Effects of Manual Therapy and Inspiratory Muscle Training
Condition: Respiratory Function
MeSH terms: Respiratory Aspiration
Study type: Interventional

Summary: 
      The effectiveness of inspiratory muscle training (IMT) and manual therapy approaches added to
      the IMT program in healthy individuals with hyperkyphosis is uncertain. This study was aimed
      to determine the effects of manual therapy techniques added to IMT and IMT on pulmonary
      functions (FVC, FEV1, FEV1 / FVC, and PEF), forward head posture, and hyperkyphosis in
      healthy individuals with hyperkyphosis. Thirty-five individuals voluntarily participate to
      study were randomly divided into IMT and manual therapy groups. While all participants
      received twenty minutes of IMT twice a week for four weeks, manual therapy techniques were
      applied to the manual therapy group in addition to IMT. Pulmonary functions, forward head
      posture, and hyperkyphosis were evaluated before and after the treatments with spirometry
      device; cervical range of joint range of motion measuring device (CROM Deluxe), C0-wall
      (OWD), and C7-wall distance measurement respectively. Statistical Package for Social Sciences
      (SPSS 25.0) will be used to analyze the data in the research.
    

Detailed description: 
      Hyperkyphosis, which is defined as a thoracic curvature higher than normal limits, is among
      the reasons that decrease chest wall mobility and lung function. In modern society, kyphosis
      in the thoracic vertebra increases with the increase in sitting time of people. It has been
      identified in studies that an increase in thoracic kyphosis and a decrease in the mobility of
      the thoracic region of the spine are associated with a decrease in respiratory functions such
      as Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 Second (FEV1).

      Manual therapy approaches consisting of different techniques (manipulation, joint
      mobilization and soft tissue mobilization) can be an effective approach to improve pulmonary
      function by increasing chest wall mobility. Manual therapy techniques applied to the thoracic
      region have been shown to cause a significant reduction in thoracic kyphosis. In a study, it
      has been shown that thoracic joint mobilization is effective in increasing FVC, FEV1 and Peak
      Expiratory Flow (PEF) in people with hyperkhyphosis and chronic neck pain. In addition,
      identified studies shows that manual therapy approaches applied to improve respiratory
      functions should include both the thoracic and cervical regions due to the relationship
      between cervical and thoracic spine movements.

      Inspiratory Muscle Training (IMT) leads among the approaches used in the current literature
      to increase respiratory functions. There is important evidence that this technique which aims
      to increase the strength or endurance of the diaphragm and respiratory assist muscles
      activated during inspiration, improves respiratory function in the patient and healthy
      population. In the literature, there are studies examining the effects of IMT and manual
      therapy approaches on respiratory functions in individuals with chronic obstructive pulmonary
      disease (COPD), asthma and smokers. In a study conducted on smokers, the effects of manual
      therapy added to the IMT program on maximum inspiratory pressure (MIP) and other respiratory
      parameters were examined and a significant increase in MIP was observed, but a significant
      increase in other respiratory parameters not observed. In another study, it was stated that
      the addition of manual therapy and therapeutic exercise protocol to IMT in asthmatic
      individuals was more effective than IMT in improving forward head posture and kyphotic
      posture.

      Although the studies on the effects of using IMT and manual therapy techniques together in
      healthy individuals on respiratory functions are very limited in the literature, more acute
      effects were investigated in these studies. In this context, the aim of our study is to
      evaluate the cervical and thoracic region manual therapy approaches added to IMT and IMT
      program in healthy individuals with hyperkyphosis; It is the determination of the effects on
      respiratory function values such as FVC, FEV1, tiffeneau index (FEV1 / FVC) and PEF, forward
      head posture and hyperkyphosis.
    

Intervention name(s): Inspiratory Muscle Training; Manual Therapy
Intervention type(s): Device; Other
Intervention description(s): Inspiratory Muscle Training (IMT) was performed with Powerbreathe Classic-Light Resistance device. To determine the intensity of the training, MIP values were measured with the help of the respiratory pressure meter-RP Check (MD Diagnostics Ltd. RP Check MIP & MEP) device before each training. The pressure corresponding to 50 percent of the MIP value in the Powerbreathe device was determined as training workload. It was applied two days a week for four weeks, with five-set and five repetitions, for 20 minutes with 30 seconds rest in between. This inspiratory muscle training program has previously been used by several studies to improve respiratory muscle strength.; In the manual diaphragm release technique; While the participant was breathing in, the physiotherapist raised his hand slowly to accompany the rising movement of the ribs and deepened the contact during exhalation. The maneuver was performed in two sets of 10 deep breaths.
In thoracic mobilization application; The physiotherapist, standing behind the participant, wrapped the crossed arms from his right upper arm with his left hand and performed stretching, extension, lateral flexion, and thoracic rotation with his right hand.
In HVLA thoracic manipulation; the physiotherapist, with the support hand on the participant's elbows, applied HVLA thrust in the posterior-anterior and inferior-superior directions with the help of his body while the manipulating hand was on the transverse processes.
For cervical joint mobilization; the physiotherapist was applied using the right hand in flexion, extension, right-left rotation, and lateral flexion directions.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The individuals are randomly allocated into Inspiratory Muscle Training (IMT) and Manual Therapy groups.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: inspiration; kyphosis; manual therapy; posture; respiratory muscles