Manual Therapy and Inspiratory Muscle Strength in Apparently Healthy Smokers

all intervention and assessment were performed at outpatient physical therapy clinical, rehabilitation health sciences department, college of applied medical sciences, Riyadh , Saudi Arabia. Subjects in the interventional group were in a supine position and the arms at the side. The physiotherapist who is certified in manual therapy performed the intervention by placing his hands on the lower last four ribs on both sides and the thumb was underneath the both hemidiaphragm just below the xiphoid process of the sternum . The physiotherapist asked the subject to take a deep breath in and out; while the physiotherapist was applying a gentle pressure downward and inward directly to both hemidiaphragm at the same time and maintain this position with the same force for five minutes. This technique was repeated 5 times. After the diaphragmatic release, the physiotherapist immediately performed the second technique which was a thoracolumbar manipulation. While the subject in the supine position with both arms crossed over the chest, the physiotherapist stood by the side of the subject and placed one hand at the level of thoracolumbar area (T12 and L1 vertebra) and the other hand was over the arms of the subject. The physiotherapist asked the subject to take a deep breath in and out for three times and at the end of the third breath, the physiotherapist performed an anteroposterior thrust force of high-velocity low amplitude at T12 and L1 vertebrae level.