The immediate effect of soft tissue manual therapy intervention on lung function in severe chronic obstructive pulmonary disease

Figures & data

Table 1 Soft tissue manual therapy protocol

Technique	Description
Suboccipital release (5 minutes)	The practitioner places the tips of their fingers pointing toward the ceiling, just immediately below the occiput and generates a pressure that releases the tissues located in this region. The practitioner then applies a slight traction force between occiput and atlas
Anterior thoracic myofascial release and sternum release (5 minutes)	The practitioner places a hand behind the head of the patient just below the occiput holding it between the thumb and the forefinger and creating a fulcrum in the area. The practitioner’s other hand is placed over the patient’s sternum with the middle finger over the midline of the sternum and with the heel of the hand placed just below the sternal joint. Distraction moves the fascia and the sternochondral joints apart with the pressure maintained until tissue release occurs
Anterior cervical myofascial release (5 minutes)	The practitioner places a hand on the inferior angle of the jaw and the other hand just below the bottom edge of the clavicle. Force is applied to both the bottom edge of the clavicle in a downward direction and the jaw in an upward direction. This pressure is maintained until tissue release occurs
Costal ligament balance (5 minutes)	The practitioner places both the hands on the patient’s back with the finger pads of each hand against the costotransverse joints. The technique begins at the 12th rib and progresses up to the 2nd rib. Using the practitioner’s fingers as a hook, the practitioner takes the angles of the ribs and applies traction in a superior and lateral direction. This traction is maintained until the ligaments stretch
Muscle energy techniques (1 minute 40 seconds each)	Scalene: The head is tilted 45° to the contralateral side. The patient places their ipsilateral hand on the upper ribs and their other hand on their forehead. The practitioner places one hand on the patient’s “rib” hand and the other hand on the patient’s “forehead” hand. From this position, the patient is required to perform neck flexion against resistance by the practitioner. Once completed the practitioner moves the “rib” contact to the other ribs in a downward and lateral direction Pectoralis minor: The patient places their ipsilateral arm on the rib behind their head (external rotation of the shoulder with flexion and abduction to 110° in the scapular plane). One hand of the practitioner contacts the 3rd, 4th and 5th ribs, whereas the other is on the patient’s elbow. The practitioner applies a resistance in the horizontal plane adducting the patient’s arm. Once this is completed, the practitioner takes the ribs and pulls in a downward and lateral direction Latissimus dorsi and serratus anterior: The patient positions their ipsilateral arm in 90° abduction and neutral rotation. The practitioner uses their body and one arm to stabilize the patient’s arm, whereas the other hand is fixed from the 6th to the 10th rib. From here, the patient resists adduction. Once this is completed, the practitioner takes the ribs and pulls them in an inferior and lateral direction

Table 2 Demographic and clinical characteristics of participants

Characteristics	Mean ± SD
Male/female (n)	9/3
Age, years	62.4±7.8
Weight (kg)	71.8±9.3
Height (m)	1.64±0.06
BMI (kg/m^2)	26.6±2.2
GOLD Stage III/IV (n)	10/2
Smoking (pack-years)	38.1±22.4
Smoking status nonsmoker/ex-smoker/smoker (n)	3/9/0

Abbreviations: BMI, body mass index; GOLD, Global Initiative for Obstructive Lung Disease; SD, standard deviation.

Table 3 Pre- and postintervention outcome measurementsa

Patient	HR (bpm)		RR (rpm)		SpO2 (%)
	Pre	Post	Pre	Post	Pre	Post
1	65	60	18	12	95	98
2	88	80	16	10	92	96
3	81	76	18	14	90	94
4	84	72	14	12	93	97
5	88	80	16	12	96	98
6	83	74	22	18	92	96
7	112	110	21	17	86	90
8	104	99	24	18	94	97
9	72	66	30	24	91	93
10	87	80	22	18	93	95
11	63	60	22	16	96	99
12	78	61	22	17	95	96
Average	83.8	76.5	20.4	15.7	92.8	95.8

Note:

a All measurements given as means.

Abbreviations: bpm, beats per minute; HR, heart rate; RR, respiratory rate; rpm, respirations per minute; SpO₂ (%), percentage oxygen saturation.

Figure 1 CONSORT flow diagram.

Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 2 Changes in lung volume and capacities pre- and postintervention.

Note: *Statistical significance: P<0.05.
Abbreviations: ERV, expiratory reserve volume; IC, inspiratory capacity; pre, preintervention; post, postintervention; RV, residual volume; TLC, total lung capacity; VC, vital capacity.