Chronic obstructive pulmonary disease and cervico-thoracic musculoskeletal dysfunction

Conservative non-pharmacological evidence-based management options for Chronic Obstructive Pulmonary Disease (COPD) primarily focus on developing physiological capacity. With co-morbidities, including those of the musculoskeletal system, contributing to the overall severity of the disease, further research was needed. This thesis presents a critical review of the active and passive musculoskeletal management approaches currently used in COPD. The evidence for using musculoskeletal interventions in COPD management was inconclusive. Whilst an evaluation of musculoskeletal changes and their influence on pulmonary function was required, it was apparent that this would necessitate a significant programme of research. In view of this a narrative review of musculoskeletal changes in the cervico-thoracic region was undertaken. With a paucity of literature exploring chest wall flexibility and recent clinical guidelines advocating research into thoracic mobility exercises in COPD, a focus on thoracic spine motion analysis literature was taken. On critically reviewing the range of current in vivo measurement techniques it was evident that soft tissue artefact was a potential source of measurement error. As part of this thesis, soft tissue artefact during thoracic spine axial rotation was quantified. Given the level was deemed unacceptable, an alternative approach was developed and tested for intra-rater reliability. This technique, in conjunction with a range of other measures, was subsequently used to evaluate cervico-thoracic musculoskeletal changes and their relationship with pulmonary function in COPD. In summary, subjects with COPD were found to have reduced spinal motion, altered posture and increased muscle sensitivity compared to controls. Reduced spinal motion and altered neck posture were associated with reduced pulmonary function and having diagnosed COPD. Results from this thesis provide evidence to support inception of a clinical trial of flexibility or mobility exercises