Preliminary evidence of Regional Interdependent Inhibition, using a ‘Diaphragm Release’ to specifically induce an immediate hypoalgesic effect in the cervical spine

Abstract

In clinical practice, Osteopaths and Manual Therapists commonly direct treatment towards the diaphragm by the use of a 'Diaphragm Release'. Currently, there is paucity within the literature to support the use of this technique, specifically in pain outcomes. This research aims to support a neurophysiological mechanism based upon the osteopathic principle "The body is a unit". Demonstrating that directing treatment to distal tissue which is neurologically related can reduce pain in the originating spinal segments. This study investigated the immediate hypoalgesic effects of a 'Diaphragm Release' on pain pressure thresholds in the cervical spine. A single-blind, randomised, sham-controlled, repeated measures within subject, crossover design was conducted on 17 asymptomatic subjects. Pain pressure thresholds were measured bilaterally in the C4 paraspinal musculature, lateral end of the clavicle and upper third of the tibialis anterior before and after a 'Diaphragm Release'. Results demonstrated a statistically significant hypoalgesic effect was only found in the spinal segment C4 in both the right (p = 0.016) and left (p = 0.004) sides. Averaging the hypoalgesic effect from both sides equates to a 17.17% change which is considered clinically significant, the effect magnitude was calculated to be small but educationally significant for the right (d = 0.26) and left (d = 0.40) sides. This study supports a novel neurophysiological mechanism, Regional Interdependent Inhibition, to induce a hypoalgesic state at segmentally related spinal segments, specifically C4. Suggesting that directing treatment towards the diaphragm, using a 'Diaphragm Release', could induce an immediate clinically and statistically significant hypoalgesic effect local to the fourth cervical segment due to its relationship with the phrenic nerve.

Added Value of Diaphragm Myofascial Release on Forward Head Posture and Chest Expansion in Patients With Neck Pain: A Randomized Controlled Trial

“…during different functional activities, this nding con rms the results of the study by McCoss et al(22) which investigated the immediate effects of diaphragm myofascial release on pain pressure thresholds in the cervical spine and found that diaphragm release could induce an immediate hypoalgesic effect at the cervical spine. It is suggested that mechanical stimulation of the diaphragm activates the mechanoreceptors in the diaphragm and subsequently the phrenic nerve which contains large diameter afferent neuron.…”

“…It is suggested that mechanical stimulation of the diaphragm activates the mechanoreceptors in the diaphragm and subsequently the phrenic nerve which contains large diameter afferent neuron. This information is then transferred to the dorsal horn of the spinal cord and synapse with inhibitory interneurons, resulting in hypoalgesia in the somatic tissues supplied by those cervical segments(22)(23)(24)(25).…”

Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial

“…In fact, it had already been shown that osteopathic visceral treatment was able to diminish sensitization in spinous processes of vertebrae related to sympathetic innervation of the colon in patients with constipation [20]. The same hypoalgesic effect has been found in asymptomatic subjects in the tissues which share innervation with the manually treated structure: diaphragm–C4 [68] and colon–L1 [69]. So, it seems that manual intervention focused on upper abdominal visceral disorders diminishes cervical sensitization, besides improving GerdQ scores.…”

The immediate effect of osteopathic cervical spine mobilization on median nerve mechanosensitivity: A triple-blind, randomized, placebo-controlled trial

“…Finally, not all previous studies have found an increase change in ROM following interventions. So, studies may implement psychological questionnaires such as the Visual Analogue Scale (VAS) (Crichton, 2001), the Pain Catastrophizing Scale (PCS) (Sullivan, Bishop, & Pivik, 1995), or Pain Pressure Thresholds (PPT) (McCoss et al, 2016) to further assess the effectiveness of these techniques and to present a wider range of outcome measures in neurodynamic testing for different interventions.…”