Manual Therapy Interventions in Patients With Chronic Obstructive Pulmonary Disease: A Comprehensive Narrative Review

Abstract

Chronic obstructive pulmonary disease (COPD) is a breathing problem with ongoing airflow issues and changes in how the chest moves. Different manual therapy methods, like releasing the diaphragm, manipulating the spine and joints, and treating soft tissues, have been used for people with COPD. This review looks into how these manual therapy approaches affect COPD patients. Articles were searched in Google Scholar, PubMed, and Elsevier using keywords such as COPD, manual therapy, thoracic excursion, and pulmonary function. Only studies conducted between 2015 and 2023, employing randomized controlled trials (RCTs), crossover RCTs, or comparative studies with COPD subjects, thoracic excursion, chest expansion, or pulmonary function tests (PFTs) as outcome measures, and involving physiotherapy interventions were included. Out of 82 articles searched, 10 met the inclusion criteria, comprising six RCTs, three crossover RCTs, and one comparative study. Data extraction was performed by one reviewer, encompassing intervention descriptions, inclusion/exclusion criteria, baseline data, and outcome values. The findings suggest that conventional physiotherapy combined with manual therapy techniques such as stretching, osteopathic manual therapy, manual diaphragmatic release, soft tissue therapy, and spinal manipulation have improved thoracic excursion and pulmonary function in COPD patients. Therefore, these manual therapy techniques are recommended for enhancing thoracic excursion and pulmonary function in COPD patients.

Keywords: copd; manual therapy; pulmonary function; respiratory muscle; thoracic excursion.

Figure 1. Diaphragmatic stretching

Image credit: [25]

Figure 2. Manual diaphragm release technique

Image credit: [26]

Figure 3. Spinal and rib manipulation

Image credit: [16] 1) Posrerior-anterior force; 2) Anterior-posterior force

Figure 4. Rib-raising technique variations

Image credit: [27] A) Supine position; B) Lateral recumbent positioning; C) Seated positioning

Figure 5. Lymphatic pump drainage

Image credit: [27] A) Thoracic lymphatic drainage; B) Peripheral lymphatic drainage