Indian Journal of Respiratory Care

IJRC Email      Register      Login

VOLUME 12 , ISSUE 4 ( October-December, 2023 ) > List of Articles

Original Article

Ultrasound Evaluation of Diaphragm Motion in Various Body Positions in Normal Adults in Age-group of 20–30 Years: A Pilot Study

Rachna D Arora, Madhura R Patil, Shenaz AZ Saifi, Trushna S Khude

Keywords : Lung ultrasound, Respiratory muscle, Ultrasonography chest

Citation Information : Arora RD, Patil MR, Saifi SA, Khude TS. Ultrasound Evaluation of Diaphragm Motion in Various Body Positions in Normal Adults in Age-group of 20–30 Years: A Pilot Study. Indian J Respir Care 2023; 12 (4):320-324.

DOI: 10.5005/jp-journals-11010-1081

License: CC BY-NC-SA 4.0

Published Online: 18-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Aims and background: Body positioning is a noninvasive therapeutic intervention used by physiotherapists, with significant effects on and benefits for pulmonary function and oxygenation. It influences ventilation distribution, perfusion, alveolar opening pressure, and diaphragmatic mechanics. This study is to assess diaphragm motion using M-mode ultrasonography (USG) in body positions of supine, side-lying, half-lying, sitting, and forward-lean sitting which are commonly used in treating respiratory patients. Materials and methods: A total of 40 healthy adults, (20 males and 20 females) nonsmokers, with normal body mass index (BMI), in the age-group of 20–30 years were enrolled after approval from the Institutional Ethics Committee. The study was conducted in collaboration with the Radiology Department of Tertiary Health Care Hospital. USG for right diaphragm motion was done using M-mode. The transducer was placed transversely on the anterior axillary line over the lower intercostal space and a three-layered image was taken. Right, diaphragm motion was assessed with subjects breathing normally and positioned supine, left-side lying, sitting, forward-lean sitting, and half-lying position. Three measurements were recorded and the highest reading was considered. Data was collected and analysis was done using Statistical Package for the Social Sciences (SPSS) version 16. Results: The right diaphragm motion was 60.04 ± 6.01 mm in supine, 39.59 ± 7.81 mm in left-side lying, 61.27 ± 5.93 mm in half-lying, 41.38 ± 7.41 mm in sitting and 38.68 ± 6.32 mm in forward-lean sitting. Diaphragm motion was highest in half-lying followed by supine, sitting, and forward-lean positions (p = 0.001). There was no significant difference between diaphragm motion in males and females (p > 0.001). Conclusion: In healthy subjects, diaphragm motion was significantly influenced by body position and was found higher in the supine and half-lying positions. Clinical significance: Ultrasonography (USG) evaluates diaphragmatic motion, useful in pulmonary rehabilitation. Diaphragm motion is highest in supine and half-lying positions, suggesting effective breathing exercises in these positions.

  1. Yamaguti WP, Paulin E, Shibao S, et al. Ultrasound evaluation of diaphragmatic mobility in different postures in healthy subjects. J Bras Pneumol 2007;33(4):407–413. DOI: 10.1590/s1806-37132007000400009
  2. Dubé BP, Dres M. Diaphragm dysfunction: diagnostic approaches and management strategies. J Clin Med 2016;5(12):113. DOI: 10.3390/jcm5120113
  3. Frownfelter D, Dean E. Cardiovascular and Pulmonary Physical Therapy: Evidence and Practice. St Louis, MO: Elsevier; 2012. pp. 293–295.
  4. Magadle R, McConnell AK, Beckerman M, et al. Inspiratory muscle training in pulmonary rehabilitation program in COPD patients. Respir Med 2007;101(7):1500–1505. DOI: 10.1016/j.rmed.2007.01.010
  5. Takazakura R, Takahashi M, Nitta N, et al. Diaphragmatic motion in the sitting and supine positions: Healthy subject study using a vertically open magnetic resonance system. J Magn Reson Imag 2004;19(5):605–609. DOI: 10.1002/jmri.20051
  6. Torres-Gallardo B, Sala-Blanch X, Gimeno-Aragón E, et al. Diaphragmatic excursion studied by M-mode ultrasonography in singers. A preliminary study. J Case Repo Imag 2017;1(1):001.
  7. Gerscovich EO, Cronan M, McGahan JP, et al. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 2001;20(6):597–604. DOI: 10.7863/jum.2001.20.6.597
  8. Lloyd T, Tang YM, Benson MD, et al. Diaphragmatic paralysis: the use of M-mode ultrasound for diagnosis in adults. Spinal Cord 2006;44(8):505–508. DOI: 10.1038/
  9. Metha M, Pawar K. To find out the effect of various body positions on peak expiratory flow rate (PEFR) in COPD patients. Int J Physio 2016;3(3):291–296. DOI: 10.15621/ijphy/2016/v3i3/100830
  10. M Dena Gardinar, Baillieritindall. The Principles of Exercise therapy, 4th Edition. CBS Publishers & Distribution Pvt. Ltd; 2005.
  11. Avinash PM, Nikhil GP, Smita SA, et al. Feasibility and utility of ultrasonography in evaluation of diaphragmatic motion and thickness in Indian population. Int J Health Sci Res 2017;7(5):60–65.
  12. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009;135(2):391–400. DOI: 10.1378/chest.08-1541
  13. Laghi FA, Saad M, Shaikh H. Ultrasound and non-ultrasound imaging techniques in the assessment of diaphragmatic dysfunction. BMC Pulm Med 2021;21(1):85. DOI: 10.1186/s12890-021-01441-6
  14. Houston JG, Angus RM, Cowan MD, et al. Ultrasound assessment of normal hemidiaphragmatic movement: relation to inspiratory volume. Thorax 1994;49(5):500–503. DOI: 10.1136/thx.49.5.500
  15. Kantarci F, Mihmanli I, Demirel MK, et al. Normal diaphragmatic motion and the effects of body composition: determination with M-mode sonography. J Ultrasound Med 2004;23(2):255–260. DOI: 10.7863/jum.2004.23.2.255
  16. Brown C, Tseng SC, Mitchell K, et al. Body position affects ultrasonographic measurement of diaphragm contractility. Cardiopulm Phys Ther J 2018;29(4):166–172. DOI: 10.1097/CPT.0000000000000083
  17. Lee LJ, Chang AT, Coppieters MW, et al. Changes in sitting posture induce multiplanar changes in chest wall shape and motion with breathing. Respir Physiol Neurobiol 2010;170(3):236–245. DOI: 10.1016/j.resp.2010.01.001
  18. Albarrati A, Zafar H, Alghadir AH, et al. Effect of upright and slouched sitting postures on the respiratory muscle strength in healthy young males. Biomed Res Int 2018;2018:3058970. DOI: 10.1155/2018/3058970
  19. Katz S, Arish N, Rokach A, et al. The effect of body position on pulmonary function: a systematic review. BMC Pulm Med 2018;18(1):159. DOI: 10.1186/s12890-018-0723-4
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.