The Role of the Diaphragm in Trunk Stability: Difference between revisions

No edit summary
No edit summary
Line 37: Line 37:


When a person takes and holds a deep breath, the diaphragm assists the muscles of the anterior abdominal wall to raise the intra-abdominal pressure.<ref>Rasheed H, Ahmad I, Javed MA, Rashid J, Javeed RS. [https://www.tandfonline.com/doi/abs/10.1080/02703181.2020.1770395 Effects of Diaphragmatic Breathing Maneuver and Abdominal Drawing-in Maneuver on trunk stability in stroke patients.] Physical & Occupational Therapy In Geriatrics. 2021 Jan 2;39(1):1-0.</ref> This manoeuvre is also known as the Valsalva manoeuvre and is used to augment heart murmurs and classify them as clinically right-sided or left-sided.<ref>Bains KN, Kashyap S, Lappin SL. [https://www.ncbi.nlm.nih.gov/books/NBK519558/ Anatomy, Thorax, Diaphragm.] StatPearls [Internet]. 2021 Jul 26.</ref><ref>Roy JK, Roy TS, Mukhopadhyay SC. [https://link.springer.com/chapter/10.1007/978-3-319-99540-3_7 Heart sound: Detection and analytical approach towards diseases.] InModern Sensing Technologies 2019 (pp. 103-145). Springer, Cham.</ref><ref>Wirth K, Hartmann H, Mickel C, Szilvas E, Keiner M, Sander A. [https://link.springer.com/article/10.1007/s40279-016-0597-7 Core stability in athletes: a critical analysis of current guidelines.] Sports medicine. 2017 Mar;47(3):401-14.</ref>
When a person takes and holds a deep breath, the diaphragm assists the muscles of the anterior abdominal wall to raise the intra-abdominal pressure.<ref>Rasheed H, Ahmad I, Javed MA, Rashid J, Javeed RS. [https://www.tandfonline.com/doi/abs/10.1080/02703181.2020.1770395 Effects of Diaphragmatic Breathing Maneuver and Abdominal Drawing-in Maneuver on trunk stability in stroke patients.] Physical & Occupational Therapy In Geriatrics. 2021 Jan 2;39(1):1-0.</ref> This manoeuvre is also known as the Valsalva manoeuvre and is used to augment heart murmurs and classify them as clinically right-sided or left-sided.<ref>Bains KN, Kashyap S, Lappin SL. [https://www.ncbi.nlm.nih.gov/books/NBK519558/ Anatomy, Thorax, Diaphragm.] StatPearls [Internet]. 2021 Jul 26.</ref><ref>Roy JK, Roy TS, Mukhopadhyay SC. [https://link.springer.com/chapter/10.1007/978-3-319-99540-3_7 Heart sound: Detection and analytical approach towards diseases.] InModern Sensing Technologies 2019 (pp. 103-145). Springer, Cham.</ref><ref>Wirth K, Hartmann H, Mickel C, Szilvas E, Keiner M, Sander A. [https://link.springer.com/article/10.1007/s40279-016-0597-7 Core stability in athletes: a critical analysis of current guidelines.] Sports medicine. 2017 Mar;47(3):401-14.</ref>
{{#ev:youtube|Z4BxBh46h_Q}}


== Trunk stability ==
== Trunk stability ==
Line 53: Line 54:
== Valsalva Maneuver ==
== Valsalva Maneuver ==
The valsalva maneuver is a forced expiration against a closed glottis, associated with an increase in the intrathoracic and intra-abdominal pressure. It is simple but associated with complex cardiovascular changes, controlling the arterial [[Blood Pressure|blood pressure]] was one of the first aims as it is affected by signals of the [[Blood Pressure|baroreceptor]].<ref>Pstras L, Thomaseth K, Waniewski J, Balzani I, Bellavere F. [https://onlinelibrary.wiley.com/doi/abs/10.1111/apha.12639 The Valsalva manoeuvre: physiology and clinical examples]. Acta physiologica. 2016 Jun;217(2):103-19.</ref>
The valsalva maneuver is a forced expiration against a closed glottis, associated with an increase in the intrathoracic and intra-abdominal pressure. It is simple but associated with complex cardiovascular changes, controlling the arterial [[Blood Pressure|blood pressure]] was one of the first aims as it is affected by signals of the [[Blood Pressure|baroreceptor]].<ref>Pstras L, Thomaseth K, Waniewski J, Balzani I, Bellavere F. [https://onlinelibrary.wiley.com/doi/abs/10.1111/apha.12639 The Valsalva manoeuvre: physiology and clinical examples]. Acta physiologica. 2016 Jun;217(2):103-19.</ref>
{{#ev:youtube|JgYOWf2OCKA}}


For more on this, please see [[Valsalva Test|Valsalva Test.]]
For more on this, please see [[Valsalva Test|Valsalva Test.]]

Revision as of 12:09, 13 February 2022

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

Overview on Muscle systems[edit | edit source]

The local muscle system is comprised of a deep layer of slow-twitch muscles that control intersegmental movements. These muscles respond to changes in posture and extrinsic loads.

Key local muscles include:

The global muscle system involves fast-twitch, long muscles that possess a large lever arm to produce torque and gross movements.

Key global muscles include:

Diaphragm: Balance, Gait and Trunk Stability[edit | edit source]

  • The diaphragms primary role is a muscle of respiration and controls how we breathe.
  • The diaphragm has an important role in stabilising the trunk to enhance balance and walking[1] in conjunction with the abdominal muscles and paraspinal muscles.[2]
  • The diaphragm also plays a role in trunk stability by controlling intra-abdominal pressure and reducing stress on the spine through cooperative action with the abdominal and pelvic floor muscles.[3]

Core Stabiliser[edit | edit source]

Diaphragm cylinder.png

The diaphragm, multifidus, transversus abdominis, and the pelvic floor muscles, act as one unit at the centre of various functional kinetic chains. It has been noted that the co-contraction of the abdominal muscles and the diaphragm increases intra-abdominal pressure, fixes the trunk, and reduces stress on the spine, especially in the lumbar region.[4]

Muscle of Abdominal Straining

The contraction of the diaphragm will assist in the contraction of the muscles of the anterior abdominal wall in raising the intra-abdominal pressure during normal processes like micturition, defecation, vomiting and parturition (childbirth).[5]

Weightlifting Muscle

When a person takes and holds a deep breath, the diaphragm assists the muscles of the anterior abdominal wall to raise the intra-abdominal pressure.[6] This manoeuvre is also known as the Valsalva manoeuvre and is used to augment heart murmurs and classify them as clinically right-sided or left-sided.[7][8][9]

Trunk stability[edit | edit source]

There are two types of spinal instability:[5]

  1. Gross Instability: obvious radiographic displacement of the vertebra associated with neurologic deficit and deformity.
  2. Functional/Clinical Instability: "Clinical instability as the loss of the spine's ability to maintain its patterns of displacement under physiologic loads so there is no initial or additional neurologic deficit, no major deformity, and no incapacitating pain“[10]
  • Core strength provides proximal trunk stability for distal mobility. Hence most of our exercises will focus on the mobility of extremities along with core/ lumbar stabilisation with deep breathing techniques.[11]
  • Training of the core involves the coordination of both sensory and motor inputs, comprising of:
    • Neuromuscular control
    • Passive structural components (osseous and ligamentous elements)
    • Active mobile components (29 pairs of muscular elements)[12]

Thoracoabdominal Pump[edit | edit source]

When people breathe in, the diaphragm descends, which decreases intrathoracic pressure and increases intra-abdominal pressure. This compresses the blood in the Inferior Vena Cava (IVC) and forces it upward into the right atrium to fill the heart. When the abdominal lymph vessels are also compressed, the upward movement of lymph within the thoracic duct is aided by the negative intrathoracic pressure. Furthermore, valves in the thoracic duct prevent the backflow of the lymph in the thoracic duct.[13] [14]

Valsalva Maneuver[edit | edit source]

The valsalva maneuver is a forced expiration against a closed glottis, associated with an increase in the intrathoracic and intra-abdominal pressure. It is simple but associated with complex cardiovascular changes, controlling the arterial blood pressure was one of the first aims as it is affected by signals of the baroreceptor.[15]

For more on this, please see Valsalva Test.

References[edit | edit source]

  1. ↑ Kocjan J, Gzik-Zroska B, Nowakowska K, Burkacki M, Suchoń S, Michnik R, Czyżewski D, Adamek M. Impact of diaphragm function parameters on balance maintenance. Plos one. 2018 Dec 28;13(12):e0208697.
  2. ↑ Wilhelm M. The Effect of Low Back Pain History on Multifidus Co-contraction During Common Lumbosacral Voluntary Stabilizing Contractions (Doctoral dissertation).
  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. ↑ Michael S, Erik S, Udo S, Edward L. Atlas of Anatomy: General Anatomy and the Musculoskeletal System.
  5. ↑ 5.0 5.1 Pandya R. The Role of the Diaphragm in Trunk Stability Course. Physioplus, 2022.
  6. ↑ Rasheed H, Ahmad I, Javed MA, Rashid J, Javeed RS. Effects of Diaphragmatic Breathing Maneuver and Abdominal Drawing-in Maneuver on trunk stability in stroke patients. Physical & Occupational Therapy In Geriatrics. 2021 Jan 2;39(1):1-0.
  7. ↑ Bains KN, Kashyap S, Lappin SL. Anatomy, Thorax, Diaphragm. StatPearls [Internet]. 2021 Jul 26.
  8. ↑ Roy JK, Roy TS, Mukhopadhyay SC. Heart sound: Detection and analytical approach towards diseases. InModern Sensing Technologies 2019 (pp. 103-145). Springer, Cham.
  9. ↑ Wirth K, Hartmann H, Mickel C, Szilvas E, Keiner M, Sander A. Core stability in athletes: a critical analysis of current guidelines. Sports medicine. 2017 Mar;47(3):401-14.
  10. ↑ Panjabi MM. Clinical spinal instability and low back pain. Journal of electromyography and kinesiology. 2003 Aug 1;13(4):371-9.
  11. ↑ Kim E, Lee H. The effects of deep abdominal muscle strengthening exercises on respiratory function and lumbar stability. Journal of physical therapy science. 2013 Jun 25;25(6):663-5.
  12. ↑ Walters S, GradCert B. Investigation into intra-abdominal pressure and neuromuscular activation to increase force production in traditional martial arts practitioners (Doctoral dissertation, University of Southern Queensland).
  13. ↑ Bains KN, Kashyap S, Lappin SL. Anatomy, Thorax, Diaphragm. StatPearls [Internet]. 2021 Jul 26.
  14. ↑ McCool FD, Manzoor K, Minami T. Disorders of the diaphragm. Clinics in chest medicine. 2018 Jun 1;39(2):345-60.
  15. ↑ Pstras L, Thomaseth K, Waniewski J, Balzani I, Bellavere F. The Valsalva manoeuvre: physiology and clinical examples. Acta physiologica. 2016 Jun;217(2):103-19.
Retrieved from "https://www.physio-pedia.com/index.php?title=The_Role_of_the_Diaphragm_in_Trunk_Stability&oldid=293979"