Author: De Paepe Carmen, MSc.Ost & De Vos Bram, MSc.Ost
Supervisor: Rodrigus Patrick, MSc.Ost
Introduction/background/relevance of the dissertation: The lumbar spine is a common location for traumatic and non- traumatic pathologies. About 85% of patients with isolated low back pain (LBP) cannot be given a precise pathoanatomical diagnosis. Such disorders may arise from improper posture during the lifting of heavy objects, or maintaining an irregular posture for a long period of time. Despite the high prevalence of LBP, effective treatment strategies are still limited. The diaphragm is well known for its role as the principal muscle of respiration. Additionally, this muscle contributes to the mechanical stabilization of the spine, functioning as the superior stabilizing structure of the “abdominal canister”. The respective scientific literature is scarce and the exact working mechanism is yet to be unravelled. Objective of the dissertation: To obtain a better insight in the stabilizing mechanism of the lumbar spine and the specific role of the diaphragm, the aim of this thesis is to investigate whether manual techniques influence the curvature and the postural parameters of the lumbar spine.
Question(s): The first research question is whether diaphragm techniques influence the curvature of the lumbar spine. Secondly, it is questioned whether the manual techniques result in differences in general postural parameters in the sagittal and/or frontal plane.
Hypotheses: Null hypothesis (H0): Manual techniques do not result in significant differences in the lumbar curvature and other postural parameters. Alternative hypothesis (Ha): Manual techniques result in significant differences in the lumbar curvature and other postural parameters.
Method applied: Fifteen healthy candidates, both men and women, between 25 and 60 years old were chosen. The spine was scanned using a three-dimensional (3D) DIERS Formetric scan. Afterwards, patients were treated applying four manual diaphragm techniques. After a five minutes pause three post-treatment scans were taken to evaluate lordotic angles, sagittal imbalance, lateral deviations and pelvic parameters.
Results: Paired t-tests showed significant differences between the pre-treatment and post-treatment group for the parameters sagittal imbalance and pelvic torsion. No significant difference was found in the lumbar curvature .
Discussion/conclusion: Manual techniques on the diaphragm do not directly influence the lumbar curvature. However, an effect on the lumbar lordosis could occur, be it indirect and only if combined with other treatment techniques such as mobilisations of the lumbar spine. The manual techniques do give significant differences on sagittal imbalance and pelvic torsion results. This could be a consequence of their close relationship with each other or it could indicate an indirect effect of the diaphragm through the generation of intra-abdominal pressure (IAP) or the fascial connections of the muscle. The findings confirm the importance of the diaphragm in its postural function and its place in the treatment strategy of the lumbar spine.