Torakal manipülasyonun torakal mobilite, solunum fonksiyonları ve fonksiyonel kapasite üzerine etkisi: pilot çalışma

Yıl 2019, Cilt: 6 Sayı: 2, 93 - 103, 23.08.2019

Rüstem Mustafaoğlu Tansu Birinci Ebru Kaya Mutlu Arzu Razak Özdincler

Öz

Amaç: Torakal manipülasyonun pulmoner fonksiyon
üzerine etkisini araştıran çalışmalar sınırlı sayıdadır ve mevcut çalışmaların sonuçları
çelişkilidir. Çalışmamızın amacı tek seans uygulanan torakal manipülasyonun göğüs
duvarı mobilitesi, solunum fonksiyonları, solunum kas kuvveti ve fonksiyonel kapasite
üzerine kısa dönem etkisini araştırmaktı.

Yöntem: Yirmi
yaş üstü 78 sağlıklı erkek gönüllü birey çalışmaya dahil edildi. Katılımcılar randomize
olarak 2 gruba ayrıldı. Grup 1’e torakal
manipülasyon (N=39) ve Grup 2’ye plasebo torakal manipülasyon (N=39) uygulandı.
Uygulamalar deneyimli bir fizyoterapist tarafından yapıldı. Uygulama öncesi ve sonrasında
olguların göğüs çevre ölçümleri, nötral, inspirasyon ve ekspirasyon sırasında aksillar,
epigastrik ve subkostal seviyelerden mezura ile ölçüldü. Solunum fonksiyonları MIR
Spirobank II, solunum kas kuvveti Carefusion Micro RPM cihazıyla ve fonksiyonel
kapasiteleri 6 Dakika Yürüme Testiyle değerlendirildi.

Bulgular: Tek seans uygulanan torakal manipülasyon
sonrasında göğüs çevre ölçümleri, solunum fonksiyonları ve solunum kas kuvveti ölçümü
ve 6 dakika yürüme mesafesi değerleri açısından gruplar arasında fark bulunmadı
(p>0,05).

Sonuç: Çalışmamızda,
manipülasyonun torakal mobilite, solunum fonksiyonları ve fonksiyonel kapasite üzerinde
minimal değişiklikler oluşturdu. Ancak bu değişiklikler klinik olarak anlamlı değildi.
Manipülasyonun sıklığı, seans süreleri ve farklı teknikler ve tedavi yöntemleriyle
birlikte uygulamalarının etkinliğini değerlendiren, kanıt düzeyi yüksek ileri çalışmalara
ihtiyaç vardır.

Anahtar Kelimeler

torakal manipulasyon, göğüs duvarı mobilitesi, solunum fonksiyonları, rehabilitasyon

Effects of thoracic manipulation on thoracic mobility, pulmonary functions, and functional capacity: a pilot study

Öz

Purpose: A limited number of studies have been investigated
the effect of thoracic manipulation on pulmonary functions and the results of
the current studies are contradictory. The aim of this study was to investigate
the acute effects of single-session thoracic manipulation on chest wall
mobility, respiratory function, respiratory muscle strength, and functional
capacity.

Methods: Seventy-eight healthy men aged 20 and over were
recruited in the study. The participants were randomly assigned to either the
thoracic manipulation group (N=39) or the placebo group (N=39). A physical
therapist who experienced in manual therapy administered thoracic manipulation
and placebo intervention. Chest wall mobility assessed during neutral,
inspiratory and expiration were measured at the axillary, epigastric and
subcostal levels using a tape measure. Pulmonary function were assessed using
Spirobank II. The Carefusion Micro RPM
device and 6-Minute Walk
Test (6MWT) were used to evaluate respiratory
muscle strength and functional capacity, respectively.

Results: After single thoracic
manipulation intervention, no significant difference was found in the
measurements of chest circumference, pulmonary
function, respiratory muscle strength, and 6MWT values between the groups
(p>0.05).

Conclusion: In our study, thoracic manipulation produced minimal
changes in thoracic mobility, respiratory
function and functional capacity.
However, these changes were not clinically significant. Further studies with a high level of evidence and evaluating the
effectiveness of the frequency of manipulation, session duration and
manipulation application combined with different techniques or treatment
methods are needed.

Anahtar Kelimeler

thoracic manipulation, chest wall mobility, respiratory functions, rehabilitation

Kaynakça

• 1. Edmond SL. Joint Mobilization/Manipulation: Extremity and Spinal Techniques. 2nd ed. Philadelphia. Mosby; 2006.
• 2. Engel R, Vemulpad S. The role of spinal manipulation, soft-tissue therapy, and exercise in chronic obstructive pulmonary disease: a review of the literature and proposal of an anatomical explanation. J Altern Complement Med. 2011;17:797-801.
• 3. Noll DR, Degenhardt BF, Johnson JC, et al. Immediate effects of osteopathic manipulative treatment in elderly patients with chronic obstructive pulmonary disease. J Am Osteopath Assoc. 2008;108:251-259.
• 4. Dougherty PE, Engel RM, Vemulpad S, et al. Spinal manipulative therapy for elderly patients with chronic obstructive pulmonary disease: a case series. ‎J Manip Physiol Ther. 2011;34:413-417.
• 5. Bockenhauer SE, Julliard KN, Lo KS, et al. Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma. J Am Osteopath Assoc. 2002;102:371-375.
• 6. Lima ISA, de Moura Filho OF, Cunha FVM, et al. Chest and neck mobilization effects on spirometric responses in healthy subjects. J Manip Physiol Ther. 2011;34:622-626.
• 7. Engel RM, Vemulpad S. The effect of combining manual therapy with exercise on the respiratory function of normal individuals: a randomized control trial. J Manip Physiol Ther. 2007;30:509-513.
• 8. Vicenzino B, Cartwright T, Collins D, et al. Cardiovascular and respiratory changes produced by lateral glide mobilization of the cervical spine. Man Ther. 1998;3:67-71.
• 9. Engel RM, Vemulpad SR, Beath K. Short-term effects of a course of manual therapy and exercise in people with moderate chronic obstructive pulmonary disease: a preliminary clinical trial. J Manip Physiol Ther. 2013;36:490-496.
• 10. Wall BA, Peiffer JJ, Losco B, et al. The effect of manual therapy on pulmonary function in healthy adults. Sci Rep. 2016;6:332-344.
• 11. Ghaffar T, Sajjad AG, Rasul A. effects of thoracic spine mobilization on vitals and blood oxygen level in healthy individuals. J Islam Int Med Coll.2016;11:163-166.
• 12. De Cordoba Lanza F, de Camargo A, Archija LRF, et al. Chest wall mobility is related to respiratory muscle strength and lung volumes in healthy subjects. Respiratory care. 2013:respcare. 02415.
• 13. Bockenhauer SE, Chen H, Julliard KN, et al. Measuring thoracic excursion: reliability of the cloth tape measure technique. J Am Osteopath Coll Radio. 2007;107:191-196.
• 14. Redelmeier DA, Bayoumi AM, Goldstein RS, et al. Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med. 1997;15:1278-1282.
• 15. Debouche S, Pitance L, Robert A, et al. Reliability and reproducibility of chest wall expansion measurement in young healthy adults. J Manip Physiol Ther. 2016;39:443-449.
• 16. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26:948-968.
• 17. Brusasco EV, Crapo R, Viegi G, et al. Series ‘‘ATS/ERS task force: standardisation of lung function testing’’. 2005.
• 18. Society AT. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166:518-624.
• 19. Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis.1969;99:696-702.
• 20. Chetta A, Zanini A, Pisi G, et al. Reference values for the 6-min walk test in healthy subjects 20–50 years old. Resp Med. 2006;100:1573-1578.
• 21. Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease.Eur Respir J.44:1428-1446.
• 22. Atchison JW. Manipulation efficacy: upper body. J Back Musculoskelet Rehabil . 2000;15:3-15.
• 23. Salom-Moreno J, Ortega-Santiago R, Cleland JA, et al. Immediate changes in neck pain intensity and widespread pressure pain sensitivity in patients with bilateral chronic mechanical neck pain: a randomized controlled trial of thoracic thrust manipulation vs non–thrust mobilization. J Manip Physiol Ther. 2014;37:312-319.
• 24. Kisner C, Colby LA, Borstad J. Therapeutic exercise: foundations and techniques. Fa Davis; 2017.
• 25. González-Iglesias J, Fernandez-De-Las-Penas C, Cleland JA, et al. Thoracic spine manipulation for the management of patients with neck pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2009;39:20-27.
• 26. Cross KM, Kuenze C, Grindstaff T, et al. Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review. J Orthop Sports Phys Ther. 2011;41:633-642.
• 27. Dunning JR, Cleland JA, Waldrop MA, et al. Upper cervical and upper thoracic thrust manipulation versus nonthrust mobilization in patients with mechanical neck pain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2012;42:5-18.
• 28. Widberg K, Karimi H, Hafström I. Self-and manual mobilization improves spine mobility in men with ankylosing spondylitis-a randomized study. Clinic Rehabil. 2009;23:599-608.
• 29. Noll DR, Johnson JC, Baer RW, et al. The immediate effect of individual manipulation techniques on pulmonary function measures in persons with chronic obstructive pulmonary disease. Osteopath Med Prim Care. 2009;3:9.
• 30. Balon J, Aker PD, Crowther ER, et al. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. N Engl J Med.1998;339:1013-1020.
• 31. Bronfort G, Evans RL, Kubic P, et al. Chronic pediatric asthma and chiropractic spinal manipulation: a prospective clinical series and randomized clinical pilot study. J Manip Physiol Ther. 2001;24:369-377.
• 32. Scholten-Peeters GG, Thoomes E, Konings S, et al. Is manipulative therapy more effective than sham manipulation in adults?: a systematic review and meta-analysis. Chiropr Man Therap. 2013;21:34.
• 33. Pepino VC, Ribeiro JD, de Oliveira Ribeiro MAG, et al. Manual therapy for childhood respiratory disease: a systematic review. J Manip Physiol Ther. 2013;36:57-65.
• 34. Wearing J, Beaumont S, Forbes D, et al. The use of spinal manipulative therapy in the management of chronic obstructive pulmonary disease: a systematic review. J Alternate Compl Med. 2016;22:108-114.