From the Guidelines
The osteopathic approach to diagnosing and treating diaphragmatic issues prioritizes manual techniques that address both structural and functional aspects of the diaphragm, focusing on improving respiratory function, posture, circulation, and visceral function. Osteopathic physicians typically begin with a thorough physical examination, including palpation of the thoracic cage, assessment of breathing patterns, and evaluation of diaphragmatic excursion 1. They may use specific osteopathic techniques such as myofascial release, rib raising, thoracic lymphatic pump, and diaphragm doming to address restrictions. Treatment often involves gentle manual pressure applied to the lower ribs and diaphragmatic attachments to release tension and improve mobility.
Key Considerations
- A thorough physical examination is essential in diagnosing diaphragmatic issues, and may include chest radiography to assess diaphragm position and provide clues to the presence of paralysis 1.
- Osteopathic techniques aim to restore normal physiological function through manual techniques and addressing the body as an integrated unit.
- Patients are typically taught breathing exercises and postural awareness to complement hands-on treatment and maintain improvements.
- In cases of complicated diaphragmatic hernia, CT scan of the chest and abdomen is the diagnostic gold standard, and laparoscopic repair is the best treatment option for stable patients 1.
Treatment Approach
- Osteopathic treatment focuses on manual techniques to address structural and functional aspects of the diaphragm.
- Visceral manipulation techniques may be employed to address relationships between the diaphragm and adjacent organs.
- Breathing exercises and postural awareness are essential components of osteopathic treatment, aiming to restore normal physiological function and improve overall quality of life.
From the Research
Osteopathic Approach to Diaphragm Diagnosis and Treatment
The osteopathic approach to diagnosing and treating diaphragmatic issues involves a comprehensive understanding of the diaphragm's role in respiratory and circulatory function.
- The diaphragm is considered a crucial component of the respiratory-circulatory model in osteopathic medicine, with its movement and function influencing overall health 2, 3.
- Osteopathic manipulative techniques (OMT) have been shown to improve diaphragmatic mobility and contractility in healthy individuals, with a statistically significant increase in diaphragmatic mobility observed after OMT 2.
- The five diaphragm model, which includes the tentorium cerebelli, tongue, thoracic outlet, diaphragm, and pelvic floor, is used to assess and treat patients, highlighting the complex interactions and anastomoses between these anatomical segments 4, 3.
Diaphragm Techniques and Treatment Outcomes
Specific diaphragm techniques are used in osteopathic manipulative treatment to improve pain and disability in patients with chronic nonspecific low back pain (NS-CLBP) and chronic obstructive pulmonary disease (COPD).
- A randomized trial found that OMT including specific diaphragm techniques improved pain and disability in patients with NS-CLBP compared to sham diaphragm techniques 5.
- The Manual Diaphragm Release Technique has been shown to improve diaphragmatic mobility, inspiratory capacity, and exercise capacity in people with COPD 6.
- These techniques may be considered in the management of patients with COPD and other conditions affecting diaphragmatic function.
Key Findings and Implications
The studies demonstrate the effectiveness of osteopathic manipulative techniques, including specific diaphragm techniques, in improving diaphragmatic function and overall health outcomes.
- The findings suggest that osteopathic medicine may be a useful adjunctive treatment for patients with respiratory and circulatory disorders, as well as those with chronic pain and disability 2, 5, 6.
- Further research is needed to confirm the benefits of osteopathic manipulative treatment for diaphragmatic issues and to identify the clinical conditions that may benefit from this approach 2, 5.