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