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Doming the Diaphragm in a Patient With Multiple Sclerosis

  • Zachary Anderson , R. Mitchell Hiserote and Stacey Pierce-Talsma
Published/Copyright: August 1, 2018
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 118 Issue 8

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

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:

Acknowledgments

Special thanks to Jeff Reedy for contributions in video production and editing and to the patient model, Joel Talsma, MS.

References

1. Hauser SL , GoodinDS. Multiple sclerosis and other demyelinating diseases. In: LongoD, FauciA, KasperD, HauserS, JamesonJ, LoscalzoJ.Harrison’s Principles of Internal Medicine.18th ed. New York, NY: McGraw-Hill Professional; 2012:3395-3409.Search in Google Scholar

2. Negahban H , RezaieS, GoharpeyS. Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study. Clin Rehabil. 2013;27(12):1126-1136. doi:10.1177/0269215513491586Search in Google Scholar

3. Wiegand S , BianchiW, QuinnTA, BestM, FotopoulosT. Osteopathic manipulative treatment for self-reported fatigue, stress, and depression in first-year osteopathic medical students. J Am Osteopath Assoc. 2015;115(2):84-93.10.7556/jaoa.2015.019Search in Google Scholar

4. Hernandez-Reif M , FieldT, FieldT, TheakstonH. Multiple sclerosis patients benefit from massage therapy. J Bodyw Mov Ther. 1998;2(3):168-174.10.1016/S1360-8592(98)80009-0Search in Google Scholar

5. Yates HA , VardyTC, KucheraML, RipleyBD, JohnsonJC. 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.Search in Google Scholar

6. Tzelepis GE , McCoolFD. Respiratory dysfunction in multiple sclerosis. Respir Med. 2015;109(6):671-679.10.1016/j.rmed.2015.01.018Search in Google Scholar PubMed

7. Tantucci C , MassucciM, PipernoR, BettiL, GrassiV, SorbiniCA. Control of breathing and respiratory muscle strength in patients with multiple sclerosis. Chest. 1994;105(4):1163-1170.10.1378/chest.105.4.1163Search in Google Scholar PubMed

8. Mutluay FK , GürsesHN, SaipS. Effects of multiple sclerosis on respiratory functions. Clin Rehabil. 2005;19(4):426-432.10.1191/0269215505cr782oaSearch in Google Scholar PubMed

9. Braley TJ , SegalBM, ChervinRD. Sleep-disordered breathing in multiple sclerosis. Neurology. 2012;79(9):929-936.10.1212/WNL.0b013e318266fa9dSearch in Google Scholar PubMed PubMed Central

10. Gilroy A , MacPhersonB. Atlas of Anatomy. 3rd ed. New York, NY: Thieme; 2016:147.10.1055/b-005-148857Search in Google Scholar

11. Chila AG , executive ed. Foundations of Osteopathic Medicine.3rd ed. Baltimore, MD: Wolters Kluwer; 2010:530-536, 697.Search in Google Scholar

12. DiGiovanna EL , SchiowitzS, DowlingDJ. An Osteopathic Approach to Diagnosis and Treatment.3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:363-366, 404.Search in Google Scholar

13. Nicholas AS , NicholasEA. Atlas of Osteopathic Techniques.3rd ed. Philadelphia, PA: Wolters Kluwer; 2016:526-527.Search in Google Scholar
Accepted: 2018-07-09
Published Online: 2018-08-01
Published in Print: 2018-08-01

© 2018 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  1. SURF
  2. Sleep and Lifestyle Habits of Osteopathic Emergency Medicine Residents During Training
  3. Addressing the Increased Incidence of Common Sexually Transmitted Infections
  4. ABSTRACTS
  5. Educating Leaders 2018: Abstracts From AACOM's Annual Conference
  6. OMT MINUTE
  7. Doming the Diaphragm in a Patient With Multiple Sclerosis
  8. EDITORIAL
  9. Resident Duty Hour Restrictions: The Implications Behind the New Data Ahead of the Single Accreditation System
  10. A Perspective on the Sleep and Lifestyle Habits of Emergency Medicine Residents
  11. LETTERS TO THE EDITOR
  12. Toxic Injury to the Gastointestinal Tract After Ipilimumab Therapy
  13. ORIGINAL CONTRIBUTION
  14. Using a Multitheory Model to Predict Initiation and Sustenance of Fruit and Vegetable Consumption Among College Students
  15. Predictors of Responsible Drinking or Abstinence Among College Students Who Binge Drink: A Multitheory Model Approach
  16. BRIEF REPORT
  17. Osteopathic Manipulative Therapy and Multiple Sclerosis: A Proof-of-Concept Study
  18. Diabetes Fellowship in Primary Care: A Survey of Graduates
  19. JAOA/AACOM MEDICAL EDUCATION
  20. Teaching Medical Students About Health Systems Science and Osteopathic Principles and Practice Using a Virtual World: The Envision Community Health Center
  21. CASE REPORT
  22. Hemiplegic Syndrome After Chopstick Penetration Injury in the Lateral Soft Palate of a Young Child
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  24. Orbital Fat Prolapse
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https://doi.org/10.7556/jaoa.2018.129
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. SURF
  2. Sleep and Lifestyle Habits of Osteopathic Emergency Medicine Residents During Training
  3. Addressing the Increased Incidence of Common Sexually Transmitted Infections
  4. ABSTRACTS
  5. Educating Leaders 2018: Abstracts From AACOM's Annual Conference
  6. OMT MINUTE
  7. Doming the Diaphragm in a Patient With Multiple Sclerosis
  8. EDITORIAL
  9. Resident Duty Hour Restrictions: The Implications Behind the New Data Ahead of the Single Accreditation System
  10. A Perspective on the Sleep and Lifestyle Habits of Emergency Medicine Residents
  11. LETTERS TO THE EDITOR
  12. Toxic Injury to the Gastointestinal Tract After Ipilimumab Therapy
  13. ORIGINAL CONTRIBUTION
  14. Using a Multitheory Model to Predict Initiation and Sustenance of Fruit and Vegetable Consumption Among College Students
  15. Predictors of Responsible Drinking or Abstinence Among College Students Who Binge Drink: A Multitheory Model Approach
  16. BRIEF REPORT
  17. Osteopathic Manipulative Therapy and Multiple Sclerosis: A Proof-of-Concept Study
  18. Diabetes Fellowship in Primary Care: A Survey of Graduates
  19. JAOA/AACOM MEDICAL EDUCATION
  20. Teaching Medical Students About Health Systems Science and Osteopathic Principles and Practice Using a Virtual World: The Envision Community Health Center
  21. CASE REPORT
  22. Hemiplegic Syndrome After Chopstick Penetration Injury in the Lateral Soft Palate of a Young Child
  23. CLINICAL IMAGES
  24. Orbital Fat Prolapse
  25. Unusual Cause of “Constipation”
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