Manual Therapy in COVID-19 Post Covid Rehabilitation- Capri4Physio

Manual Therapy in COVID-19

Hey there!

The bigger question that can come in the minds of a manual therapist is that how can manual therapy be beneficial during covid-19.

What can we as manual therapists can do?

The main focus that we have is breathing exercises and strategies on how to increase the SpO2 of a person, indeed that is the major concern, but in order for the lungs to expand we need a good mobility of the thoracic spine, intercostals, costo-vertebral and costo-chondral joints, that can be achieved with great ease with manual therapy!

Why do we need to do it?

Now these are the things that can’t be ignored since in order to increase the SpO2 you need the lungs to expand and sometimes due to lack of mobility there is no proper pump handle or bucket handle movement that may take place and hence wouldn’t allow the maximum lung function and vital capacity to be achieved by the patient. This isn’t a new fact rather a well-established one, it has been seen that the vital capacity is reduced in scoliotic patients and other patients with reduced thoracic mobility.

How to do it?

The major question arrives at is how to do it? These techniques are easy to administer and can be done by a physiotherapist.

The thoracic cage as the following joints: thoracic intervertebral joints, costochondral joints, costovertebral joints and the intercostal joints

Thoracic Spine

This forms the posterior aspect of the thoracic cage where the lungs are situated, in order to mobilize this, the therapist can make the patient lie down in prone lying and with the use of the heal of the hand they can hook the spinous process and push the vertebrae towards the eyeball of the patient

The same glide can be given on the transverse process of the thoracic spine

Costochondral and Costovertebral Joints

These are the joints that can be mobilized individually or can be mobilized together, it totally depends on the therapist, the key is palpation of the joints

The costochondral joint will be 1 or 2 fingers away from the sternum and the costovertebral joint can be found just adjacent to the transverse process of the thoracic vertebrae

Once the palpation is done, the manual therapist needs to put their pisiform lateral to the joint line and then mobilize the joint by pushing them in the desired direction, the optimal direction would be cranially

The best thing to do along with the mobilisation is to make the patient do active breathing that would allow you to do move the joint along with the mobilisation and would help you get better results

Intercostal Joints

They play an important role in the bucket handle movement of the rib cage, the bucket handle movement is more important in diaphragmatic breathing and the expansion of the lower lobes.

Mobilising it also becomes important since the covid infection is majorly affecting the lower lobes of the patients

It can be achieved by standing behind the patient and making the patient sit on a plinth, once that is done the manual therapist takes their ulnar border of the hand and hooks it on both sides of the same level of the intercostal joints, i.e if on the right side we hook the intercostal joint between the rib 6 and 7, we need to do the same on the left side as well

Make sure the wrist are extended and the elbow flexed which allows us to be close to the patient, the palm needs to be in an inclined manner, in order to properly hook the rib

Once you do hook the rib on both the side you need to push the rib in a superior direction and ask the patient to do active breathing

So this was the basic mobilisation techniques that can be performed during this day and age and can be done in order to help the patients and remember a strong lung and a good vital capacity is very important in order to fight the virus.

Keep your patients motivated and happy, they need to have faith that they will be fine and once they have the motivation there is no one that can stop them from recovering.

Cheers

Dr Deepak Kumar Capri

MSPT, FIAP, PhD

Capri Institute – Capri4Physio