Diaphragm muscles show osteopathic training potential

By Lucy Piper

Osteopathic manipulative intervention to obtain functional equilibrium of the diaphragm increases lower esophageal sphincter (LES) pressure in patients with gastroesophageal reflux disease (GERD), researchers have found.

This positive influence on the LES suggests that inspiratory muscles, including the diaphragm, could be trained in the same way that gait muscles are, thereby strengthening them and improving their performance, the team explains.

"Our results demonstrated that there was an increase of 9-27% of the LES pressure in patients who performed the osteopathic maneuvers, while in the group of patients who did not perform the maneuvers, a reduction of that pressure was observed," Tomas Navarro-Rodriguez (University of São Paulo School of Medicine, Brazil) and colleagues report.

A total of 38 patients with GERD participated in the study, 22 of whom received osteopathic manipulation, involving a diaphragm-stretching technique commonly used by osteopathic physicians to obtain functional equilibrium of the muscles. The remaining participants received a sham technique.

Manometry measures of the average respiratory pressure (ARP) and maximum expiratory pressure showed an increase following osteopathy, from 20.03 to 21.87 and 12.03 to 14.56, respectively.

For patients receiving sham treatment, the readings for ARP and MEP fell, from 25.74 to 22.13 and 16.87 to 15.51, respectively.

The average difference in ARP before versus after osteopathy reached statistical significance compared with before versus after the sham technique. Furthermore, the difference in ARP was of a high enough magnitude to be considered clinically relevant according to Cohen calculations.

"Our data are of extreme clinical importance and of high practical relevance because in the assessment by the LES esophageal manometry, we assessed the regions of the LES having greater pressure either by ARP or MEP, and not the average of all the sphincter assessment," note the researchers in Diseases of the Esophagus.

"Our findings appear important in connection with the potential clinical applications of the osteopathic treatment for GERD and consequently its benefit as co-adjuvant in the clinical or surgical treatment or maybe even in the future as a single therapy for some kinds of specific patients," they conclude.

"It is still not possible to say if these changes are durable, which requires continuation of the research in other centers and with a larger number of patients."

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