The Role of Manual Therapy in Patients with COPD

So the title of this article is pretty divisive so lets walk through this review article slowly and from a neutral standpoint. Yes Chronic obstructive pulmonary disease is a disease of the lungs but for the application of manual therapy to work we need to think about the extrapulmonary manifestations – the impact of the condition outside of the lungs – and specifically on the chest wall mechanics.

COPD and Musculoskeletal Changes

A number of changes occur in patients with COPD. The respiratory muscle changes largely result as a consequence of hyperinflation. The big muscle we are talking about here is of course the diaphragm, which is forced to under stretch and therefore ineffectively.

This hyperinflation also passively increases chest wall rigidity which also reduces compliance. This then recruits the accessory muscles which become hypertrophied. A concequence of this is a reduction in neck motion and shoulder/scapula movement also both of which contribute to altered posture and kyphosis.

Manual Therapy Application in COPD

So if we think of manual therapy in this context, as being any technique that can improve muscular and postural changes, what does this mean? Well within this review article a number of previous studies have been included and the list of techniques included two broad areas:

  • Soft Tissue & Spinal Manipulation covering the thoracic spine and musulature
  • Osteopathic Manipulative Treatment specifically: massage, rib raising, diaphragm release, sub occipital decompression, thoracic inlet myofacial release, pectoral traction, thoracic lymphatic pump

Treatment duration varied in length and typically were single sessions over a number of weeks. Please read the article for full details.

In terms of benefits there were varying amounts of improvement to FVC, with a substantial gain reported when soft tissue techniques were combined with pulmonary rehabilitation (PR). However it is important to note that there was no improvement seen in quality of life, dyspnoea or anxiety and depression. This makes the overall benefit of any of the treatments, individually or when combined with PR, as unclear.

Limitations & Clinical Considerations

The jury is still out on this one. It appears that there many be some benefit to pain, breathlessness and lung volume when manual therapy techniques are applied in single sessions but when combined with other management strategies the effect is less so. As the authors of this study rightly point out the sessions are long and time intensive when performed in a clinical setting. There is a lack of clarity in which technique is most effective and yes, no harm was noted by patient or therapist but there doesn’t appear to have been much benefit either. Overall it probably isn’t something we should all be jumping to as the next best treatment option.