Effect of Diaphragmatic Breathing on Shoulder Rotational Mobility- Single-Blind Randomized Controlled Study

Abstract

Aim: Shoulder mobility has an important place in both sports and daily life activities. The low rotational mobility of the shoulder in sports injuries is considered to be in the first place in the aetiology. The innervational and myofascial connection between the diaphragm muscle and the shoulder is known. This study aims to examine the instantaneous effect of the breathing exercise focused on the diaphragm muscle on shoulder mobility. Method: 136 young, healthy, recreationally active adults aged 18-25 years were included in the study. Participants were randomly divided into two groups the intervention group (n=86) and the control group (n=50). The control group did nothing for 90 seconds while the intervention group engaged in the diaphragmatic breathing technique that had previously been taught. Shoulder mobility was assessed using the Functional Movement Screen (FMS™) test both before and after the intervention. Results: Although substantial gains in shoulder mobility were observed in both shoulders of the intervention group, only the left shoulder in the control group exhibited a significant increase in mobility. In the comparison between the groups, there is a significant difference in both arms before and after the intervention (p<0,05). Conclusion: The present study demonstrates the impact of diaphragmatic exercise on shoulder mobility. Nevertheless, for cases involving shoulder pain or considerable mobility limitations, further studies are necessary to evaluate not only the acute effects but also the outcomes of longer-term training.

Keywords

• Glenohumeral joint
• myofascia
• postural control
• range of motion
• respiration

Diyafragmatik Solunumun Omuz Rotasyonel Mobilitesine Etkisi- Tek Kör Randomize Kontrollü Çalışma

Abstract

Amaç: Omuz mobilitesi hem spor hem de günlük yaşam aktivitelerinde önemli bir yere sahiptir. Spor yaralanmalarında omuzun kısıtlı rotasyonel hareketliliği etiyolojide ilk sıralarda yer almaktadır. Diyafram kası ile omuz arasındaki innervasyonel ve miyofasyal bağlantı bilinmektedir. Bu çalışmanın amacı diyafram kasına odaklanan nefes egzersizinin omuz hareketliliği üzerindeki anlık etkisini incelemektir. Yöntem: Çalışmaya 18-25 yaş arası toplam 136 genç, sağlıklı, rekreasyonel aktif yetişkin dahil edildi. Katılımcılar müdahale grubu (n=86) ve kontrol grubu (n=50) olmak üzere rastgele iki gruba ayrıldı. Müdahale grubu daha önce öğretilmiş olan diyafragmatik solunum tekniğini uygularken kontrol grubu 90 saniye boyunca hiçbir şey yapmadı. Hem müdahale öncesi hem de müdahale sonrası omuz mobilitesi, Fonksiyonel Hareket Taraması (FMS™) testi kullanılarak değerlendirildi. Bulgular: Müdahale grubundaki her iki omuzda omuz rotasyon mobilitesinde önemli bir artış varken, kontrol grubunda sadece sol omuzda hareketlilikte önemli artış görüldü. Gruplar arası karşılaştırmada müdahale öncesi ve sonrası her iki kolda anlamlı farka rastlanıldı (p<0,05). Sonuç: Bu çalışma, diyafram solunum egzersizinin omuz mobilitesi üzerinde etkisi olduğunu göstermiştir. Ancak omuz ağrısı veya belirgin hareket kısıtlılığı olan olgularda sadece akut etkiyi değil aynı zamanda uzun süreli antrenmanların etkilerini de değerlendiren çalışmalara ihtiyaç vardır.

Keywords

• Glenohumeral eklem
• myofasya
• postural kontrol
• eklem hareket açıklığı
• solunum

References

1. 1. Janet SK, Mangala G. Effectiveness of deep breathing exercise on blood pressure among patients with hypertension. International Journal of Pharma and Biosciences. 2017;B256-60. doi: 10.22376/ıjpbs.2017.8.1.b256-260
2. 2. Bordoni B, Marelli F, Bordoni G. A review of analgesic and emotive breathing: a multidisciplinary approach. Journal of Multidisciplinary Healthcare. 2016;9:97–102. doi: 10.2147/JMDH.S101208
3. 3. Hirasawa T, Fujimoto S, Kuratani S. Expansion of the neck reconstituted the shoulder diaphragm in amniote evolution. Development, Growth & Differentiation. 2016;58(1):143-153. doi: 10.1111/dgd.12243
4. 4. Hirasawa T, Kuratani S. A new scenario of the evolutionary derivation of the mammalian diaphragm from shoulder muscles. Journal of Anatomy. 2013;222(5):504-517. doi: 10.1111/joa.12037
5. 5. Panicek DM, Benson CB, Gottlieb RH, Heitzman ER. The diaphragm: anatomic, pathologic, and radiologic considerations. Radiographics. 1988;8(3):385-425.
6. 6. Dayal S, Manjunath KY. The variations in the roots of origin of the phrenic nerve. Journal of Mahatma Gandhi Institute of Medical Sciences. 2009;(14)2:24-7.
7. 7. Fernández-López I, Peña-Otero D, Atín-Arratibel MLÁ, et al. Effects of diaphragm muscle treatment in shoulder pain and mobility in subjects with rotator cuff injuries: A dataset derived from a pilot clinical trial. Data Brief. 2021;35,106867. doi: 10.1016/j.dib.2021.106867
8. 8. Lv S, Wang Q, Ni Q, et al. Progress of muscle chain theory in shoulder pain rehabilitation: potential ideas for pulmonary rehabilitation. Evidence-Based Complementary and Alternative Medicine: eCAM, 2022;2537957. doi:10.1155/2022/2537957

9. 9. Bradley H, Esformes JD. Breathing pattern disorders and functional movement. International Journal of Sports Physical Therapy. 2014;9(1):28.
10. 10. Kim E, Lee H. The effects of deep abdominal muscle strengthening exercises on respiratory function and lumbar stability. Journal of Physical Therapy Science. 2013;25(6):663-665. doi:10.1589/jpts.25.663
11. 11. Andrade LS, Jaison J, Jyotsna B, Lewis CR, Prasanna LC. A study on the variants of phrenic nerve roots with histological correlation. Translational Research in Anatomy. 2021;23:100123. doi: 10.1016/j.tria.2021.100123
12. 12. Luime JJ, Koes BW, Hendriksen IJ, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian Journal of Rheumatology. 2004;33(2):73-81. doi: 10.1080/03009740310004667
13. 13. Gharisia O, Lohman E, Daher N, Eldridge A, Shallan A, Jaber H. Effect of a novel stretching technique on shoulder range of motion in overhead athletes with glenohumeral internal rotation deficits: a randomized controlled trial. BMC Musculoskeletal Disorders. 2021;22(1):402. doi: 10.1186/s12891-021-04292-8
14. 14. Cook G, Burton L, Hoogenboom BJ, Voight M. Functional movement screening: the use of fundamental movements as an assessment of function - part 1. International Journal of Sports Physical Therapy. 2014;9(3):396–409.
15. 15. Kendall FP, McCreary EK, Provance PG. Muscles Testing And Function With Posture And Pain. In Muscles Testing And Function With Posture And Pain. 4th edition. 1993;pp.xv-451. Lippincott Williams & Wilkins, Baltimore and Philadelphia.
16. 16. Cohen J. Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Routledge. 1988. https://doi.org/10.4324/9780203771587
17. 17. Lee BK. Effects of the combined PNF and deep breathing exercises on the ROM and the VAS score of a frozen shoulder patient: Single case study. Journal of Exercise Rehabilitation. 2015;11(5):276-281. doi:10.12965/jer.150229
18. 18. Tyree KA, May J. A novel approach to treatment utilizing breathing and a total motion release® exercise program in a high school cheerleader with a diagnosis of frozen shoulder: a case report. International Journal of Sports Physical Therapy. 2018;13(5):905-919.
19. 19. Shiri R, Varonen H, Heliövaara M, Viikari-Juntura E. Hand dominance in upper extremity musculoskeletal disorders. Journal of Rheumatology. 2007;34(5):1076-1082.