The relation between diaphragmatic mobility and spinal curvatures in patients with chronic obstructive pulmonary disease
DOI:
https://doi.org/10.1590/1809-2950/15809024032017Keywords:
Pulmonary Disease Chronic Obstructive, Diaphragm, SpineAbstract
In the chronic obstructive pulmonary disease (COPD), patients may have reduced diaphragmatic mobility and a series of compensations in the thoracic spine, the scapular and pelvic girdles. However, the relation between diaphragmatic mobility and postural changes in these individuals’ vertebral column and pelvis is not clear. The aim of this study was to verify if there is a relation between diaphragmatic mobility and spinal curvatures in patients with COPD and in apparently healthy individuals. Were evaluated 22 patients with COPD and 22 apparently healthy individuals. The evaluations consisted of: anthropometry, spirometry, diaphragmatic mobility and postural evaluation. Four postural alterations were analyzed: cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic position. There was no statistically significant difference between the groups, in relation to the variables age, body mass, stature and BMI, confirming that the groups were paired. There was no statistically significant difference in any of the variables related to spinal curvatures and pelvic position between the studied groups. In the COPD group, there was a correlation between diaphragmatic mobility and thoracic kyphosis (r=-0.543; p=0.009). Regarding the group of apparently healthy individuals, there was no correlation of mobility as the apparently healthy individuals presented the same angles of curvature of the vertebral column and the same position of the pelvis. However, there was a relation between diaphragmatic mobility and the angle of the thoracic curvature in patients with COPD.Downloads
References
Global Initiative for Chronic Obstructive Lung Disease
(GOLD). Global strategy for the diagnosis, management,
and prevention of chronic obstructive pulmonary disease.
[acesso em 10 ago. 2017]. Disponível em:https://goo.gl/
SwBHGa
Pachioni CAS, Ferrante JA, Panissa TSD, Ferreira DMA,
Ramos D, Moreira GL, et al. Avaliação postural em pacientes
com doença pulmonar obstrutiva crônica. Fisioter Pesqui.
;18(4):341-5. doi: 10.1590/S1809-29502011000400008
Dias CS, Kirkwood RN, Parreira VF, Sampaio RF. Orientation
and position of the scapula, head and kyphosis thoracic in
male patients with COPD. Can J Respir Ther. 2009;45(2):30-4.
Russi EW, Stammberger U, Weder W. Lung volume reduction
surgery for emphysema. Eur Respir J. 1997;10(1):208-18.
Laghi F, Tobin MJ. Disorders of the respiratory muscles.
Am J Respir Crit Care Med. 2003;168(1):10-48. doi: 10.1164/
rccm.2206020
Cassart M, Pettiaux N, Gevenois PA, Paiva M, Estenne M.
Effect of chronic hyperinflation on diaphragm length and
surface area. Am J Respir Crit Care Med. 1997;156(2 Pt.1):504-
doi: 10.1164/ajrccm.156.2.9612089
Suga K, Tsukuda T, Awaya H, Takano K, Koike S, Matsunaga
N, et al. Impaired respiratory mechanics in pulmonary
emphysema: evaluation with dynamic breathing MRI. J
Magn Reson Imaging. 1999;10(4):510-20. doi: 10.1002/
(sici)1522-2586(199910)10:4<510::aid-jmri3>3.0.co;2-g
Unal O, Arslan H, Uzun K, Ozbay B, Sakarya ME. Evaluation
of diaphragmatic movement with MR fluoroscopy in
chronic obstructive pulmonary disease. Clin Imaging.
;24(6):347-50. doi: 10.1016/S0899-7071(00)00245-X
Iwasawa T, Kagei S, Gotoh T, Yoshiike Y, Matsushita K,
Kurihara H, et al. Magnetic resonance analysis of abnormal
diaphragmatic motion in patients with emphysema. Eur Respir
J. 2002;19(2):225-31. doi: 10.1183/09031936.02.00044602
Paulin E, Yamaguti WPS, Chammas MC, Shibao S, Stelmach
R, Cukier A, et al. Influence of diaphragmatic mobility on
exercise tolerance and dyspnea in patients with COPD. Respir
Med. 2007;101(10):2113-18. doi: 10.1016/j.rmed.2007.05.024
Yamaguti WPS, Paulin E, Shibao S, Chammas MC, Salge
JM, Ribeiro M, et al. Air trapping: the major factor limiting diaphragm mobility in chronic obstructive pulmonary
disease patients. Respirology. 2008;13(1):138-44. doi:
1111/j.1440-1843.2007.01194.x
Yamaguti, WPS, Claudino RC, Neto AP, Chammas MC, Gomes
AC, Salge JM et al. Diaphragmatic breathing training program
improves abdominal motion during natural breathing
in patients with chronic obstructive pulmonary disease:
a randomized controlled trial. Arch Phys Med Rehabil.
;93(4):571-7. doi: 10.1016/j.apmr.2011.11.026
Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux
B, Marty C, et al. Sagittal alignment of spine and pelvis
regulated by pelvic incidence: standard values and prediction
of lordosis. Eur Spine J. 2006;15(4):415-22. doi: 10.1007/
s00586-005-0984-5
Butcher SJ, Meshke JM, Sheppard MS. Reductions in
functional balance, coordination, and mobility measures
among patients with stable chronic obstructive pulmonary
disease. J Cardiopulm Rehabil. 2004;24(4):274-80. doi:
1097/00008483-200407000-00013
World Health Organization. Obesity: Preventing and
Managing the Global Epidemic. Report of a WHO Consultation
(WHO Technical Report Series 894). Geneva: World Health
Organization. 2000[acesso em 10 ago. 2017];284:256.
Disponível em: https://goo.gl/GyeLBX
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R,
Coates A, et al. Standardisations of spirometry. Series “ATS/
ERS task force: standardisation of lung function testing”. Eur
Respir J. 2005;26:319-38. doi:10.1183/09031936.05.00034805
Pereira CA, Sato T, Rodrigues SC. New reference
values for forced spirometry in white adults in Brazil.
J Bras Pneumol, 2007;33(4):397-406. doi: 10.1590/
S1806-37132007000400008
Saltiel RV, Grams ST, Pedrini A, Paulin E. High reliability of
measure of diaphragmatic mobility by radiographic method
in healthy individuals. Braz J Phys Ther, 2013;17(2):128-136.
doi: 10.1590/S1413-35552012005000076
Ferreira EAG, Duarte M, Maldonado EP, Burke TN, Marques
AP. Postural assessment software (PAS/SAPO): validation
and reliability. Clinics. 2010;65(7):675-81. doi: 10.1590/
S1807-59322010000700005
Yi LC, Jardim JR, Inoue DP, Pignatari SSN. The relationship
between excursion of the diaphragm and curvatures of
the spinal column in mouth breathing children. J Pediatr.
;84(2):171-7. doi: 10.1590/S0021-75572008000200014
Martinez FJ, Couser JI, Celli BR. Factors influencing
ventilatory muscle recruitment in patients with chronic
airflow obstruction. Am Rev Respir Dis. 1990;142(2):276-82.
doi: 10.1164/ajrccm/142.2.276
Trevisan ME, Porto AS, Pinheiro TM. Influência do
treinamento da musculatura respiratória e de membros
inferiores no desempenho funcional de indivíduos com
DPOC. Fisioter Pesqui. 2010;17(3)209-13. doi: 10.1590/
S1809-29502010000300004
Breslin EH, Garoutte BC, Kohlman-Carrieri V, Celli
BR. Correlations between dyspnea, diaphragm, and
sternomastoid recruitment during inspiratory resistance
breathing in normal subjects. Chest. 1990;98(2):298-302.
doi: 10.1378/chest.98.2.298
Pasinato F, Corrêa ECR, Peroni ABF. Avaliação
da mecânica ventilatória em indivíduos com
disfunção têmporo-mandibular e assintomáticos.
Rev Bras Fisioter. 2006;10(3)285-9. doi: 10.1590/
S1413-35552006000300006
Corrêa ECR, Bérzin F. Efficacy of physical therapy on
cervical muscle activity and on body posture in school-age
mouth breathing children.Int J Pediatr Otorhinolaryngol.
;71(10):1527-35. doi: 10.1016/j.ijporl.2007.05.031
Teramoto S, Suzuki M, Matsuse T, Ohga E, Katayama H,
Nagase T, et al. Influence of kyphosis on the age-related
decline in pulmonary function. Nihon Ronen Igakkai Zasshi.
;35(1):23-7. Disponível em: https://goo.gl/Vh5Ti5
Di Bari M, Chiarlone M, Matteuzzi D, Zacchei S, Pozzi C,
Bellia V, et al. Thoracic kyphosis and ventilatory dysfunction
in unselected older persons: an epidemiological study in
Dicomano, Italy. J Am Geriatr Soc. 2004;52(6):909-15. doi:
1111/j.1532-5415.2004.52257.x
Loubresse CG, Vialle R, Wolff S. Cyphoses pathologiques:
pathological kyphosis. EMC Rhumatol Orthop. 2005;2(3):294-
doi: 10.1016/j.emcrho.2004.11.002
Ryan SD, Fried LP The impact of kyphosis on daily functioning.
J Am Geriatr Soc. 1997;45(12):1479-86. doi: 10.1111/j.1532-
1997.tb03199.x
Takahashi T, Ishida K, Hirose D, Nagano Y, Okumiya K,
Nishinaga M, et al. Trunk deformity is associated with
a reduction in outdoor activities of daily living and life
satisfaction in community-dwelling older people. Osteoporos
Int. 2005;16(3):273-9. doi: 10.1007/s00198-004-1669-3
Kado DM, Huang MH, Karlamangla AS, Barrett-Connor E,
Greendale GA. Hyperkyphotic posture predicts mortality in
older community-dwelling men and women: a prospective
study. J Am Geriatr Soc. 2004;52(10):1662-7. doi:
1111/j.1532-5415.2004.52458.x
Lacourt MX, Marini LL. Decréscimo da função muscular
decorrente do envelhecimento e a influência na qualidade
de vida do idoso: uma revisão de literatura. RBCEH. Rev
Bras Cienc Envelhec Hum. 2006;3(1):114-21. doi: http://dx.doi.
org/10.5335/rbceh.2012.51
Hinman, MR. Comparison of thoracic kyphosis and postural
stiffness in younger and older women. Spine J. 2004;4(4):413-
doi: 10.1016/j.spinee.2004.01.002
Downloads
Published
Issue
Section
License
Copyright (c) 2017 Fisioterapia e Pesquisa
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
