Does Manual Therapy Provide Additional Benefit To Breathing Retraining In The Management Of Dysfunctional Breathing? A Randomised Controlled Trial

Purpose: Dysfunctional breathing (DB) is associated with an abnormal breathing pattern, unexplained breathlessness and significant patient morbidity. Treatment involves breathing retraining through respiratory physiotherapy. Recently, manual therapy (MT) has also been used, but no evidence exists to validate its use. This study sought to investigate whether MT produces additional benefit when compared with breathing retraining alone in patients with DB. Methods: Sixty subjects with primary DB were randomised into either breathing retraining (standard treatment; n¼30) or breathing retraining plus MT (intervention; n¼30) group. Both the groups received standardised respiratory physiotherapy, which included: DB education, breathing retraining, home regimen, and audio disc. Intervention group subjects additionally received MT following further assessment. Data from 57 subjects were analysed. Results: At baseline, standard treatment group subjects were statistically younger (41.7 + 13.5 versus 50.8 + 13.0 years; p¼0.001) with higher Nijmegen scores (38.6 + 9.5 versus 31.5 + 6.9; p¼0.001). However, no significant difference was found between the groups for primary outcome Nijmegen score (95% CI ( 1.1, 6.6) p¼0.162), or any secondary outcomes (Hospital Anxiety & Depression Score, spirometry or exercise tolerance). Conclusion: Breathing retraining is currently the mainstay of treatment for patients with DB. The results of this study suggest MT provides no additional benefit in this patient group.Juliana Burgess, Dr Robert Wilson, Royal Brompton & Harefield NHS Foundation Trust, and Dr Andy Jones fo

Sunrise Dam Gold Mine, Western Australia: mechanical controls on an Archean lode gold hydrothermal system

The Sunrise Dam Gold Mine is the largest gold deposit in the eastern part of the Yilgarn craton. In several ways it is a typical Archean lode gold deposit, other than its exceptional size. Mineralization is hosted in intermediate-mafic metavolcanics and metasedimentary rocks. The major structures are gently NW to NNW dipping shear zones, which are connected by sub-vertical NNE and NE trending fault and breccia zones. Ore bodies occur parallel to the shear zones and faults. At least 6 deformation events can be distinguished. The majority of the gold mineralisation occurred in D3 and D4, with some also possibly occurring in the first event. The two major deformation/ mineralizing events had strike slip kinematics, reflecting SE and NE shortening respectively. Two key mechanical factors in the formation of the Sunrise Dam deposit were reactivation, and the existence of structures and competent bodies that caused stress perturbations. The identification of these factors could have useful exploration implications