Dysfunctional breathing (DB) is related to an abnormal breathing pattern, unexplained breathlessness and significant patient morbidity. Treatment is comprised of breathing retraining through respiratory physiotherapy. Recently, manual therapy (MT) has also been used, but no evidence exists to validate its use. This study aimed to examine whether MT produces added benefit when compared with breathing retraining alone in patients with DB. Sixty subjects with primary DB were placed at random into either breathing retraining (standard treatment; n = 30) or breathing retraining plus MT (intervention; n = 30) group. Both the groups received standardised respiratory physiotherapy, which included: DB education, breathing retraining, home regimen, and audio disc. Intervention group subjects additionally received MT following further assessment. Data from 57 subjects were analysed. At baseline, standard treatment group subjects were statistically younger (41.7 + 13.5 versus 50.8 + 13.0 years; p = 0.001) with higher Nijmegen scores (38.6 + 9.5 versus 31.5 + 6.9; p = 0.001). However, no significant difference was found between the groups for primary outcome Nijmegen score (95% CI (-1.1, 6.6) p = 0.162), or any secondary outcomes (Hospital Anxiety & Depression Score, spirometry or exercise tolerance).
Breathing retraining is currently the foundation of treatment for patients with DB. The results of this study indicate MT provides no additional benefit in this patient group. Implications for Rehabilitation Dysfunctional breathing (DB) is related to significant patient morbidity but often goes unrecognised, leading to prolonged investigation and significant use of health care resources. Breathing retraining remains the primary management of this condition. However, physiotherapists are also using manual therapy (MT) as an adjunctive treatment for patients with DB. However, the results of this study indicate that MT provides no greater benefit and cannot be suggested in the clinical management of this condition.