Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013;8(3):e56724.
doi: 10.1371/journal.pone.0056724. Epub 2013 Mar 14.

Diaphragm postural function analysis using magnetic resonance imaging

Pavel Vostatek  1 , Daniel Novák, Tomas Rychnovský, Sarka Rychnovská
Affiliations

Diaphragm postural function analysis using magnetic resonance imaging

Pavel Vostatek et al. PLoS One. 2013.

Abstract

We present a postural analysis of diaphragm function using magnetic resonance imaging (MRI). The main aim of the study was to identify changes in diaphragm motion and shape when postural demands on the body were increased (loading applied to a distal part of the extended lower extremities against the flexion of the hips was used). Sixteen healthy subjects were compared with 17 subjects suffering from chronic low back pain and in whom structural spine disorders had been identified. Two sets of features were calculated from MRI recordings: dynamic parameters reflecting diaphragm action, and static parameters reflecting diaphragm anatomic characteristics. A statistical analysis showed that the diaphragm respiratory and postural changes were significantly slower, bigger in size and better balanced in the control group. When a load was applied to the lower limbs, the pathological subjects were mostly not able to maintain the respiratory diaphragm function, which was lowered significantly. Subjects from the control group showed more stable parameters of both respiratory and postural function. Our findings consistently affirmed worse muscle cooperation in the low back pain population subgroup. A clear relation with spinal findings and with low back pain remains undecided, but various findings in the literature were confirmed. The most important finding is the need to further address various mechanisms used by patients to compensate deep muscle insufficiency.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: Tomas and Sarka Rychnovska are employees of Avete omne company. They have no financial interest in the research. The authors declare no other potential conflicts of interest with respect to the authorship and/or publication of this article. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Differential area definition.
Figure shows t-th image from a sequence with corrensponding diaphragm contour. The t-th diaphragm contour together with the lowest placed diaphragm contour in the sequence form the diferential area formula image.
Figure 2
Figure 2. Differential area calculation.
Image on t-th position in a sequence is subtracted from the background image (the image with the lowest placed diaphragm) (A). Subtracted image is thresholded, providing a binary image with a clearly visible crescent corresponding to movement of the diaphragm (B). The red-bordered part, surrounding the highest and the lowest diaphragm position from the whole sequence reducing the space for crescent location. Continuous image parts inside the border are labeled and the part corresponding to diaphragm movement is than processed (C). Some of the extracted parameters were normalized using the thorax width measure shown here (D).
Figure 3
Figure 3. Dif-curves (A, B, solid line) and appropriate spectra (C, D, solid line).
Extracted res-curves (red dashed line, A, B) and pos-curves (green dotted line, A, B) with corresponding spectral peaks (C, D) marked in the spectra with a red dot (respiratory peak) and a green square (postural peak).
Figure 4
Figure 4. Dif-curves (solid line) and extracted res-curves (red dashed line) and pos-curves (green dotted line).
Example of harmonic breathing (A), breath with a strong postural part after the load occurred (B), harmonic breath which became partly non-harmonic after the load occurred (C, D), and breath which almost lost its ability of respiration movement ability after the load occurred (E, F).
Figure 5
Figure 5. Parameters .
Parameters formula image are computed as vertical subtraction of caudal from cranial diaphragm position. The three parameters correspond to the anterior (formula image), middle (formula image) and posterior (formula image) diaphragm part. Points were spread evenly on the diaphragm contour with small constant drift of formula image and formula image from the contour margins.
Figure 6
Figure 6. Measurement of the diaphragm inclination.
Inclination of the diaphragm was measured by angle between the line fitted to the diaphragm contour and horizontal axis. The inclination was measured during the caudal diaphragm position.
Figure 7
Figure 7. Measurement of the diaphragm height .
Measurement was done during the diaphragm caudal position. The middle line is the line fitted to the diaphragm contour by least squares method.
Figure 8
Figure 8. Measurement of the diaphragm height in the trunk.
The figure indicates when the height is negative (the diaphragm higher than the back marker) and when the height is positive (the diaphragm placed under the back marker).
Figure 9
Figure 9. Correlation between parameter and parameter in situation .
Diaphragm height were the only diaphragm parameter which was statistically significantly correlated (p = 0.0035) with the subjects' low back pain indicated during the month before imaging. Pearson correlation coefficient was 0.67.
See this image and copyright information in PMC

References

    1. Lewit K (1980) Relation of faulty respiration to posture and with clinical implications. The Journal of the American Osteopathic Association 525–529. - PubMed
    1. Barr KP, Griggs M, Cadby T (2005) Lumbar stabilization: Core concepts and current literature, part 1. American journal of physical medicine and rehabilitation 473–480. - PubMed
    1. Hodges PW, Richardson CA (1999) Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Archives of physical medicine and rehabilitation 1005–1012. - PubMed
    1. Cholewicki J, Ivancic PC, Radebold A (2002) Can increased intra-abdominal pressure in humans be decoupled from trunk muscle co-contraction during steady state isometric exertions? European journal of applied physiology 127–133. - PubMed
    1. Cohen E, Mier A, Heywood P, Murphy K, Boultbee J, et al. (1994) Excursion-volume realtion of the right hemidiaphragm measured by ultrasonography and respiratory airow measurement. Thorax 885–889. - PMC - PubMed

Publication types