The Somatic Connection  |   July 2015
Manual Therapy Improves Pulmonary Function Acutely
Author Affiliations
  • Hollis H. King, DO, PhD
    University of California, San Diego School of Medicine
Article Information
The Somatic Connection   |   July 2015
Manual Therapy Improves Pulmonary Function Acutely
The Journal of the American Osteopathic Association, July 2015, Vol. 115, 463. doi:
The Journal of the American Osteopathic Association, July 2015, Vol. 115, 463. doi:
González-Álvarez FJ, Valenza MC, Cabrera-Martos I, Torres-Sanchez I, Valenza-Demet G. Effects of a diaphragm stretching technique on pulmonary function in healthy participants: a randomized-controlled trial. Int J Osteopath Med. 2015;18:5-12. 
Researchers in the Physical Therapy Department at the University of Granada, Spain, examined the effects of a diaphragm-stretching technique on pulmonary functions in a randomized controlled trial. Eighty-six healthy participants recruited from the university were randomly assigned to an intervention or placebo group. Inclusion criteria were healthy participants of both sexes, age 20 to 50 years, and body mass index lower than 28. Exclusion criteria were back pain or illness in the past week, pregnancy, severe emotional stress, regular use of analgesic or anti-inflammatory medications, caffeine consumption within the past 24 hours, smoking more than 20 cigarettes per day, and manual therapy received within the previous month. Forty-three participants were allocated to the intervention group and 37 to the placebo group. 
The outcome measures were obtained before the intervention and 5 and 20 minutes after the intervention—a procedure used in osteopathic medicine that involved stretching of the diaphragm. 
The outcome measures were forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). Diaphragm muscle strength is measured by MIP, and abdominal muscle strength is measured by MEP. 
The intervention consisted of the practitioner, positioned behind the seated participant, placing his or her fingers bilaterally beneath the costal margins. For 5 to 7 minutes while the participant exhaled, slight resistance traction to exhalation was maintained as the ribs descended fully. The placebo was nontherapeutic ultrasound applied for 7 minutes. 
The results showed statistically significant improvement in all outcomes for the intervention group from before to after the procedure (FVC, P=.006; FEV1, P=.042; and MIP and MEP, P<.001). Also the between-group outcomes were significantly better for the intervention group (FVC, P<.001; FEV1, P=.031; and MIP and MEP, P<.001). The FVC and FEV1 improvements maintained at 5 minutes after the intervention, but they slightly declined at the 20-minute assessment. 
The authors attributed the improvements to the enhanced elastic capacity of the respiratory muscles and proposed that the procedure may be of value for short-term enhancement of pulmonary function, such as that needed in athletic performance. My clinical experience suggests that the periodic application of diaphragm stretching and other procedures such as rib raising and thoracic lymphatic pump treatment in patients with respiratory disorders, in addition to medication, reduces the morbidity from these conditions.