Efficacy of Osteopathic Manipulative Techniques in Patients With Chronic Obstructive Pulmonary Disease

The participant lay in the supine position and the therapist stood at the participant's head, the therapist passed his hands (the hypothenar and the lateral 3 fingers) under the costal cartilage of the seventh to the tenth ribs bilaterally, with the therapist's forearm aligned up toward the subject's shoulder. Then, the therapist quietly drew the diaphragm in and upward during the inspiratory phase. The therapist then went deeply with both hands toward the inner costal margin during the expiratory phase to resist the rebounding movement of the thoracic cage. The depth of this manual contact was progressively increased in subsequent respiratory cycles. The maneuver was repeated in 4 sets, each of which consisted of 5 deep breaths with 2-min intervals in between if needed

• The patient is in supine position and therapist hand under the thorax The fingertips take up contact with the angular costae and move it up and in lateral traction and maintained and this will repeated until all ribs on the side are mobilized. This movement will be repeated several times until perceives an improvement in the rib flexibility

"* Patient in the supine position and therapist will stand the participant's head, facing The therapist places the thenar eminence of each hand to the pectoral region and infra clavicular and the other fingers were spread around the thoracic cage and angled toward the body's side to create consistent, compressive force across the thoracic cage The participant was then allowed to breathe in deeply and breath out. The therapist slowly reduced the compressive force and withdrew the participant.~* During breath out rhythmic oscillatory compression in the posterior and caudal direction was applied to the chest wall.~* By the end of the expiratory phase, the compressive force was maintained, and ask to take another deep breath. In this way, the participant encountered some resistance equivalent to the chest-wall movement during inspiration. The maneuver was repeated for 5 respiratory cycles, then hands to allow for full inspiration."