Effect of Adding Diaphragmatic Myofascial Release to Corrective Exercise on the Thoracic Curvature Angle and Pulmonary Function Testing in Hyperkyphotic Adolescent Girls

Abstract

OBJECTIVE: The aim of the study was to investigate whether adding diaphragmatic release to corrective exercise could improve the Cobb angle and pulmonary function more than corrective exercise alone in hyperkyphotic adolescent girls. DESIGN: This is a single-blinded, randomized, controlled trial. METHODS: One hundred eighteen adolescent hyperkyphotic girls were allocated randomly into two equal groups. Control group received only corrective exercise, while study group received diaphragmatic release in addition to corrective exercise. Primary outcome was Cobb angle, assessed by lateral radiographs. Secondary outcomes were pulmonary function testing, assessed by computerized spirometery. Outcomes were assessed before and after treatment, after 3 mos of interventions, in both groups. RESULTS: Two-way analysis of variance revealed that both Cobb angle and pulmonary function testing significantly improved after treatment in both groups ( P < 0.001). Time*group interaction revealed that the study group had a superior improvement in Cobb angle and pulmonary function testing compared to the control group ( P < 0.003 and P < 0.001, respectively). CONCLUSIONS: Adding diaphragmatic release to 3 mos of multimodal corrective exercise program showed superior improvements in Cobb angle and pulmonary function testing than corrective exercise alone in hyperkyphotic adolescent girls within a shorter timeframe compared to previous studies. These results strengthen the hypothesis of its potential as a beneficial addition to the treatment of thoracic hyperkyphosis. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Recognize poor habits that play a significant role in developing hyperkyphosis in adolescents; (2) Construct the link between diaphragm malfunction and adolescent hyperkyphosis and its associated disorders of the cervical and thoracic spine and pulmonary function testing; (3) Carry out diaphragmatic myofascial release and corrective exercise for the spine; (4) Design a multimodal program to improve the Cobb angle and pulmonary function testing in hyperkyphotic adolescents; and (5) Measure the improvement of the Cobb angle and pulmonary function testing after treatment in hyperkyphotic adolescents. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.