Physiotherapy management of traumatized diaphragm
The diaphragm is a double – domed musculoskeletal partition separating the thoracic and abdominal cavities. It helps you inhale and exhale. In addition to helping you breathe, your diaphragm increases pressure inside your abdomen.
Traumatic diaphragmatic injuries (TDI) include wounds and diaphragm ruptures due to thoraco – abdominal blunt or penetrating traumas.
Causes :
- Blunt trauma : RTA’s , fall from height
- Penetrating trauma : gun shot injuries , stab wounds, lesions .
- Iatrogenic causes like surgery
- Phrenic nerve injury – diaphragm paralysis
Physiotherapy management :
Assessment –
Evaluate respiratory function , diaphragmatic excursion and the presence of associated injuries.
Assessment is primarily focused on physical examination, chest expansion, Arterial blood gases (ABG) analysis, pulmonary function test, chest x-ray, oxygen saturation, peripheral muscle strength and cardiopulmonary exercise testing.
The main aim in the postoperative phase
are to maintain adequate ventilation, to assist in the removal of any excess lung secretions and to aid in
the general positioning, bed mobility and early ambulation of the patient.
- Soft tissue mobilization –
Soft tissue techniques, such as myofascial release, to remove any restrictions or adhesions in the soft tissues surrounding the diaphragm.
Gentle, targeted pressure can help improve tissue extensibility and reduce muscle tension.
- Diaphragmatic Release Techniques:
Utilize manual techniques to release tension in the diaphragm itself.
This may involve specific hands-on methods to encourage relaxation and optimal function of the diaphragmatic muscle fibers.
- Diaphragmatic Breathing exercises :
The patient is instructed to relax the shoulder and upper chest, take a slow deep breath in to fill up the lungs as fully as they can, hold breath for 3 sec, and breathe out slowly through the mouth.
- Lymphatic drainage :
Incorporate lymphatic drainage techniques to reduce swelling and promote optimal fluid dynamics in the affected area.
Gentle manual maneuvers can support the body’s natural lymphatic drainage processes.
- Pain management:
Implement pain control strategies like manual therapy to facilitate patient comfort during rehabilitation.
Use modalities such as ice, heat, or transcutaneous electrical nerve stimulation (TENS) to manage pain.
- Active cycle of breathing :
Combination of breathing control, thoracic expansion exercise and forced expiratory technique. Used in airway clearance and improving pulmonary function.
Huffing and coughing are also used in clearing secretions from large airways.