Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia

Abstract

Pneumonia, the inflammatory state of lung tissue primarily due to microbial infection, claimed 52,306 lives in the United States in 2007 1 and resulted in the hospitalization of 1.1 million patients 2 . With an average length of in-patient hospital stay of five days 2 , pneumonia and influenza comprise significant financial burden costing the United States $40.2 billion in 2005 3 . Under the current Infectious Disease Society of America/American Thoracic Society guidelines, standard-of-care recommendations include the rapid administration of an appropriate antibiotic regiment, fluid replacement, and ventilation (if necessary). Non-standard therapies include the use of corticosteroids and statins; however, these therapies lack conclusive supporting evidence 4 . (Figure 1) Osteopathic Manipulative Treatment (OMT) is a cost-effective adjunctive treatment of pneumonia that has been shown to reduce patients’ length of hospital stay, duration of intravenous antibiotics, and incidence of respiratory failure or death when compared to subjects who received conventional care alone 5 . The use of manual manipulation techniques for pneumonia was first recorded as early as the Spanish influenza pandemic of 1918, when patients treated with standard medical care had an estimated mortality rate of 33%, compared to a 10% mortality rate in patients treated by osteopathic physicians 6 . When applied to the management of pneumonia, manual manipulation techniques bolster lymphatic flow, respiratory function, and immunological defense by targeting anatomical structures involved in the these systems 7,8, 9, 10 . The objective of this review video-article is three-fold: a) summarize the findings of randomized controlled studies on the efficacy of OMT in adult patients with diagnosed pneumonia, b) demonstrate established protocols utilized by osteopathic physicians treating pneumonia, c) elucidate the physiological mechanisms behind manual manipulation of the respiratory and lymphatic systems. Specifically, we will discuss and demonstrate four routine techniques that address autonomics, lymph drainage, and rib cage mobility: 1) Rib Raising, 2) Thoracic Pump, 3) Doming of the Thoracic Diaphragm, and 4) Muscle Energy for Rib 1. 5,11

Proposal for a New Manual Evaluation Scale for the Diaphragm Muscle: Manual Evaluation of the Diaphragm Scale – MED Scale

“…Several studies valuated the effects of manual therapy and Osteopathy in COPD. The approach varies widely, both in terms of techniques and time management: thoracic spinal mobilization, lymphatic drainage or pump, diaphragmatic release trigger points, massage, articulation techniques for the ribs, myofascial release to the thoracic outlet, sub-occipital decompression, and muscular stretching [24][25][26][27]. While the results of the various respiratory parameters have been generally positive, we do not have enough information to draw definitive conclusions.…”

Lymphatic Pump Manipulation in Patients with Chronic Obstructive Pulmonary Disease

“…The speed of the lymphatic flow is approximately 125 mL/h in a person at rest but can increase by a factor of 10 during active movements [12][13]. Another passive mechanism that can manage lymphatic flow is oxygen pressure, particularly at low gradients (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40); if the oxygen pressure is higher, the lymphatic flow slows down. Temperature can also influence the speed of the lymphatic flow; the function of the lymphatic system is optimal at temperatures ranging between 32°C and 37°C, and probably acts via extracellular osmotic changes.…”

Diaphragm postural function in injured subtalar joint

“…It was repeated for five respiratory cycles. During the final inhalation phase, right before the patient completed a full deep inhalation, the therapist rapidly removed the hands from the patient's chest to allow for a sudden influx of air into the chest [4].…”

“…Manual manipulation of the diaphragm is a technique used by both manual therapist and osteopaths. It has been reported effective in patients with pulmonary disease, as well as those with short hamstring syndrome [4][5][6]. On the basis of an anatomical concept, the use of osteopathic diaphragm manipulation and thoracic pump technique in swollen ankle and postural imbalance may be reasoned [7].…”