Effects of diaphragm stretching on posterior chain muscle kinematics and rib cage and abdominal excursion: a randomized controlled trial

González-Álvarez, Francisco J.; Valenza, Marie C.; Torres-Sánchez, Irene; Cabrera-Martos, Irene; Rodríguez-Torres, Janet; Castellote-Caballero, Yolanda

doi:10.1590/bjpt-rbf.2014.0169

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Brazilian Journal of Physical Therapy

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Original Articles • Braz. J. Phys. Ther. 20 (05) • Oct 2016 • https://doi.org/10.1590/bjpt-rbf.2014.0169 copy

Effects of diaphragm stretching on posterior chain muscle kinematics and rib cage and abdominal excursion: a randomized controlled trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background

Few studies have explored the effects of stretching techniques on diaphragm and spine kinematics.

Objective

To determine whether the application of diaphragm stretching resulted in changes in posterior chain muscle kinematics and ribcage and abdominal excursion in healthy subjects.

Method

Eighty healthy adults were included in this randomized clinical trial. Participants were randomized into two groups: the experimental group, which received a diaphragmatic stretching technique, or the placebo group, which received a sham-ultrasound procedure. The duration of the technique, the position of participants, and the therapist who applied the technique were the same for both treatments. Participant assessment (cervical range of movement, lumbar flexibility, flexibility of the posterior chain, and rib cage and abdominal excursion) was performed at baseline and immediately after the intervention by a blinded assessor.

Results

The mean between-group difference [95% CI] for the ribcage excursion after technique at xiphoid level was 2.48 [0.97 to 3.99], which shows significant differences in this outcome. The remaining between-group analysis showed significant differences in cervical extension, right and left flexion, flexibility of the posterior chain, and ribcage excursion at xiphoid level (p<0.05) in favor of the experimental group.

Conclusion

Diaphragm stretching generates a significant improvement in cervical extension, right and left cervical flexion, flexibility of the posterior chain, and ribcage excursion at xiphoid level compared to a placebo technique in healthy adults.

Keywords:
muscle stretching exercises; diaphragm; movement; physical therapy

	Stretching group (n=43)	Control group (n=37)
Sex n (% males)	19 (44.18)	15 (40.54)
Age (years) Mean±SD	36.33±15.93	37.4±15.82
Height (cm) Mean±SD	167±0.83	169±0.99
Weight (kg) Mean±SD	65.22±12.59	66.5±12.10
BMI (kg/cm²) Mean±SD	23.26±3.31	23.02±3.36
Smokers n (%)	22 (51.16)	19 (51.35)

	Stretching group (n=43)	Control group (n=37)
Cervical range of movement
Flexion (degrees)	46.21±9.36	49.07±6.66
Extension (degrees)	53.14±11.02	55.19±8.02
Right lateral flexion (degrees)	40.35±7.59	41.67±7.07
Left lateral flexion (degrees)	40.51±6.19	43.52±7.05
Schober’s test (cm)	14.52±1.06	14.28±1.08
Finger-to-floor test (cm)	4.66±6.76	3.37±5.24
Rib cage excursion
Axillary level (cm)	3.89±2.50	3.83±1.59
Xiphoid level (cm)	4.30±2.41	4.69±2.08
Abdominal level (cm)	0.10±2.87	–0.74±1.68

	Stretching group (n=43)	P-value	Control group (n=37)	P-value	Mean between-group difference (95% CI)	Between-groups p value
Cervical range of movement
Flexion Pre-technique Post-technique	46.21±9.31 51.51±7.62	p<0.001^ Significant differences p≤0.001.	49.07±6.61 50.00±6.72	0.379	1.51 [–2.06 to 5.09]	0.402
Extension Pre-technique Post-technique	53.14±11.0 59.3±9.9	p<0.001^ Significant differences p≤0.001.	55.19±8.0 55.00±6.35	0.852	4.3 [0.006 to 8.59]	0.050^* * Significant differences p<0.05.
Right lateral flexion Pre-technique Post-technique	40.35±7.5 44.42±6.51	p<0.001^ Significant differences p≤0.001.	41.67±7.01 41.30±5.90	0.646	3.12 [0.01 to 6.23]	0.049^* * Significant differences p<0.05.
Left lateral flexion Pre-technique Post-technique	40.51±6.11 46.98±6.2	p<0.001^ Significant differences p≤0.001.	43.52±7.01 43.7±5.20	0.832	3.27 [0.37 to 6.17]	0.028^* * Significant differences p<0.05.
Schober’s test Pre-technique Post-technique	14.52±1.05 15.01±1.03	p<0.001^ Significant differences p≤0.001.	14.27±1.07 14.33±1.10	0.376	0.67 [0.15 to 1.19]	0.011^* * Significant differences p<0.05.
Finger-to-floor test Pre-technique Post-technique	4.66±6.76 3.37±5.80	0.001^ Significant differences p≤0.001.	3.37±5.21 3.33±5.32	0.646	0.039 [–2.72 to 2.8]	0.978
Rib cage excursion
Axillary level Pre-technique Post-technique	3.89±2.50 4.27±1.87	0.352	3.83±1.59 3.87±1.43	0.895	0.34 [–0.43 to 1.23]	0.347
Xiphoid level Pre-technique Post-technique	4.30±2.40 6.93±3.45	p<0.001^ Significant differences p≤0.001.	4.69±2.08 4.44±2.36	0.582	2.48 [0.97 to 3.99]	0.002^* * Significant differences p<0.05.
Abdominal level Pre-technique Post-technique	0.10±2.87 –0.12±2.57	0.885	–0.74±1.68 0.741±1.66	0.020^* * Significant differences p<0.05.	-0.75 [-1.86 to 0.35]	0.181

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[1] *Correspondence Marie Carmen Valenza University of Granada Department of Physical Therapy Avda. de la Ilustración, 18016 Granada, Spain e-mail: cvalenza@ugr.es