The elaboration of the hypothesis and design of this study stems from the idea of proposing a valid manual therapy protocol in the context of a diaphragmatic tension and thoracic hypomobility framework in a taekwondo athlete. In the first part of the study, the roles of the diaphragm and respiratory mechanics were defined, and then deepened the importance of the spirometric examination with the relative lung volumes in the competitive athlete. In the second part, the causes that in taekwondo agonists could lead to a progressive diaphragmatic tension and consequent retraction of the anterior inspiratory chain, which plays a fundamental role, are specifically analyzed. The anterior inspiratory chain is in fact a significant example of fascial connections that start from the skull base, continue with the fascia of the neck in the mediastinum, form envelopes for organs and large vessels, thus involving the diaphragmatic respiratory dynamics and the balance of endothoracic and abdominal pressures. . The causes of diaphragmatic tension have been identified in the posture that the athlete assumes in combat guard, in the explosive acts of latching and taking the blows that cause a perennial and forced contraction of this muscle, and finally in the psychological involvement of the athlete in which performance anxiety plays an important role. Subsequently, the consequent effects relating to diaphragmatic tension and thoracic hypomobility that this sport could entail were analyzed: the sensation of air hunger perceived by the athlete during the fight and the reduction of lung volumes calculated through spirometry. In the third part of the study, a postural assessment of the athlete under consideration is made and finally the practical methods of rehabilitation treatment are explained.An athlete from the Italian Taekwondo National Team was selected who respects the criterion of inclusion of anterior postural retraction resulting in a feeling of dyspnea in training and difficulty in achieving the minimum level of expiratory force to be achieved in spirometry for the annual competitive certificate. The athlete underwent a total of five treatments ten days apart, followed by a final follow-up session and final measurements one month later. The purpose of the study is to measure the effectiveness of manual therapy in improving diaphragmatic and thoracic mobility, ensuring better performance of the competitive athlete in sports thanks to the increase in lung volumes. The treatment cycle was in fact also performed in view of the U21 European Championship in which the athlete would participate with the Italian National team following the last session, with the hope of providing valid support for athletic performance in this important competition. The athlete was measured with universally recognized assessment scales, such as the modified mMRC scale for the sensation of dyspnea; the MED scale (manual diaphragm assessment scale) to describe the effectiveness of manual therapy intervention on the thoracic diaphragm; spirometry to detect any improvements in lung volumes after treatments and the VAS (visual analgesic scale of pain) to evaluate the pain perceived by the patient during manual treatment maneuvers. The results showed that manual therapy was decisive in improving diaphragmatic mobility and restoring the harmony of the upper respiratory district. In terms of posture, the manual therapy work has made it possible to redefine a new balance of the physiological curves evaluated through the photos of the patient before and after the treatments, in comparison. This was possible thanks to the detensioning of the deep bands which made the anterior chain more refractory to elongation.
L’elaborazione dell’ipotesi e del disegno di questo studio nascono dall’idea di proporre un valido protocollo di terapia manuale nel contesto di un quadro di tensione diaframmatica e ipomobilità toracica in un atleta di taekwondo. Nella prima parte dello studio, sono stati definiti i ruoli del diaframma e la meccanica respiratoria, per poi approfondire l’importanza dell’esame spirometrico con i relativi volumi polmonari nell’atleta agonista. Nella seconda parte, si analizzano specificatamente le cause che negli agonisti di taekwondo, potrebbero portare ad una progressiva tensione diaframmatica e conseguente retrazione della catena inspiratoria anteriore, che gioca un ruolo fondamentale. La catena inspiratoria anteriore è infatti un esempio significativo di connessioni fasciali che partono dalla base cranica, proseguono con le fasce del collo nel mediastino, formano involucri per organi e grandi vasi, coinvolgendo così la dinamica respiratoria diaframmatica e l’equilibrio delle pressioni endotoracica e addominale. Le cause della tensione diaframmatica sono state identificate nella postura che l’atleta assume in guardia di combattimento, negli atti esplosivi di sferramento e incassamento dei colpi che causano una perenne e forzata contrazione di questo muscolo, ed infine nel coinvolgimento psicologico dell’atleta in cui l’ansia da prestazione assume un ruolo importante. Successivamente sono stati analizzati gli effetti conseguenti relativi alla tensione diaframmatica e ipomobilità toracica che questo sport potrebbe comportare: la sensazione di fame d’aria percepita da parte dell’atleta durante il combattimento e la riduzione dei volumi polmonari calcolati attraverso la spirometria. Nella terza parte dello studio viene fatta una valutazione posturale dell’atleta preso in considerazione ed infine vengono spiegate le modalità pratiche del trattamento riabilitativo. È stata selezionata un’atleta della Nazionale Italiana di Taekwondo che rispetta il criterio di inclusione di retrazione posturale anteriore con conseguente sensazione di dispnea in allenamento e difficoltà di realizzazione del livello minimo di forza espiratoria da raggiungere nella spirometria per il certificato agonistico annuale. L’atleta è stata sottoposta ad un totale di cinque trattamenti a distanza di dieci giorni, seguiti da un’ultima seduta di follow-up e misurazioni finali a distanza di un mese. Lo scopo dello studio è quello di misurare l’efficacia della terapia manuale nel migliorare la mobilità diaframmatica e toracica, garantendo un miglior rendimento dell’atleta agonista nell’attività sportiva grazie all’incremento dei volumi polmonari. Il ciclo di trattamenti è stato infatti eseguito anche in vista del Campionato Europeo U21 a cui l’atleta avrebbe partecipato con la Nazionale Italiana a seguito dell’ultima seduta, con la speranza di fornire un valido supporto alla prestazione atletica in questa importante competizione. L’atleta è stato misurato con scale di valutazione universalmente riconosciute, come la scala mMRC modificata per la sensazione di dispnea; la MED scale (scala di valutazione manuale del diaframma) per descrivere l’efficacia dell’intervento di terapia manuale sul diaframma toracico; la spirometria per rilevare eventuali miglioramenti dei volumi polmonari dopo i trattamenti e la VAS (scala visuo-analgica del dolore) per valutare il dolore percepito dal paziente durante le manovre del trattamento manuale. I risultati hanno dimostrato che la terapia manuale è stata risolutiva nel migliorare la mobilità diaframmatica e nel ristabilire l’armonia del distretto respiratorio alto. In termini di postura, il lavoro di terapia manuale ha permesso, grazie al detensionamento delle fasce profonde, di ridefinire un nuovo equilibrio delle curve fisiologiche valutate attraverso delle foto della paziente prima e dopo i trattamenti, a confronto.
Mobilità toracica e diaframmatica Efficacia della terapia manuale nel migliorare i volumi polmonari in atleti di taekwondo Case report.
AL HALWANI, SARAH
2020/2021
Abstract
The elaboration of the hypothesis and design of this study stems from the idea of proposing a valid manual therapy protocol in the context of a diaphragmatic tension and thoracic hypomobility framework in a taekwondo athlete. In the first part of the study, the roles of the diaphragm and respiratory mechanics were defined, and then deepened the importance of the spirometric examination with the relative lung volumes in the competitive athlete. In the second part, the causes that in taekwondo agonists could lead to a progressive diaphragmatic tension and consequent retraction of the anterior inspiratory chain, which plays a fundamental role, are specifically analyzed. The anterior inspiratory chain is in fact a significant example of fascial connections that start from the skull base, continue with the fascia of the neck in the mediastinum, form envelopes for organs and large vessels, thus involving the diaphragmatic respiratory dynamics and the balance of endothoracic and abdominal pressures. . The causes of diaphragmatic tension have been identified in the posture that the athlete assumes in combat guard, in the explosive acts of latching and taking the blows that cause a perennial and forced contraction of this muscle, and finally in the psychological involvement of the athlete in which performance anxiety plays an important role. Subsequently, the consequent effects relating to diaphragmatic tension and thoracic hypomobility that this sport could entail were analyzed: the sensation of air hunger perceived by the athlete during the fight and the reduction of lung volumes calculated through spirometry. In the third part of the study, a postural assessment of the athlete under consideration is made and finally the practical methods of rehabilitation treatment are explained.An athlete from the Italian Taekwondo National Team was selected who respects the criterion of inclusion of anterior postural retraction resulting in a feeling of dyspnea in training and difficulty in achieving the minimum level of expiratory force to be achieved in spirometry for the annual competitive certificate. The athlete underwent a total of five treatments ten days apart, followed by a final follow-up session and final measurements one month later. The purpose of the study is to measure the effectiveness of manual therapy in improving diaphragmatic and thoracic mobility, ensuring better performance of the competitive athlete in sports thanks to the increase in lung volumes. The treatment cycle was in fact also performed in view of the U21 European Championship in which the athlete would participate with the Italian National team following the last session, with the hope of providing valid support for athletic performance in this important competition. The athlete was measured with universally recognized assessment scales, such as the modified mMRC scale for the sensation of dyspnea; the MED scale (manual diaphragm assessment scale) to describe the effectiveness of manual therapy intervention on the thoracic diaphragm; spirometry to detect any improvements in lung volumes after treatments and the VAS (visual analgesic scale of pain) to evaluate the pain perceived by the patient during manual treatment maneuvers. The results showed that manual therapy was decisive in improving diaphragmatic mobility and restoring the harmony of the upper respiratory district. In terms of posture, the manual therapy work has made it possible to redefine a new balance of the physiological curves evaluated through the photos of the patient before and after the treatments, in comparison. This was possible thanks to the detensioning of the deep bands which made the anterior chain more refractory to elongation.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/745