The immediate effect of thoracolumbar manipulation and diaphragmatic release on inspiratory muscle strength inhealthy smokers: A randomized clinical trial

BACKGROUND: Diaphragmatic release technique and thoracolumbar manipulation have been found effective in restoring normal diaphragmatic movement in healthy and diseased populations. Smoking has deleterious effects on human systems, including the musculoskeletal system. OBJECTIVE: The current study aimed to investigate the immediate effects of diaphragmatic release technique and thoracolumbar manipulation on diaphragm muscle strength in healthy smokers. METHODS: A double-blinded randomized clinical trial was conducted on 30 asymptomatic healthy smokers randomly assigned into two groups [intervention group (IG) and sham group (SG)] with 15 participants each. The IG received thoracolumbar manipulation and diaphragmatic release techniques, while the SG received no active treatment. The outcome measure was sniff nasal inspiratory pressure (SNIP). RESULTS: The IG showed a significant increase in the SNIP with a mean difference of 20.13 cmH2O (95% CI: 13.62–26.64; P< 0.001), while the SG had a reduction in the SNIP value -3.27 cmH2O (95% CI: -0.65 to -5.89; P= 0.02). Diaphragmatic release technique and thoracolumbar manipulation significantly improved SNIP values immediately after the intervention, with a between-group difference of 31.07 cmH2O (95% CI: 15.26–46.87; P< 0.001). CONCLUSIONS: Diaphragmatic release technique and thoracolumbar manipulation increased the diaphragm strength in healthy adult smokers, suggesting its potential utility in the management of participants with reduced respiratory muscle strength.

Biomechanical Impacts of Forward Head Posture on the Respiratory Function

Introduction: Forward head posture (FHP) is a very common problem among the working population. Being one of the most subconscious function in humans, respiratory function utilizes both the diaphragmand external intercostal muscles for quiet breathing. However during labored breathing, many other muscles will be recruited, and mostly these muscles have attachments in the cervical, thoracic ribcage,and even lumbar vertebrae. By the nature of attachments of these muscles on the cervical vertebra and thoracic cage, it is then plausible that FHP would affect the respiratory function. Methods: Thorough searches were done through international journals for the last ten years regarding the topic of FHP and its impacts to the respiratory biomechanics. Discussion: Previous studies have reported how prolonged FHP will result in kyphotic posture, reducing the mobility of ribcage, and modifies all respiratory muscular attachments such as sternocleidomastoids, intercostals, and to a certain extent, the diaphragm. All these result in a restrictive lung disorder, signified by reducing spirometry values, such as Forced Vital Capacity, Sniff Nasal Inspiratory Pressure, and Peak Flow Rate. Conclusion: Forward head posture disturb the respiratory biomechanics.