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Thoracic injuries, in high level competitive Brazilian jiu jitsu (BJJ) athletes occupied a significant percentage of all musculoskeletal injuries in this population. Important factors for reducing injury rates are suggested to be spine and thoracic flexibility, which assist athletes in performing offensive/defensive techniques. The diaphragm, as one of the main thoracic and breathing muscles, appears to affect spinal flexibility and chest expansion. Thus, this study's objective was to investigate the immediate effects of a myofascial release technique of the diaphragm on chest mobility (expansion) and spinal range of movement (ROM) in BJJ athletes.
In order to be assesed the immediate effects of a myofascial release technique on diaphragm, competitive BJJ athletes were subjected to a diaphragmatic release technique and to a sham breathing technique, in random order, across a two-week interval with outcome measures involving thoracic flexion/extension ROM, chest expansion, finger-to-floor (FTF) test and Modified-modified Schober's test (MMST).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Myofascial release intervention arm | Experimental | This myofascial technique was a manual hterapy treatment technique performed in sitting. With this technique, the athlete slightly bends his/her torso in order to relax the abdominal wall and breathes calmly and deeply . The therapist is behind the athlete holding his/her lower ribs, and during exhalation the therapist directs his hands caudally. This steady but gentle 'traction' is maintained throughout the breathing cycles for 4-5 minutes. |
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| Sham intervention arm | Sham Comparator | With this technique (also performed in sitting), the therapist stood behind the athlete touching the outside of the person's lower ribs without folding his or her fingers or applying any pressure. The athlete is verbally instructed, after fully exhaling the air in their lungs to take deep breaths opening his/her ribs as much as he/she can whistle the therapist's hands follow the movement (without applying any manual pressure or traction). The procedure here also lasted for 4-5 minutes. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Manual therapy intervention (Chaitow's myofascial diaphragm release) | Other | Participants were given a myofascial release technique from a seated position, as described by Chaitow. With this technique, the athlete slightly bends his/her torso in order to relax the abdominal wall and breathes calmly and deeply (Figure 2). The therapist is behind the athlete holding his/her lower ribs, and during exhalation the therapist directs his hands caudally. This steady but gentle 'traction' is maintained throughout the breathing cycles for 4-5 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Chest expansion measurement as assesed by tape measure | Chest expansion was measured in centimeters with a tape measure at two thoracic levels. For the upper chest, the anatomical landmarks used were T5 spinous process, the midline of the clavicle and the third intercostal space. For the lower chest, T10 spinous process and the xiphoid process were used. | Before and immediately after the intervention |
| Measure | Description | Time Frame |
|---|---|---|
| mobility of the thoracolumbar region as assesed by the Modified-modified Schober's test (MMST) | The Modified-modified Schober's test (MMST) was used to measure the mobility of the lumbar/thoracolumbar region in centimeters (cm). The physiotherapist marked the midpoint between the posterior superior iliac spines on the athlete and a line was drawn 15 cm above this point with a dermatographic pen. The distance between the two marked points was measured in upright position. Then, the athlete bended forward as far as possible with knees extended, and the distance between the two marked points was measured again in flexion. The difference between the initial and final measurements in centimeters (cm) represented the lumbar/thoracolumbar total mobility |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Evdokia Billis, Physiotherapy | University of Patras | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Laboratory of Clinical Physiotherapy and Research (CPR lab) | Pátrai | 26504 | Greece |
Happy to share primary outcome's data
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| Sham Comparison | Other | With this sham comparator technique, the therapist stood behind the athlete (who was sitting) touching the outside of the person's lower ribs without folding his or her fingers or applying any pressure. The athlete is verbally instructed, after fully exhaling the air in their lungs to take deep breaths opening his/her ribs as much as he/she can whistle the therapist's hands follow the movement (without applying any manual pressure or traction). The procedure here also lasted for 4-5 minutes |
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| Before and immediately acfter the intervention |
| goniometry of the thoracic flexion and extension range of movement as assessed by buble inclinometers | Two circular bubble inclinometers (goniometers) were used which calculated the range of motion in degrees. Before the measurements, the levels C7/T1 and T12/L1 were identified by palpation and marked on the athlete's body with a dermatographic pen, to point the beginning and end of the thoracic spine. The two inclinometers were then firmly placed at each point with the athlete simulating an upright posture and waited until the inclinometers calibrated to zero. The subject was then asked to bend forward with legs extended, whistle the examiner maintained the inclinometers in perpendicular contact with the marked thoracic points for recording the degree of flexion. To calculate the total thoracic flexion ROM, the A7/T1 inclinometer measurement in degrees was subtracted from that of the T12/L1 level. The same procedure was performed for extension. | Before and immediately after the intervention |
| overall mobility of the posterior kinetic chain as assesed by the Fingertip-to-Floor (FTF) test | To assess the overall mobility of the posterior kinetic chain, in the FTF test the subject stood upright on a 20 cm platform with the feet together. He/She was asked to bend forward as far as he/she could while keeping knees parallel and extended with hands and fingers together in full extension. The distance between the tip of the middle finger of the right hand with the ground was measured with a tape measure in centimeters (cm). | Before and immediately after the intervention |