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

Dulce Marieli Danieli; Fabíola de Almeida Gomes; Bruna Eibel; William Dhein

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

Authors

Dulce Marieli Danieli Centro Universitário da Serra Gaúcha (FSG) https://orcid.org/0000-0002-5727-0242
Fabíola de Almeida Gomes Centro Universitário da Serra Gaúcha (FSG) https://orcid.org/0000-0001-8693-352X
Bruna Eibel Centro Universitário da Serra Gaúcha (FSG) https://orcid.org/0000-0002-2077-3751
William Dhein Centro Universitário da Serra Gaúcha (FSG) https://orcid.org/0000-0002-8476-7342

DOI:

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

Keywords:

Diaphragm, Manipulations Musculoskeletal, Diaphragmatic Release

Abstract

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.

Downloads

Download data is not yet available.

References

ÁLVAREZ, F. J. G.; VALENZA, M. C.; MARTOS, I. C.; SÁNCHEZ, I. T.; DEMET, G. V. Effects of a diaphragm stretching technique on pulmonary function in healthy participants: a randomized-controlled trial. International Journal of Osteopathic Medicine, London, v. 18, n. 1, p. 5-12, 2015.

ATS/ERS. American Thoracic Society/European Respiratory Society. Statement on Respiratory Muscle Testing. American Journal of Respiratory and Critical Care Medicine, New York, v. 166, n. 4, p. 518-624, 2002.

BARR, K. P.; GRIGGS, M.; CADBY, T. Lumbar stabilization: core concepts and current literature, Part 1. American Journal of Physical Medicine & Rehabilitation, San Juan, v. 84, n. 6, p. 473-80, 2005.

BELVAUX, A.; BOUCHOUCHA, M.; BENAMOUZIG, R. Osteopathic management of chronic constipation in women patients. Results of a pilot study. Clinics and Research in Hepatology and Gastroenterology, Paris, v. 41, n. 5, p. 602-11, 2017.

BLACK, L. F.; HYATT, R. E. Maximal respiratory pressures: normal values and relationship to age and sex. The American Review of Respiratory Disease, New York, v. 99, n. 5, p. 696-702, 1969.

BORDONI, B; MARELLI, F. Failed back surgery syndrome: review and new hypotheses. Journal of Pain Research, London, v. 9, p. 17, 2016.

BORDONI, B.; MARELLI, F.; BORDONI, G. A review of analgesic and emotive breathing: a multidisciplinary approach. Journal of Multidisciplinary Healthcare, London, v. 9, p. 97, 2016.

BORDONI, B.; ZANIER, E. Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary Healthcare, London, v. 6, p. 281, 2013.

DINIZ, L. R.; NESI, J.; CURI, A. C.; MARTINS, W. Qualitative evaluation of osteopathic manipulative therapy in a patient with gastroesophageal reflux disease: a brief report. The Journal of the American Osteopathic Association, Chicago, v. 114, n. 3, p. 180-188, 2014.

HEIDI, C.; ROBERTS, M. D. Imaging the diaphragm. Chest Surgery Clinics of North America, Amsterdan, v. 8, n. 2, p. 237, 2009.

HODGES, P. W. ERIKSSON, A. E. M.; SHIRLEY, D.; GANDEVIA, S. C. Intra-abdominal pressure increases stiffness of the lumbar spine. Journal of Biomechanics, Saint Louis, v. 38, n. 9, p. 1873-80, 2005.

JARDINE, W. M.; GILLIS, C.; RUTHERFORD, D. The effect of osteopathic manual therapy on the vascular supply to the lower extremity in individuals with knee osteoarthritis: A randomized trial. International Journal of Osteopathic Medicine, London, v. 15, n. 4, p. 125-33, 2012.

KELLY, R. C.; ARMSTRONG, M.; BENSKY, A.; FOTI, A.; WASSERMAN, J. B. Soft tissue mobilization techniques in treating chronic abdominal scar tissue: A quasi-experimental single subject design. Journal of Bodywork and Movement Therapies, London, v. 23, n. 4, p. 805-14, 2019.

KOLAR, P.; SULC, J.; KYNCL, M.; SANDA, J.; NEUWIRT, J.; BOKARIUS, A. V.; KOBESOVA, A. Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment. Journal of Applied Physiology, Rockville, v. 109, n. 4, p. 1064-71, 2010.

LEITH, D. E; BRADLEY, M. Ventilatory muscle strength and endurance training. Journal of Applied Physiology, Rockville, v. 41, n. 4, p. 508-16, 1976.

LICCIARDONE, J. C.; BUCHANAN, S.; HENSEL, K. L.; KING, H. H.; FULDA, K. G.; STOLL, S. T. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. American Journal of Obstetrics and Gynecology, New York, v. 202, n. 1, p. 43.e1-43.e8, 2010.

LIEBER, R. L.; WARD, S. R. Skeletal muscle design to meet functional demands. Philosophical Transactions of the Royal Society B: Biological Sciences, London, v. 366, n. 1570, p. 1466-76, 2011.

MACÍAS, E. L.; SÁNCHEZ, I. T.; MARTOS, I. C.; RUBIO, O.; LÓPEZ, L. L.; VALENZA,M. C. Effects of manual therapy on the diaphragm in asthmatic patients: a randomized pilot study. International Journal of Osteopathic Medicine, London, v. 29, p. 26-31, 2018.

MANCINI, D.; CESARI, M.; LUNGHI, C.; BENIGNI, A. M.; INCALZI, R. A.; SCARLATA, S. Ultrasound evaluation of diaphragmatic mobility and contractility after osteopathic manipulative techniques in healthy volunteers: a prospective, randomized, double-blinded clinical trial. Journal of Manipulative and Physiological Therapeutics, Arlington, v. 42, n. 1, p. 47-54, 2019.

MARIZEIRO, D. F.; FLORÊNCIO, A. C. L.; NUNES, A. C. L.; CAMPOS, N. G.; LIMA, P. O. P. Immediate effects of diaphragmatic myofascial release on the physical and functional outcomes in sedentary women: a randomized placebo-controlled trial. Journal of Bodywork and Movement Therapies, London, v. 22, n. 4, p. 924-9, 2018.

McCOSS, C. A.; JOHNSTON, R.; EDWARDS, D. J.; MILLWARD, C. Preliminary evidence of Regional Interdependent Inhibition, using a ‘Diaphragm Release’to specifically induce an immediate hypoalgesic effect in the cervical spine. Journal of Bodywork and Movement Therapies, London, v. 21, n. 2, p. 362-74, 2017.

MOHER, D.; LIBERATI, A.; TETZLAFF, J.; ALTMAN, D. G. The PRISMA Group – Preferred Reporting items for systematic reviews and meta-analyses: The PRISMA statement. PloS Med, Berkeley, v. 6, n. 7, p. e100097, 2009.

NAIR, A.; ALAPARTHI, G. K.; KRISHNAN, S.; RAI, S.; ANAND, R.; ACHARYA, V.; ACHARYA, P. Comparison of diaphragmatic stretch technique and manual diaphragm release technique on diaphragmatic excursion in chronic obstructive pulmonary disease: a randomized crossover trial. Pulmonary Medicine, London, v. 2019, p. 1-7, 2019.

NASON, L. K.; WALKER, C. M.; McNEELEY, M. F.; BURIVONG, W.; FLIGNER, C. L.; GODWIN, J. D. Imaging of the diaphragm: anatomy and function. Radiographics, Oak Brook, v. 32, n. 2, p. e51-e70, 2012.

POOLER, A.; BEECH, R. Examining the relationship between anxiety and depression and exacerbations of COPD which result in hospital admission: a systematic review. International Journal of Chronic Obstructive Pulmonary Disease, London, v. 9, p. 315, 2014.

REID, W. D.; DECHMAN, G. Considerations when testing and training the respiratory muscles. Physical Therapy, Oxford, v. 75, n. 11, p. 971-82, 1995.

ROCHA, T.; SOUZA, H.; BRANDAO, D. C.; RATTES, C.; RIBEIRO, L.; CAMPOS, S. L.; DE ANDRADE, A. D. The Manual diaphragm release technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomized trial. Journal of Physiotherapy, Melbourne, v. 61, n. 4, p. 182-9, 2015.

SALVADOR, M. M.; MOREO, L. H.; FERNÁNDEZ, J. D.; LISÓN, J. F.; ARGUISUELAS, M. D. Osteopathic manipulative treatment including specific diaphragm techniques improves pain and disability in chronic nonspecific low back pain: a randomized trial. Archives of Physical Medicine and Rehabilitation, Reston, v. 99, n. 9, p. 1720-9, 2018.

SMITH, L.; BERKOWITZ, M. R. Osteopathic approach to chronic constipation in Prader-Willi Syndrome: a case report. International Journal of Osteopathic Medicine, London, v. 19, p. 73-7, 2016.

SOLLANEK, K. J.; SMUDER, A. J.; WIGGS, M. P.; MORTON, A.B.; KOCH, L. G.; BRITTON, S. L.; POWERS, S. K. Role of intrinsic aerobic capacity and ventilator-induced diaphragm dysfunction. Journal of Applied Physiology, Rockville, v. 118, n. 7, p. 849-57, 2015.

SONBERG, M.; MULLINGER, B.; RAJENDRAN, D. Can osteopathy help women with a history of hypothyroidism and musculoskeletal complaints? Outcome of a preliminary, prospective, open investigation. International Journal of Osteopathic Medicine, London, v. 13, n. 1, p. 11-6, 2010.

THOMAZ, S. R.; TEIXEIRA, F. A.; DE LIMA, A. C. G.; JÚNIOR, G. C.; FORMIGA, M.F.; CAHALIN, L. P. Osteopathic manual therapy in heart failure patients: A randomized clinical trial. Journal of Bodywork and Movement Therapies, London, v. 22, n. 2, p. 293-9, 2018.

TZELEPIS, G. E.; VEGA, D. L.; COHEN, M. E.; McCOOL, F. D. Lung volume specificity of inspiratory muscle training. Journal of Applied Physiology, Rockville, v. 77, n. 2, p. 789-94, 1994.

TZELEPIS, G. E.; VEGA, D. L.; COHEN, M. E.; McCOOL, F. D. Pressure-flow specificity of inspiratory muscle training. Journal of Applied Physiology, Rockville, v. 77, n. 2, p. 795-801, 1994.

WAKELING, J. M.; UEHLI, K.; ROZITIS, A. I. Muscle fibre recruitment can respond to the mechanics of the muscle contraction. Journal of The Royal Society Interface, London, v. 3, n. 9, p. 533-44, 2006.

WILLIAMS, P. L.; WARWICK, R.; DYSON, M.; BANNISTER, L. H. Gray’s anatomy. 37. ed. Edinburgh: Churchill Livingstone, 1989.

YAO, S.; HASSANI, J.; GAGNE, M.; GEORGE, G.; GILLIAR, W. Osteopathic manipulative treatment as a useful adjunctive tool for pneumonia. Journal of Visualized Experiments, Cambridge, n. 87, p. e50687, 2014.