Posture and Mobility of the Upper Body Quadrant and Pulmonary Function in COPD: an Exploratory Study

Overview

Journal Braz J Phys Ther

Specialty Rehabilitation Medicine

Date 2016 Aug 25

PMID 27556391

Citations 7

Authors

Nuno Morais

Joana Cruz

Alda Marques

Affiliations

Soon will be listed here.

Abstract

Background: There is limited evidence regarding interactions between pulmonary (dys)function, posture, and mobility of the upper body quadrant in patients with chronic obstructive pulmonary disease (COPD).

Objectives: This exploratory study aimed to investigate whether postural alignment and mobility of the upper quadrant are related to changes in pulmonary function and compare such variables between patients with COPD and healthy individuals.

Method: Fifteen patients with COPD (67.93±9.71yrs) and 15 healthy controls (66.80±7.47yrs) participated. Pulmonary function (FEV1, FVC) was assessed with spirometry. Alignment and mobility of the head, thoracic spine, and shoulder were assessed using digital photographs. Pectoralis minor muscle (PmM) length and thoracic excursion were assessed with a measuring tape. Groups were compared and linear regression analyses were used to assess potential relationships between postural and mobility variables and pulmonary function.

Results: Patients with COPD were more likely to have a forward head position at maximal protraction (28.81±7.30º vs. 35.91±8.56º, p=0.02) and overall mobility of the head (21.81±10.42º vs. 13.40±7.84º, p=0.02) and a smaller range of shoulder flexion (136.71±11.91º vs. 149.08±11.58º, p=0.01) than controls. Patients' non-dominant PmM length and maximal head protraction were predictors of FEV1 (r2adjusted=0.34). These variables, together with the upper thoracic spine at maximal flexion and thoracic kyphosis at maximal extension, were predictors of FVC (r2adjusted=0.68).

Conclusion: Our findings suggest that impaired pulmonary function is associated with muscle length and mobility adaptations. Further studies are needed to understand the underlying mechanisms and clinical value of these relationships.

Citing Articles

Pulmonary function, body posture and balance in young adults with asthma: A cross-sectional study.

Alaparthi G, Moustafa I, Lopes A, Ferreira A PLoS One. 2025; 20(3):e0316663.

PMID: 40029906 PMC: 11875369. DOI: 10.1371/journal.pone.0316663.

Multifaceted associations between walking performance, physical fitness, extremity function, health status, and depression in individuals with COPD.

Aldhahi M, Baattaiah B, Alharbi M, Alotaibi M, Nazer R, Albarrati A Ann Med. 2024; 56(1):2338248.

PMID: 38590164 PMC: 11005873. DOI: 10.1080/07853890.2024.2338248.

Analysis of the Active Measurement Systems of the Thoracic Range of Movements of the Spine: A Systematic Review and a Meta-Analysis.

Esteban-Gonzalez P, Sanchez-Romero E, Villafane J Sensors (Basel). 2022; 22(8).

PMID: 35459026 PMC: 9026805. DOI: 10.3390/s22083042.

Effectiveness of 12-week inspiratory muscle training with manual therapy in patients with COPD: A randomized controlled study.

Buran Cirak Y, Yilmaz Yelvar G, Durustkan Elbasi N Clin Respir J. 2022; 16(4):317-328.

PMID: 35332685 PMC: 9060133. DOI: 10.1111/crj.13486.

Effects of Proprioceptive Neuromuscular Facilitation Stretching Combined with Aerobic Training on Pulmonary Function in COPD Patients: A Randomized Controlled Trial.

Liu K, Yu X, Cui X, Su Y, Sun L, Yang J Int J Chron Obstruct Pulmon Dis. 2021; 16:969-977.

PMID: 33880021 PMC: 8053505. DOI: 10.2147/COPD.S300569.

References

de Groot J, Brand R . A three-dimensional regression model of the shoulder rhythm. Clin Biomech (Bristol). 2001; 16(9):735-43. DOI: 10.1016/s0268-0033(01)00065-1. View

McKeough Z, Alison J, Bye P . Arm positioning alters lung volumes in subjects with COPD and healthy subjects. Aust J Physiother. 2003; 49(2):133-7. DOI: 10.1016/s0004-9514(14)60129-x. View

Costa L, Maher C, Lopes A, de Noronha M, Costa L . Transparent reporting of studies relevant to physical therapy practice. Rev Bras Fisioter. 2011; 15(4):267-71. DOI: 10.1590/s1413-35552011005000009. View

Edmondston S, Waller R, Vallin P, Holthe A, Noebauer A, King E . Thoracic spine extension mobility in young adults: influence of subject position and spinal curvature. J Orthop Sports Phys Ther. 2011; 41(4):266-73. DOI: 10.2519/jospt.2011.3456. View

Lewis J, Green A, Reichard Z, Wright C . Scapular position: the validity of skin surface palpation. Man Ther. 2002; 7(1):26-30. DOI: 10.1054/math.2001.0405. View

Raine S, Twomey L . Head and shoulder posture variations in 160 asymptomatic women and men. Arch Phys Med Rehabil. 1997; 78(11):1215-23. DOI: 10.1016/s0003-9993(97)90335-x. View

Decramer M . Hyperinflation and respiratory muscle interaction. Eur Respir J. 1997; 10(4):934-41. View

Borstad J . Resting position variables at the shoulder: evidence to support a posture-impairment association. Phys Ther. 2006; 86(4):549-57. View

Spruit M, Singh S, Garvey C, ZuWallack R, Nici L, Rochester C . An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013; 188(8):e13-64. DOI: 10.1164/rccm.201309-1634ST. View

10.

Borstad J, Ludewig P . The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther. 2005; 35(4):227-38. DOI: 10.2519/jospt.2005.35.4.227. View

11.

Martinez F, Couser J, Celli B . Respiratory response to arm elevation in patients with chronic airflow obstruction. Am Rev Respir Dis. 1991; 143(3):476-80. DOI: 10.1164/ajrccm/143.3.476. View

12.

Orozco-Levi M . Structure and function of the respiratory muscles in patients with COPD: impairment or adaptation?. Eur Respir J Suppl. 2003; 46:41s-51s. DOI: 10.1183/09031936.03.00004607. View

13.

Heneghan N, Adab P, Balanos G, Jordan R . Manual therapy for chronic obstructive airways disease: a systematic review of current evidence. Man Ther. 2012; 17(6):507-18. DOI: 10.1016/j.math.2012.05.004. View

14.

Celli B, Criner G, Rassulo J . Ventilatory muscle recruitment during unsupported arm exercise in normal subjects. J Appl Physiol (1985). 1988; 64(5):1936-41. DOI: 10.1152/jappl.1988.64.5.1936. View

15.

Mandrusiak A, Giraud D, MacDonald J, Wilson C, Watter P . Muscle length and joint range of motion in children with cystic fibrosis compared to children developing typically. Physiother Can. 2011; 62(2):141-6. PMC: 2871023. DOI: 10.3138/physio.62.2.141. View

16.

Dolmage T, Maestro L, Avendano M, Goldstein R . The ventilatory response to arm elevation of patients with chronic obstructive pulmonary disease. Chest. 1993; 104(4):1097-100. DOI: 10.1378/chest.104.4.1097. View

17.

Ruivo R, Pezarat-Correia P, Carita A . Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain. Braz J Phys Ther. 2014; 18(4):364-71. PMC: 4183261. DOI: 10.1590/bjpt-rbf.2014.0027. View

18.

Velloso M, Stella S, Cendon S, Silva A, Jardim J . Metabolic and ventilatory parameters of four activities of daily living accomplished with arms in COPD patients. Chest. 2003; 123(4):1047-53. DOI: 10.1378/chest.123.4.1047. View

19.

Miller M, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A . Standardisation of spirometry. Eur Respir J. 2005; 26(2):319-38. DOI: 10.1183/09031936.05.00034805. View

20.

Dougherty P, Engel R, Vemulpad S, Burke J . Spinal manipulative therapy for elderly patients with chronic obstructive pulmonary disease: a case series. J Manipulative Physiol Ther. 2011; 34(6):413-7. DOI: 10.1016/j.jmpt.2011.05.004. View