Free
OMT Minute  |   August 2018
Doming the Diaphragm in a Patient With Multiple Sclerosis
Author Notes
  • From the Touro University College of Osteopathic Medicine-CA in Vallejo. 
  • Financial Disclosures: None reported. 
  • Support: This video was produced by Touro University College of Osteopathic Medicine-CA. 
  •  *Address correspondence to R. Mitchell Hiserote, DO, 1310 Club Dr, Mare Island, Vallejo, CA 94592-1187. Email: mitchell.hiserote@tu.edu
     
Article Information
Neuromusculoskeletal Disorders
OMT Minute   |   August 2018
Doming the Diaphragm in a Patient With Multiple Sclerosis
The Journal of the American Osteopathic Association, August 2018, Vol. 118, e83. doi:10.7556/jaoa.2018.129
The Journal of the American Osteopathic Association, August 2018, Vol. 118, e83. doi:10.7556/jaoa.2018.129
Web of Science® Times Cited: 2
  
OMT Minute: Doming the Diaphragm in a Patient with Multiple Sclerosis
eVideo. Patients with multiple sclerosis may have fatigue related to breathing and weakness of the respiratory muscles. In this video, R. Mitchell Hiserote, DO, demonstrates doming the diaphragm to improve respiratory dysfunction.
Symptoms of multiple sclerosis (MS) are varied, but common complaints include fatigue, pain, weakness, paresthesia, spasticity, coordination, and gait issues.1,2 Small studies have demonstrated that manipulative therapies, including osteopathic manipulative treatment (OMT), can decrease fatigue and increase quality of life in healthy patients and/or those with chronic diseases, such as MS, in which fatigue is a major complaint.2-5 Work involved in breathing can play a role in fatigue, and fatigue may contribute to weakness of the respiratory muscles.6 
Patients with MS may have compromised respiratory physiology.7-9 Moderate to advanced MS may cause significant respiratory dysfunction and complications.6 Diagnosis and treatment of the thoracic diaphragm may improve respiratory dysfunction affecting lung, vascular, and lymphatic physiologic motion. 
The thoracic diaphragm is a domed circular muscle of respiration with a central tendon. Its anterior attachments include the costal/cartilaginous margins of ribs 7 to 12 and the xiphoid. Posteriorly, the diaphragm attaches to the lumbar vertebra L1-L3 via the diaphragmatic crura, and the medial and lateral longitudinal arches over the iliopsoas and quadratus lumborum muscles.10 On inhalation, the thoracic diaphragm contracts, descending and flattening from a fully domed position while concurrently increasing the lateral diameter of the lower costal structures.11 Osteopathic manipulative treatment of the thoracic diaphragm can “redome” a dysfunctional or flattened muscle to optimize its physiologic motion in respiration.12 
The thoracic doming technique is primarily a passive myofascial technique (video). Diaphragm doming is generally well tolerated; however, contraindications may include intravenous lines, drainage tubes, incisions near the area, severe hernias, rib or vertebral fractures, malignancy in the area, or undiagnosed epigastric or chest pain.13 This technique works best when also examining and treating the ribs, sternum, thoracic spine, and lumbar spine to address the diaphragm attachments.12 
Acknowledgments
Special thanks to Jeff Reedy for contributions in video production and editing and to the patient model, Joel Talsma, MS. 
References
Hauser SL, Goodin DS. Multiple sclerosis and other demyelinating diseases. In: Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrisons Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill Professional; 2012:3395-3409.
Negahban H, Rezaie S, Goharpey S. Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study. Clin Rehabil. 2013;27(12):1126-1136. doi: 10.1177/0269215513491586 [CrossRef] [PubMed]
Wiegand S, Bianchi W, Quinn TA, Best M, Fotopoulos T. Osteopathic manipulative treatment for self-reported fatigue, stress, and depression in first-year osteopathic medical students. J Am Osteopath Assoc. 2015;115(2):84-93. [PubMed]
Hernandez-Reif M, Field T, Field T, Theakston H. Multiple sclerosis patients benefit from massage therapy. J Bodyw Mov Ther. 1998;2(3):168-174. [CrossRef]
Yates HA, Vardy TC, Kuchera ML, Ripley BD, Johnson JC. Effects of osteopathic manipulative treatment and concentric and eccentric maximal-effort exercise on women with multiple sclerosis: a pilot study. J Am Osteopath Assoc. 2002;102(5):267-275. [PubMed]
Tzelepis GE, McCool FD. Respiratory dysfunction in multiple sclerosis. Respir Med. 2015;109(6):671-679. [CrossRef] [PubMed]
Tantucci C, Massucci M, Piperno R, Betti L, Grassi V, Sorbini CA. Control of breathing and respiratory muscle strength in patients with multiple sclerosis. Chest. 1994;105(4):1163-1170. [CrossRef] [PubMed]
Mutluay FK, Gürses HN, Saip S. Effects of multiple sclerosis on respiratory functions. Clin Rehabil. 2005;19(4):426-432. [CrossRef] [PubMed]
Braley TJ, Segal BM, Chervin RD. Sleep-disordered breathing in multiple sclerosis. Neurology. 2012;79(9):929-936. [CrossRef] [PubMed]
Gilroy A, MacPherson B. Atlas of Anatomy. 3rd ed. New York, NY: Thieme; 2016:147.
Chila AG, executive ed. Foundations of Osteopathic Medicine. 3rd ed. Baltimore, MD: Wolters Kluwer; 2010:530-536, 697.
DiGiovanna EL, Schiowitz S, Dowling DJ. An Osteopathic Approach to Diagnosis and Treatment. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:363-366, 404.
Nicholas AS, Nicholas EA. Atlas of Osteopathic Techniques. 3rd ed. Philadelphia, PA: Wolters Kluwer; 2016:526-527.
  
OMT Minute: Doming the Diaphragm in a Patient with Multiple Sclerosis
eVideo. Patients with multiple sclerosis may have fatigue related to breathing and weakness of the respiratory muscles. In this video, R. Mitchell Hiserote, DO, demonstrates doming the diaphragm to improve respiratory dysfunction.