Osteopathy and Asthma
Before attempting to treat asthma it is important that the osteopath understands the pathophysiology of the disease and the biomechanics.
Asthma is a disease triggered by factors such as dust, anxiety, cold air and animal-hair, defined as the chronic hyperactivity of lung tissue resulting in constriction of the bronchial tree. The constriction of the bronchial tree causes dysponea (difficulty breathing), wheezing and coughing. It results in excess production of mucous, bronchospasm and oedema. Since the airways are narrowed, the asthmatic finds it difficult to exhale, the exhalation phase is prolonged leading to hyperinflated lungs and the osteopath may observe "barrel-chest".
Exposed to the allergen, the acute asthmatic responds with the production of inflammatory cells and mast cells which initiate mucous production and bronchospasm. However when asthma becomes chronic it results in the hypertrophy of the smooth muscle, fibrosis and an increase in the number of blood vessels in the bronchiole mucosa. This is why it is so important to treat the asthmatic from an early age.
Observation of the patient by the osteopath is focused mainly on the respiratory mechanics – the relationship between the thoracic spine, ribs, sternum, clavicle, scapulae, cervical spine, cervical fascia and diaphragm. The osteopath should palpate for somatic dysfunction in all of these areas, observing compliance and flexibility. The osteopath should check to what extent each area is able to accommodate inhalation and exhalation and to what degree the lower 6 ribs are compliant to allow the diaphragm to descend. The secondary respiratory muscles are often hypertonic in the asthmatic patient and the osteopath should check to what extent this is the case and whether there is any asymmetry of hypertonicity in the body. The osteopath should observe the face and the relationship of the mouth, nose, eyes, forehead, ears and palate noting any asymmetry and compression that may cause obstruction in the sinuses and airways.
A common cause of asthma in children is gastric reflux so the osteopath should take into consideration the overlapping areas of the respiration and digestion, in other words, the diaphragm, the upper lumber spine, the lower ribs and the sternum.
When examining the asthmatic patient the osteopath needs to pay due attention to the areas directly related to breathing:
Upper thoracic vertebrae and ribs.
Sympathetic nerve supply to the lungs (T1-5).
Vagus nerve (cranial nerve X) which innervates the smooth muscle of the bronchioles.
Anterior cervical musculature
Diaphragm locally – the lower 6 ribs, the attachments of the crura – L1 and 2 and its nerve supply C3,4,5 – phrenic nerve.
Accessory muscles of respiration –sternocleidomastoid, scalene muscles and the intercostal muscles.
There are a few objectives to the osteopathic treatment:
a) To improve the breathing mechanics.
b) To balance the sympathetic and parasympathic nervous system.
c) To encourage lymphatic drainage.
The order of treatment should obviously be what the osteopath deems appropriate but a simple guide after checking for somatic dysfunction could be to first treat any dysfunction observed in the primary breathing mechanics that is the ribs, thoracic spine, sternum and diaphragm. Next the osteopath moves on to the more peripheral areas such as the scapulae, the secondary respiratory mechanics, that is the cervical muscles and fascia.
Next the osteopath can address the sympathetic nerve supply to the bronchioles – T1-6 as well as paying due attention to vagus nerve specifically as it exits the occipito-atlantal joint and the phrenic nerve which innervates the diaphragm.
The osteopath can end off with a gentle lymphatic pump either thoracic or pedal.
Treatment of the asthmatic patient by the osteopath really does require a holistic approach and the osteopath should remember to address more than just the patient's musculo-skeletal system. The approach needs to be multifactorial, combining environmental advice, dietary advice, exercises and relaxation techniques.
1. Steyer TE, Mallin R, Blair M. Pediatric asthma [review]. Clin Fam Pract.
2003;5(2):343. Available at:
Accessed January 12, 2005.
2. Morris NV, Abramson MJ, Strasser RP. Adequacy of control of asthma in
a general practice: Is the maximum peak expiratory flow rate a valid index of
asthma severity? Med J Aust. 1994;160:68–71.
3. Rowane W, Rowane MP. An osteopathic approach to asthma [review].
J Am Osteopath Assoc. 1999;99:259–264.
4. Beal MC, Morlock JW. Somatic dysfunction associated with pulmonary
disease. J Am Osteopath Assoc. 1984;84:179–183.
5. Howell RK, Kappler RE. The influence of osteopathic manipulative therapy
on a patient with advanced cardiopulmonary disease. J Am Osteopath Assoc.
6. Allen TW, Kelso AF. Osteopathic research and respiratory disease. J Am
Osteopath Assoc. 1980;79:360.
7. Bockenhauer SE, Julliard KN, Lo KS, Huang E, Sheth A. Quantifiable
effects of osteopathic manipulative techniques on patients with chronic
asthma. J Am Osteopath Assoc. 2002;102:371–375. Available at:
Accessed December 27, 2004.
8. Paul FA, Buser BR. Osteopathic manipulative treatment applications for the
emergency department patient. J Am Osteopath Assoc. 1996;96:403–409.
9. Reddel HK, Salome CM, Peat JK, Woolcock AJ. Which index of peak expiratory
flow is most useful in the management of stable asthma? Am J Respir
Crit Care Med. 1995;151:1320–1325..
By Gregory Rabi