática na doença pulmonar obstrutiva crônica

“…A respeito da DPOC, esta consiste numa obstrução persistente do fluxo aéreo determinada por uma resposta inflamatória das vias aéreas e pulmões a agentes ou gases nocivos 4 . Sua progressão leva a uma significativa incapacidade, perda da 1 produtividade e piora na qualidade de vida dos pacientes 5 . Apesar de seu caráter crônico, apresenta também episódios de agudização definidos com piora clínica de rápida instalação dos sintomas de dispneia e fadiga 6 .…”

Relationship between Thoracic Kyphosis and Selected Cardiopulmonary Parameters and Respiratory Symptoms of Patients with Chronic Obstructive Pulmonary Disease and Asthma

“…[5][6][7][8][9][10][11] The increase in airway resistance and airflow limitation in these patients cause pulmonary hyperinflation, encouraging greater recruitment of the accessory muscles of respiration necessary to cope with the increased work of breathing. 12 The hyperinflation forces the diaphragm to operate at non-optimal lengths while the increased load on the accessory respiratory muscles imposes limitations in upper limbbased functional tasks. [13][14][15] The limitations in the upper limb use also contribute to increased respiratory muscle tightening, joint stiffness and increased work of breathing.…”

“…15 The shortened respiratory muscle length and muscle weakness experienced by these patients lead to reduced chest expansion and reduced chest movements during respiration. 12,16,17 There is reduction of thoracic mobility in all the three dimensions (anterior-posterior, superior-inferior and lateral dimensions) and this increases the effort of breathing resulting in stooping posture as a compensatory response in advanced stages of COPD. 17,18 The increases in chest wall rigidity and respiratory muscle tightness may be linked to the postural deviations seen in COPD.…”