The Effect of Posture on the Diaphragm: Difference between revisions

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<div class="editorbox"> '''Original Editor '''- [[User:Carin Hunter|Carin Hunter]] based on the course by [https://members.physio-pedia.com/course_tutor/rina-pandya/ Rina Pandya]<br>'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
<div class="editorbox"> '''Original Editor '''- [[User:Carin Hunter|Carin Hunter]] based on the course by [https://members.physio-pedia.com/course_tutor/rina-pandya/ Rina Pandya]<br>'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>


== Effect of posture on Diaphragm ==
== Effect of posture on the Diaphragm ==
When optimising diaphragm function, a vertical length of the body is needed. We need both the thoracic and the abdominal cavities to be long enough for the diaphragm to create negative and positive pressures during inspiration and expiration. A patient needs to be able to take a deep breath down to the base of the lungs so the ribs can flare out, the diaphragm can dropdown.
When optimising diaphragm function, a vertical length of the body is needed. We need both the thoracic and the abdominal cavities to be long enough for the diaphragm to create negative and positive pressures during inspiration and expiration. A patient needs to be able to take a deep breath down to the base of the lungs so the ribs can flare out, the diaphragm can drop down.


[[Forward Head Posture|Forward head posture]] (FHP) and [[Thoracic Hyperkyphosis|Kyphosis]] have been shown to alter the breathing mechanism including diaphragm mobility.
[[Forward Head Posture|Forward head posture]] (FHP) and [[Thoracic Hyperkyphosis|Kyphosis]] have been shown to alter the breathing mechanism including diaphragm mobility.
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The increased degree of FHP has a bearing effect on chest expansion and respiratory muscles activities which can lead to reduced alveolar ventilation. <ref>Okuro RT, Morcillo AM, Ribeiro MÂ, Sakano E, Conti PB, Ribeiro JD. [https://www.scielo.br/j/jbpneu/a/tCkpp5ZTsgjpwqvSFmTZfxs/?lang=en Mouth breathing and forward head posture: effects on respiratory biomechanics and exercise capacity in children]. Jornal Brasileiro de Pneumologia. 2011;37:471-9.</ref> This could be a result of temporary entrapment of the phrenic nerve, which supplies the diaphragm, reduces neural activity, and consequently weakens diaphragm activity. <ref>Lane MA. [https://www.sciencedirect.com/science/article/abs/pii/S1569904811002473 Spinal respiratory motoneurons and interneurons]. Respiratory physiology & neurobiology. 2011 Oct 15;179(1):3-13.</ref>
The increased degree of FHP has a bearing effect on chest expansion and respiratory muscles activities which can lead to reduced alveolar ventilation. <ref>Okuro RT, Morcillo AM, Ribeiro MÂ, Sakano E, Conti PB, Ribeiro JD. [https://www.scielo.br/j/jbpneu/a/tCkpp5ZTsgjpwqvSFmTZfxs/?lang=en Mouth breathing and forward head posture: effects on respiratory biomechanics and exercise capacity in children]. Jornal Brasileiro de Pneumologia. 2011;37:471-9.</ref> This could be a result of temporary entrapment of the phrenic nerve, which supplies the diaphragm, reduces neural activity, and consequently weakens diaphragm activity. <ref>Lane MA. [https://www.sciencedirect.com/science/article/abs/pii/S1569904811002473 Spinal respiratory motoneurons and interneurons]. Respiratory physiology & neurobiology. 2011 Oct 15;179(1):3-13.</ref>


Hodges et al deduced that altered diaphragm function leads to core muscles instability, which will further lead to other systemic and musculoskeletal disorders including spinal instability. <ref>Hodges PW, Gurfinkel VS, Brumagne S, Smith TC, Cordo PC. [https://link.springer.com/article/10.1007/s00221-002-1040-x Coexistence of stability and mobility in postural control: evidence from postural compensation for respiration.] Experimental brain research. 2002 Jun;144(3):293-302.</ref>
Hodges et al <ref>Hodges PW, Gurfinkel VS, Brumagne S, Smith TC, Cordo PC. [https://link.springer.com/article/10.1007/s00221-002-1040-x Coexistence of stability and mobility in postural control: evidence from postural compensation for respiration.] Experimental brain research. 2002 Jun;144(3):293-302.</ref> deduced that altered diaphragm function leads to core muscle instability, which will further lead to other systemic and musculoskeletal disorders including spinal instability.


A FHP disturbs the normal respiratory biomechanics<ref>Triangto K, Widjanantie SC, Nusdwinuringtyas N. [http://indojournalpmr.org/IJPMR/article/view/249 Biomechanical Impacts of Forward Head Posture on the Respiratory Function.] Indonesian Journal of Physical Medicine & Rehabilitation. 2019;8(02):50-64.</ref> and therefore, results in expansion of the upper thorax and contraction of the lower thorax. The consequence of these changes is decreased respiratory function. <ref>Koseki T, Kakizaki F, Hayashi S, Nishida N, Itoh M. [https://www.jstage.jst.go.jp/article/jpts/31/1/31_jpts-2018-328/_pdf/-char/ja Effect of forward head posture on thoracic shape and respiratory function.] Journal of physical therapy science. 2019;31(1):63-8.</ref>
A FHP disturbs the normal respiratory biomechanics<ref>Triangto K, Widjanantie SC, Nusdwinuringtyas N. [http://indojournalpmr.org/IJPMR/article/view/249 Biomechanical Impacts of Forward Head Posture on the Respiratory Function.] Indonesian Journal of Physical Medicine & Rehabilitation. 2019;8(02):50-64.</ref> and therefore, results in expansion of the upper thorax and contraction of the lower thorax. The consequence of these changes is decreased respiratory function. <ref>Koseki T, Kakizaki F, Hayashi S, Nishida N, Itoh M. [https://www.jstage.jst.go.jp/article/jpts/31/1/31_jpts-2018-328/_pdf/-char/ja Effect of forward head posture on thoracic shape and respiratory function.] Journal of physical therapy science. 2019;31(1):63-8.</ref>
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== Kyphotic posture: ==
== Kyphotic posture: ==
Kyphosis can be a result of torticollis and FHP leading to the development of a secondary thoracic curve to compensate for the flattening of the cervical spine curve.  Alteration of cervicothoracic mobility impairs normal breathing mechanics by reducing diaphragm mobility and strength. <ref>Chaitow L. [https://www.bodyworkmovementtherapies.com/article/S1360-8592(14)00139-9/fulltext Functional movement and breathing dysfunction.] Journal of bodywork and movement therapies. 2016 Jul 1;20(3):455-6.</ref>
Kyphosis can be a result of torticollis and FHP leading to the development of a secondary thoracic curve to compensate for the flattening of the cervical spine curve.  Altered cervicothoracic mobility impairs normal breathing mechanics by reducing diaphragm mobility and strength. <ref>Chaitow L. [https://www.bodyworkmovementtherapies.com/article/S1360-8592(14)00139-9/fulltext Functional movement and breathing dysfunction.] Journal of bodywork and movement therapies. 2016 Jul 1;20(3):455-6.</ref>


When an individual is slumped with a kyphotic posture, this approximation of ribs and pelvis has been shown to increase intra-abdominal pressure making movement of the diaphragm difficult. This can lead to:  
When an individual is slumped with a kyphotic posture, this approximation of ribs and pelvis has been shown to increase intra-abdominal pressure making movement of the diaphragm difficult. This can lead to:  
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# Decreased Forced Vital Capacity<ref>Haque MF, Akhter S, Tasnim N, Haque M, Paul S, Begum M. [https://www.banglajol.info/index.php/BMRCB/article/view/42541 Effects of different sitting postures on forced vital capacity in healthy school children.] Bangladesh Medical Research Council Bulletin. 2019 Aug 7;45(2):117-21.</ref>
# Decreased Forced Vital Capacity<ref>Haque MF, Akhter S, Tasnim N, Haque M, Paul S, Begum M. [https://www.banglajol.info/index.php/BMRCB/article/view/42541 Effects of different sitting postures on forced vital capacity in healthy school children.] Bangladesh Medical Research Council Bulletin. 2019 Aug 7;45(2):117-21.</ref>


When assessing a patient with FHP and torticollis, respiratory function should be included. When assessing respiratory function, the SNIP tool (Sniff Nasal Inspiratory Pressure)<ref>Prigent H, Lejaille M, Falaize L, Louis A, Ruquet M, Fauroux B, Raphael JC, Lofaso F. [https://link.springer.com/article/10.1385/NCC:1:4:475 Assessing inspiratory muscle strength by sniff nasal inspiratory pressure.] Neurocritical care. 2004 Dec;1(4):475-8.</ref> could be used. It is simple, easy to use and can be integrated into practice for screening individuals with mal-posture. <ref>Zafar H, Albarrati A, Alghadir AH, Iqbal ZA. [https://www.hindawi.com/journals/bmri/2018/4518269/ Effect of different head-neck postures on the respiratory function in healthy males.] BioMed research international. 2018 Jul 12;2018.</ref>
Respiratory function should also be assessed in patients presenting with FHP and torticollis. The SNIP tool (Sniff Nasal Inspiratory Pressure)<ref>Prigent H, Lejaille M, Falaize L, Louis A, Ruquet M, Fauroux B, Raphael JC, Lofaso F. [https://link.springer.com/article/10.1385/NCC:1:4:475 Assessing inspiratory muscle strength by sniff nasal inspiratory pressure.] Neurocritical care. 2004 Dec;1(4):475-8.</ref> is useful for assessing respiratory function. It is simple, easy to use and can be integrated into practice for screening individuals with mal-posture. <ref>Zafar H, Albarrati A, Alghadir AH, Iqbal ZA. [https://www.hindawi.com/journals/bmri/2018/4518269/ Effect of different head-neck postures on the respiratory function in healthy males.] BioMed research international. 2018 Jul 12;2018.</ref>


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{{#ev:youtube|9D4qWWc9MKc}}


== Posture in an ICU Bed ==
== Posture in an ICU Bed ==
Often to make a patient comfortable, pillows are placed under the head and under the knees. The patient is now lying in a hammock position in the bed. These steps are in fact reducing the ability of the diaphragm to function.
Pillows placed under the head and knees are often used to make patients comfortable in bed. This results in the patient lying in a 'hammock' position in the bed which reduces the ability of the diaphragm to function optimally.


'''Poor ICU positioning results in:'''
'''Poor ICU positioning results in:'''
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* Increased apical breathing  
* Increased apical breathing  
* Decreased diaphragmatic breathing
* Decreased diaphragmatic breathing
'''Consequences''':
'''Consequences''':
# Anterior neck muscle tightness  
* Anterior neck muscle tightness
# Cervical extensor muscle weakness  
* Cervical extensor muscle weakness
# Diaphragmatic weakness.
* Diaphragmatic weakness.


== Other factors to consider ==
== Other factors to consider ==
'''Diaphragm influences:'''  
'''The diaphragm influences:'''  


# Oesophageal function
# Oesophageal function

Revision as of 03:14, 16 November 2021

Original Editor - Carin Hunter based on the course by Rina Pandya
Top Contributors - Ewa Jaraczewska, Carin Hunter, Jess Bell, Lucinda hampton, Merinda Rodseth and Kim Jackson

Effect of posture on the Diaphragm[edit | edit source]

When optimising diaphragm function, a vertical length of the body is needed. We need both the thoracic and the abdominal cavities to be long enough for the diaphragm to create negative and positive pressures during inspiration and expiration. A patient needs to be able to take a deep breath down to the base of the lungs so the ribs can flare out, the diaphragm can drop down.

Forward head posture (FHP) and Kyphosis have been shown to alter the breathing mechanism including diaphragm mobility.

Forward head posture[edit | edit source]

The increased degree of FHP has a bearing effect on chest expansion and respiratory muscles activities which can lead to reduced alveolar ventilation. [1] This could be a result of temporary entrapment of the phrenic nerve, which supplies the diaphragm, reduces neural activity, and consequently weakens diaphragm activity. [2]

Hodges et al [3] deduced that altered diaphragm function leads to core muscle instability, which will further lead to other systemic and musculoskeletal disorders including spinal instability.

A FHP disturbs the normal respiratory biomechanics[4] and therefore, results in expansion of the upper thorax and contraction of the lower thorax. The consequence of these changes is decreased respiratory function. [5]

For the diaphragm to be most effective during breathing we need to:

  1. Restore normal length-tension relationship
  2. Improve mobility and expansion in the chest wall
  3. Relieve the load on accessory respiratory muscles in the neck[6]

Kyphotic posture:[edit | edit source]

Kyphosis can be a result of torticollis and FHP leading to the development of a secondary thoracic curve to compensate for the flattening of the cervical spine curve.  Altered cervicothoracic mobility impairs normal breathing mechanics by reducing diaphragm mobility and strength. [7]

When an individual is slumped with a kyphotic posture, this approximation of ribs and pelvis has been shown to increase intra-abdominal pressure making movement of the diaphragm difficult. This can lead to:

  1. Reduced lung capacity
  2. Reduced inspiratory flow [8]
  3. Decreased Forced Vital Capacity[9]

Respiratory function should also be assessed in patients presenting with FHP and torticollis. The SNIP tool (Sniff Nasal Inspiratory Pressure)[10] is useful for assessing respiratory function. It is simple, easy to use and can be integrated into practice for screening individuals with mal-posture. [11]

Posture in an ICU Bed[edit | edit source]

Pillows placed under the head and knees are often used to make patients comfortable in bed. This results in the patient lying in a 'hammock' position in the bed which reduces the ability of the diaphragm to function optimally.

Poor ICU positioning results in:

  • Increased forward head angle
  • Increased apical breathing
  • Decreased diaphragmatic breathing


Consequences:

  • Anterior neck muscle tightness
  • Cervical extensor muscle weakness
  • Diaphragmatic weakness.

Other factors to consider[edit | edit source]

The diaphragm influences:

  1. Oesophageal function
  2. Digestive function
    • The peristaltic movements, massaging of the abdominal contents
  3. Vascular function with the blood pressure
  4. Immune system
    • The diaphragm helps with immunity because it's creating fresh flow and assists with the absorption of nutrients and vitamins.

References[edit | edit source]

  1. ↑ Okuro RT, Morcillo AM, Ribeiro MÂ, Sakano E, Conti PB, Ribeiro JD. Mouth breathing and forward head posture: effects on respiratory biomechanics and exercise capacity in children. Jornal Brasileiro de Pneumologia. 2011;37:471-9.
  2. ↑ Lane MA. Spinal respiratory motoneurons and interneurons. Respiratory physiology & neurobiology. 2011 Oct 15;179(1):3-13.
  3. ↑ Hodges PW, Gurfinkel VS, Brumagne S, Smith TC, Cordo PC. Coexistence of stability and mobility in postural control: evidence from postural compensation for respiration. Experimental brain research. 2002 Jun;144(3):293-302.
  4. ↑ Triangto K, Widjanantie SC, Nusdwinuringtyas N. Biomechanical Impacts of Forward Head Posture on the Respiratory Function. Indonesian Journal of Physical Medicine & Rehabilitation. 2019;8(02):50-64.
  5. ↑ Koseki T, Kakizaki F, Hayashi S, Nishida N, Itoh M. Effect of forward head posture on thoracic shape and respiratory function. Journal of physical therapy science. 2019;31(1):63-8.
  6. ↑ Haghighat F, Moradi R, Rezaie M, Yarahmadi N, Ghaffarnejad F. Added Value of Diaphragm Myofascial Release on Forward Head Posture and Chest Expansion in Patients With Neck Pain: A Randomized Controlled Trial.
  7. ↑ Chaitow L. Functional movement and breathing dysfunction. Journal of bodywork and movement therapies. 2016 Jul 1;20(3):455-6.
  8. ↑ Lin F, Parthasarathy S, Taylor SJ, Pucci D, Hendrix RW, Makhsous M. Effect of different sitting postures on lung capacity, expiratory flow, and lumbar lordosis. Archives of physical medicine and rehabilitation. 2006 Apr 1;87(4):504-9.
  9. ↑ Haque MF, Akhter S, Tasnim N, Haque M, Paul S, Begum M. Effects of different sitting postures on forced vital capacity in healthy school children. Bangladesh Medical Research Council Bulletin. 2019 Aug 7;45(2):117-21.
  10. ↑ Prigent H, Lejaille M, Falaize L, Louis A, Ruquet M, Fauroux B, Raphael JC, Lofaso F. Assessing inspiratory muscle strength by sniff nasal inspiratory pressure. Neurocritical care. 2004 Dec;1(4):475-8.
  11. ↑ Zafar H, Albarrati A, Alghadir AH, Iqbal ZA. Effect of different head-neck postures on the respiratory function in healthy males. BioMed research international. 2018 Jul 12;2018.
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