Aplicabilidade clínica das técnicas de liberação manual diafragmática: uma revisão sistemática

Autores

DOI:

https://doi.org/10.36453/2318-5104.2020.v18.n3.p111

Palavras-chave:

diafragma, manipulações musculoesqueléticas, liberação diafragmática.

Resumo


INTRODUÇÃO: O diafragma é o principal músculo respiratório e desempenha um papel importante na respiração e na regulação fisiológica. Uma terapia que visa melhorar essas condições referentes ao diafragma, é a técnica de liberação manual diafragmática. OBJETIVO: O objetivo deste estudo foi verificar a aplicabilidade clínica das técnicas manuais de liberação diafragmática e identificar as principais técnicas, populações investigadas, variáveis avaliadas e seus desfechos. MÉTODOS: Foram pesquisadas as seguintes bases de dados: PubMed, Scielo e Science Direct, com os descritores “Diaphragm [Mesh]” e “Musculoskeletal Manipulations [Mesh]” com seus correspondentes no mesmo idioma. Foram incluídos ensaios clínicos randomizados, não randomizados, estudos semi, quase-experimentais e estudos pilotos ou de caso, que abordaram técnicas de liberação manuais diafragmáticas.RESULTADOS: Há variadas técnicas de liberação diafragmática, sendo as mais mencionadas: normalização dos pilares do diafragma, alongamento e estiramento do diafragma, relaxamento dos pilares do diafragma. Além disso, as técnicas de liberação diafragmática vêm sendo associadas a protocolos de terapia manipulativa osteopática (TMO). As principais populações estudadas foram de pacientes saudáveis, com lombalgia, cervicalgia, osteoartrite, asmáticos, doença pulmonar obstrutiva crônica, constipados, cardiopatas e com refluxo gastroesofágico. Os principais desfechos avaliados são variáveis musculoesqueléticas (dor, flexibilidade, amplitude, espessura diafragmática), variáveis cardiorrespiratórias (pressão inspiratória/expiratória máxima (PImax e Pemax), mobilidade torácica, frequência cardíaca e respiratória), qualidade de vida e disfunções gastrointestinais/gastroesofágicas. CONCLUSÃO: A aplicabilidade clínica das técnicas de liberação diagramática está sendo investigada associado com outras técnicas osteopáticas, em protocolos de TMO em pacientes saudáveis, pneumopatas, cardiopatas, gestantes, em cicatriz pós-cirúrgica, constipados, com refluxo gastroesofágico, osteoartrite, cervicalgia e com lombalgia. Evidencia-se: diminuição ou eliminação das dores musculoesqueléticas, aumento da flexibilidade, ADM, Pimáx e Pemáx, aumento da mobilidade torácica, aumento da qualidade de vida, diminuição do inchaço e dor abdominal e sem efeito em cardiopatas.ABSTRACT. Clinical applicability of manual diaphragmatic release techniques: a systematic review.BACKGROUND: The diaphragm is the main respiratory muscle and plays an important role in breathing and physiological regulation. A therapy that aims to improve these conditions regarding the diaphragm, is the manual diaphragmatic release technique.OBJECTIVE: The aim of this study was to verify the clinical applicability of manual diaphragmatic release techniques and searching the main techniques, population, evaluated variables, and outcomes. METHODS: The following electronic databases were searched: PubMed, Scielo, and Science Direct, with the descriptors “Diaphragm [Mesh]” and “Musculoskeletal Manipulations [Mesh]” with their correspondents in the same language. There were included randomized clinical trial, non-randomized clinical trials, semi, and quasi-experimental studies, and pilot or case studies, which addressed manual diaphragmatic release techniques.RESULTS: There are various diaphragmatic release techniques, the most mentioned are: normalization of the diaphragm pillars, stretching of the diaphragm, relaxation of the diaphragm pillars, and protocols for osteopathic manipulative therapy (OMT) for the diaphragm. The main populations studied were healthy patients, with low back pain, asthmatics, chronic pulmonary obstructive disease, constipated, cardiac patients, and gastroesophageal reflux. The main outcomes assessed are musculoskeletal variables (pain, flexibility, range of motion, diaphragmatic thickness), cardiorespiratory variables (maximal inspiratory/expiratory pressure (MIP and MEP), chest mobility, heart, and respiratory rate), quality of life, and gastrointestinal/ gastroesophageal disorders.CONCLUSION: The clinical applicability of diagrammatic release techniques is being investigated in association with other osteopathic techniques, in protocols of OMT in healthy subjects, patients with lung diseases, heart disease, pregnant women, scar tissue, constipated, with gastroesophageal reflux, osteoarthritis, cervicalgia and with low back pain. There is evidence of reduction and elimination of musculoskeletal pain, increased MIP, increased chest mobility, an increase in health quality, a decrease of bloating and abdominal pain related to constipation, and a decrease of reflux symptoms.

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27-10-2020

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DANIELI, D. M.; GOMES, F. de A.; EIBEL, B.; DHEIN, W. Aplicabilidade clínica das técnicas de liberação manual diafragmática: uma revisão sistemática. Caderno de Educação Física e Esporte, Marechal Cândido Rondon, v. 18, n. 3, p. 111–116, 2020. DOI: 10.36453/2318-5104.2020.v18.n3.p111. Disponível em: https://e-revista.unioeste.br/index.php/cadernoedfisica/article/view/25407. Acesso em: 29 nov. 2021.