Efficacy of Osteopathic Manipulative Techniques With Progressive Pulmonary Fibrosis Patients

The goal of this clinical trial is to learn if osteopathic manipulative techniques add benefits for treatment of patients with progressive pulmonary fibrosis. The main questions it aims to answer are : Could osteopathic manipulative techniques add benefits for treatment of patients with progressive pulmonary fibrosis? Researchers will compare osteopathic manipulative techniques with chest physiotherapy to chest physiotherapy alone to see if osteopathic manipulative techniques works to treat progressive pulmonary fibrosis. Participants will: Take osteopathic manipulative techniques 2 days a week for 4 weeks and chest physiotherapy 3 days a week for 4 weeks

In this study researchers want to see if osteopathic manipulative techniques add benefits to treat progressive pulmonary fibrosis. two group of patients : study group will receive osteopathic manipulative techniques with conventional chest physiotherapy . control group will receive only conventional chest physiotherapy . osteopathic manipulative techniques will be done for 2 days a week for 4 weeks while conventional chest physiotherapy will be done 3 days a week for 4 weeks.

Inclusion Criteria: * Their age \> 18. * Both sexes. * Patients without excerbations. * FVC of the patient \<50% . * FEV1/ FVC of the patient \<50%. * Hemodynamic stable. * Conscious and cooperative. * Are able to participate in training actively. Exclusion Criteria: * Patients with acute excerbations. * Acute or Uncontrolled Infections. * Active Malignancy. * Chest deformity