**Chest Mobilization Techniques for Improving Ventilation and Gas Exchange in Chronic Lung Disease**

Donrawee Leelarungrayub *Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University Thailand* 

### **1. Introduction**

398 Chronic Obstructive Pulmonary Disease – Current Concepts and Practice

Tibaldi V., Isaia G., Scarafiotti C., Gariglio F., Zanocchi M., Bo M., Bergerone S. & Aimonino

Wilson A., Parker H., Wynn A., Jagger C., Spiers N., Jones J. & Parker G. (1999). Randomised

World Health Organization (WHO). (2011). Chronic obstructive pulmonary disease (COPD).

Yesavage J.A., Brink T.L., Rose T.L., Lum O., Huang V., Adey M. & Leirer V.O. (1982).

trial. *Arch Intern Med*, 169, 17, 1569-1575.

with hospital care. *BMJ*, 319, 1542-1546.

www.who.int/mediacentre/factsheets/fs315/en/index.html

Fact sheet no. 315. Available at:

report. *J Psychiatr Res*, 17, 37-49.

Ricauda N. (2009). Hospital at home for elderly patients with acute decompensation of chronic heart failure. A prospective randomized controlled

controlled trial of effectiveness of Leicester hospital at home scheme compared

Development and validation of a geriatric depression screening scale: a preliminary

The clinical treatment and rehabilitation of chronic lung disease such as Chronic Obstructive Pulmonary Disease (COPD) is very challenging, as the chronic and irreversible condition of the lung, and poor quality of life, causes great difficulty to the protocol for intervention or rehabilitation. Most of the problems are, for example, air trapping and destroyed parenchymal lung, which cause chest wall abnormalities and respiratory muscle dysfunction that relate to dyspnea and decreased exercise tolerance (ATS/ERS 2006). Many intergrated problems such as increased airflow resistance, impaired central drive, hypoxemia, or hyperinflation result in respiratory muscle dysfunction, for instance, lack of strength, low endurance level, and early fatigue. Lung hyperinflation in COPD increases the volume of air remaining in the lung and reduces elastic recoil, thus giving rise to air trapping, which results in alveolar hypoventilation (Ferguson 2006). Thus, poor biomechanic chest movement and weak respiratory muscles affect respiratory ventilation (Jones & Moffatt, 2002). Furthermore, in COPD, the combination of V/Q mismatch, diffusion limitation, shunt and hypoventilation or hyperventilation is presented commonly, which leads to gas exchange impairment (West 2003). To solve inefficient ventilation from thoracic pump dysfunction, thoracic mobility exercise or mobilization techniques can be performed (Rodrigues & Watchie, 2010). Chest mobilization is one of many techniques and very important in conventional chest physical therapy for increasing chest wall mobility and improving ventilation (Jennifer & Prasad, 2008). Either passive or active chest mobilizations help to increase chest wall mobility, flexibility, and thoracic compliance. The mechanism of this technique increases the length of the intercostal muscles and therefore helps in performing effective muscle contraction. The techniques of chest mobilization are composed of rib torsion, lateral stretching, back extension, lateral bending, trunk rotation, etc. This improves the biomechanics of chest movement by enhancing direction of anterior-upward of upper costal and later outward of lower costal movement, including downward of diaphragm directions. Maximal relaxed recoiling of the chest wall helps in achieving effective contraction of each intercostal muscle. Thus, chest mobilization using breathing, respiratory muscle exercise or function training allows clinical benefit in chronic lung disease, especially COPD with lung hyperinflation or barrel-shaped chest (Jones & Moffat,

Chest Mobilization Techniques for Improving

the spine (Neumann, 2002).

(Grant, 2001; Lee, 2002)

2. **Lateral flexion** 

Ventilation and Gas Exchange in Chronic Lung Disease 401

approximately 20-25 degrees. Thorax extension presents the opposite movement to flexion, with backward sagittal rotation by posterior translation and slight distraction of

Fig. 1. Anterior rotation of the spine during flexion, and posterior rotation during extension.

Fig. 2. Extension of the thorax; showing the movement in superior upward and posterior

In flexion direction, the thoracic body rotates slightly on the flexion side, while the posterior rotates in the opposite direction so that the costovertebral joint is opened and inferior

Fig. 3. Biomechanics of lateral flexion to the right; showing the movement of thoracic body

gliding of the costotransverse joint. (Grant, 2001; Lee, 2002)

and costovetebral joint on both sides. (Grant, 2001; Lee, 2002)

2002). Therefore, the technique of chest mobilization helps in chest wall flexibility, respiratory muscle function and ventilatory pumping, and results from this relieve both dyspnea symptoms and accessory muscle use. This technique is still controversial because it lacks clinical evidence, but it does show clinical benefit , especially in COPD by improving pulmonary function, breathing pattern and weaning from a ventilator.
