Obstructive Lung Disease (OLD) is a category of lung conditions characterized by airway obstruction, such as asthma, bronchiectasis, bronchitis, and chronic obstructive pulmonary disease (COPD).

OLD often leads to dysfunction of the diaphragm, but it is uncertain whether manual therapy techniques that focus on the zone of apposition (ΖΟΑ) of the diaphragm are effective.

Previous systematic reviews have examined the effectiveness of manual therapy on broad areas of the thorax and cervical spine among individuals with COPD. These systematic reviews found that the available evidence is not sufficient to support the effectiveness of manual therapy for individuals with COPD.

Recently, Tsimouris et al. conducted a systematic review of the literature to assess the impact of manual therapy on several factors in individuals with OLD, including lung function, diaphragm excursion, chest expansion, exercise capacity, maximal inspiratory pressure (PImax), and dyspnea.

The researchers systematically searched key databases, and two reviewers independently screened the papers to determine their eligibility. The methodological quality of the included studies was evaluated using the PEDro scale, while the quality of evidence was assessed using the GRADE approach. After conducting an initial search of databases, a total of 2,844 potential studies were identified. From these, 1,564 titles were screened, with 1,528 being excluded. Finally, 19 full-text articles of the studies were assessed for eligibility, from which, two studies were included for final analysis.

In one study, diaphragmatic stretching and the manual diaphragm release technique were found to enhance diaphragm excursion and chest expansion significantly (p<0.001, p<0.05, respectively); in the other study, the manual diaphragm release technique was shown to significantly improve diaphragm excursion and exercise capacity (p<0.05, p<0.05, respectively).

The findings of this systematic review suggest that manual therapy focusing on the ZOA of the diaphragm may be a viable intervention for enhancing diaphragm excursion, chest expansion, and exercise capacity among individuals with COPD. However, there is a lack of evidence supporting the effectiveness of manual therapy on the diaphragm as a treatment for individuals with asthma.

These results show initial evidence regarding the effectiveness of manual therapy in targeting the ZOA of the diaphragm among individuals with COPD. Further studies are necessary to determine the effectiveness of manual therapy in individuals with other types of OLD.

Reference:

Tsimouris, D., Arvanitidis, M., Moutzouri, M., Koumantakis, G. A., Gioftsos, G., Papandreou, M., & Grammatopoulou, E. (2023). Is manual therapy of the diaphragm effective for people with Obstructive Lung Diseases? A Systematic Review. Respiratory Medicine and Research, 101002.