**5.2 Postero-lateral chest wall mobilization**

410 Chronic Obstructive Pulmonary Disease – Current Concepts and Practice

From the overall outcomes, chest expansion, dyspnea, chest radiography, and dynamic lung ventilation are most important in representing the effectiveness of a technique. Other parameters can be evaluated such as breathing pattern, respiratory rate, oxygen saturation,

Chest mobilization techniques are the original protocol used in chronic lung disease, which has the tendency to cause poor posture, rigidity, or lack of thoracic spine and rib cage movement (Vibekk, 1991). These techniques are divided into passive and active chest mobilization, which depends on the patient's condition. In the case of an unconscious patient, as seen in an intensive care unit (ICU) where prolonged treatment is carried out with or without ventilator support, the" **Passive Chest Mobilization Technique**" can be performed on the chest wall by a therapist. Whereas, in the case of a patient in recovery or good condition, the "**Active Chest Mobilization Technique**" can be performed. In some general practices, patients who have just recovered can have modified Active-Passive Chest Mobilization to improve flexibility of the chest wall. The aim of these techniques is to improve thoracic mobility at the upper, middle or lower parts of the chest. Furthermore, these techniques need to be selected carefully to minimize dyspnea, and they should be applied in sitting, sitting leaning forward or high side lying positions (Lee, 2002; Rodrigues

Fig. 11. Chest Mobilization Techniques for improving thoracic mobility at the postero-lateral parts (trunk rotation) (Vibekk, 1991) by active and passive trunk rotation on both sides. Exhalation in a forward position is carried out at the beginning of flexion, and rotation of the left side is performed laterally with inspiration. However, an exhalation phase is carried

The original technique is similar to the previously mentioned protocol (Frownfelter, 1987). This pattern is suitable for giving benefit in cases of shortening pectoralis muscles. Some evidence has shown that winging and trunk rotation can improve vital capacity (Pryor et al., 2000). The benefits of this pattern improve both ventilation in upper lobes of boths and also

etc., and respiratory muscle strength if protocol training is included.

**5. Chest mobilization techniques** 

& Watchie, 2010).

out during passive trunk rotation.

stretches the pectoralis muscle that may tight.

**5.1 Antero-posterior upper costal chest wall mobilization** 

This technique has many procedures such as trunk torsion, rotation, and lateral bending (Frownfelter, 1987). It not only affects the ribs and tissue, but also moves the costovertebral and facet joints. This pattern is very useful in ordet to improve the ventilation around in the lower lobe of both lungs.
