The Link Between COPD, Musculoskeletal Pain, and Thoracic Mobility

Written By David Han

Chronic Obstructive Pulmonary Disease (COPD) is well known for its impact on breathing, but its effects on musculoskeletal (MSK) pain and thoracic/rib cage mobility are often overlooked. Research has shown that COPD patients frequently experience chronic pain, postural dysfunction, and movement restrictions that can contribute to a reduced quality of life. Understanding the underlying mechanisms can help chiropractors and healthcare professionals develop effective strategies to manage these secondary complications.

How COPD Affects Musculoskeletal Health

1. Altered Breathing Mechanics and Rib Cage Stiffness

One of the primary changes in COPD is lung hyperinflation, which occurs when air becomes trapped in the lungs due to airflow limitation. This leads to an elevated, fixed rib cage position that reduces thoracic mobility and increases stiffness in the costovertebral and costosternal joints (O’Donnell et al., 2014). Studies suggest that this restriction can cause pain in the mid-back and rib cage, limiting functional movements such as rotation and deep breathing (Borge et al., 2015).

2. Diaphragm Dysfunction and Overuse of Accessory Muscles

In COPD, the diaphragm becomes flattened and weakened due to chronic lung hyperinflation, reducing its effectiveness in breathing. As a result, patients rely more on accessory muscles such as the sternocleidomastoid, scalenes, and upper trapezius (Gosselink et al., 2000). This compensatory mechanism can lead to chronic tension, myofascial pain, and restricted cervical and thoracic mobility.

3. Postural Changes and Spinal Load

COPD patients often adopt a forward-leaning posture (e.g., "tripod position") to improve breathing efficiency by optimising accessory muscle function. However, this posture can:

  • Increase thoracic kyphosis and reduce spinal extension (Smith et al., 2014).

  • Increase mechanical load on the lumbar spine, leading to low back pain (Manali et al., 2016).

  • Reduce shoulder mobility due to rounded shoulders and tight pectoral muscles.

4. Chronic Inflammation and Pain Sensitisation

COPD is associated with systemic inflammation, which can contribute to muscle atrophy and pain hypersensitivity (Spruit et al., 2013). Chronic inflammation, along with hypoxia (low oxygen levels), has been linked to increased pain perception and higher rates of fibromyalgia-like symptoms in COPD patients (Vogiatzis et al., 2013).

5. Cough-Induced Rib and Intercostal Muscle Strain

Frequent coughing, a hallmark of COPD, can lead to:

  • Costovertebral joint irritation.

  • Intercostal muscle strain.

  • Rib dysfunction, causing localised thoracic pain and restricted rib mobility (Borge et al., 2015).

Chiropractic and Manual Therapy for COPD-Related MSK Pain

Given the significant impact of COPD on musculoskeletal function, chiropractic care and manual therapy can play a crucial role in improving mobility and reducing pain. Evidence-based interventions include:

1. Thoracic and Rib Cage Mobilisation

  • Gentle thoracic spinal adjustments and rib mobilisation techniques can help restore segmental mobility and reduce rib cage stiffness (Heneghan et al., 2018).

  • Mobilisation of the costovertebral and costosternal joints may alleviate rib pain and improve breathing mechanics.

2. Soft Tissue Therapy for Overactive Muscles

  • Myofascial release and trigger point therapy targeting the scalenes, trapezius, and intercostal muscles can reduce muscle tension and pain.

  • Diaphragmatic release techniques can improve breathing efficiency and reduce compensatory strain on accessory muscles.

3. Postural and Breathing Retraining

  • Postural correction exercises to counteract thoracic kyphosis and forward head posture.

  • Diaphragmatic breathing exercises to reduce reliance on accessory muscles and improve oxygen efficiency (Schenk et al., 2018).

  • Functional movement training to improve thoracic extension and rib mobility.

4. Strength Training and Physical Activity

  • Progressive resistance exercises targeting the core and back muscles to support the spine and improve postural endurance.

  • Pulmonary rehabilitation programs incorporating low-impact aerobic exercises to improve cardiorespiratory function and reduce deconditioning.

Conclusion

COPD is not just a respiratory condition—it has profound effects on musculoskeletal health, particularly in the thoracic spine, rib cage, and accessory breathing muscles. Chiropractors and manual therapists can play a crucial role in addressing these dysfunctions through mobilisation, soft tissue therapy, breathing retraining, and exercise-based rehabilitation. By taking a holistic and evidence-based approach, we can help COPD patients improve mobility, pain levels, and overall quality of life.

References

  • Borge, C. R., Hagen, K. B., Mengshoel, A. M., & Wahl, A. K. (2015). Pain and quality of life in COPD patients. International Journal of Chronic Obstructive Pulmonary Disease, 10, 2229-2240.

  • Gosselink, R., Troosters, T., & Decramer, M. (2000). Peripheral muscle weakness contributes to exercise limitation in COPD. American Journal of Respiratory and Critical Care Medicine, 161(2 Pt 1), 496-502.

  • Heneghan, N. R., Adab, P., & Jordan, R. E. (2018). Manual therapy for chronic respiratory disease: A systematic review of the literature. International Journal of Osteopathic Medicine, 29, 12-19.

  • Manali, E. D., Lyberopoulos, P., Triantafillou, C., et al. (2016). Posture in COPD patients: The effect of severity and the role of spinal alignment. COPD: Journal of Chronic Obstructive Pulmonary Disease, 13(2), 242-247.

  • O’Donnell, D. E., Milne, K. M., James, M. D., et al. (2014). Dyspnea in COPD: New mechanisms, diagnostic advances, and therapeutic interventions. The Lancet Respiratory Medicine, 2(6), 401-415.

  • Schenk, P., Lins, C., & Uher, E. (2018). The role of breathing training in COPD patients. European Respiratory Journal, 52(Suppl 62), PA1293.

  • Smith, M. D., Russell, A., & Hodges, P. W. (2014). The role of breathing and trunκ stabilization in COPD. Clinical Biomechanics, 29(7), 697-703.

  • Spruit, M. A., Gosselink, R., Troosters, T., et al. (2013). Skeletal muscle dysfunction in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 187(6), 662-669.

  • Vogiatzis, I., Simoes, D. C. M., Stratakos, G., et al. (2013). Hypoxia-induced muscle dysfunction in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 187(4), 397-402.

David Han
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