The Role of Diaphragmatic Myofascial Release in Reducing Abdominal Pain in a Patient with Shoulder Pain: A Case-Based Perspective

Postoperative abdominal and visceral pain is a common complication in patients following appendectomy, especially when associated with peritonitis. The diaphragm, as the primary respiratory muscle innervated by the phrenic nerve (C3–C5), has extensive anatomical and functional relationships with thoracoabdominal and pelvic structures. Fascial restrictions or dysfunction in diaphragmatic movement may contribute to increased intra-abdominal tension and altered visceral mobility, thereby intensifying pain in the abdominal and pelvic regions. This case report presents a 45-year-old female patient who developed persistent abdominal and right thigh pain following an appendectomy complicated by peritonitis. The patient also suffered from right shoulder pain and was referred to physiotherapy for treatment of shoulder pain. In addition to standard physiotherapy, six sessions of diaphragmatic myofascial release were administered. Outcome’s measure was Pain that assessed using the Visual Analog Scale (VAS), chest expansion by tape measure, the Shoulder Pain and Disability Index by SPADI, and the satisfaction by SF-12 quality of life questionnaire. After six sessions treatment consists of diaphragmatic release besides of conventional treatment on shoulder, the patient reported a 90% reduction in visceral pain in the abdominal and inguinal areas. Chest expansion increased from 1.6 cm to 3.5 cm, and the SPADI score improved from 40 to 25. These findings suggest that restoring diaphragmatic mobility through myofascial release can significantly alleviate postoperative abdominal and referred pain, likely by reducing fascial tension and improving neurovisceral dynamics.