title: The immediate effect of individual manipulation techniques on pulmonary function measures in persons with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  The use of manipulation has long been advocated in the treatment of chronic obstructive pulmonary disease (COPD), but few randomized controlled clinical trials have measured the effect of manipulation on pulmonary function. In addition, the effects of individual manipulative techniques on the pulmonary system are poorly understood. Therefore, the purpose of this study was to determine the immediate effects of four osteopathic techniques on pulmonary function measures in persons with COPD relative to a minimal-touch control protocol.
  
  
  METHODS
  Persons with COPD aged 50 and over were recruited for the study. Subjects received five, single-technique treatment sessions: minimal-touch control, thoracic lymphatic pump (TLP) with activation, TLP without activation, rib raising, and myofascial release. There was a 4-week washout period between sessions. Protocols were given in random order until all five techniques had been administered. Pulmonary function measures were obtained at baseline and 30-minutes posttreatment. For the actual pulmonary function measures and percent predicted values, Wilcoxon signed rank tests were used to test within-technique changes from baseline. For the percent change from baseline, Friedman tests were used to test for between-technique differences.
  
  
  RESULTS
  Twenty-five subjects were enrolled in the study. All four tested osteopathic techniques were associated with adverse posttreatment changes in pulmonary function measures; however, different techniques changed different measures. TLP with activation increased posttreatment residual volume compared to baseline, while TLP without activation did not. Side effects were mild, mostly posttreatment chest wall soreness. Surprisingly, the majority of subjects believed they could breathe better after receiving osteopathic manipulation.
  
  
  CONCLUSIONS
  In persons with COPD, TLP with activation, TLP without activation, rib raising, and myofascial release mildly worsened pulmonary function measures immediately posttreatment relative to baseline measurements. The activation component of the TLP technique appears to increase posttreatment residual volume. Despite adverse changes in pulmonary function measures, persons with COPD subjectively reported they benefited from osteopathic manipulation.
authors.affiliation: Academic Medicine Inc, 800 W Jefferson St, Kirksville, MO 63501, USA.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Noll
authors.affiliation: A.T. Still Research Institute, A.T. Still University, 800 W Jefferson St, Kirksville, MO 63501, USA.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Johnson
authors.affiliation: Department of Physiology, A.T. Still University, 800 W Jefferson St, Kirksville, MO 63501, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Baer
authors.affiliation: Department of Osteopathic Manipulative Medicine, A.T. Still University, 800 W Jefferson St, Kirksville, MO 63501, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Snider