Effect of Diaphragmatic Breathing Exercises on Stress, Pain Perception, and Functional Mobility in Chronic Low Back Pain

Abstract

Background: Chronic low back pain (CLBP) is perpetuated by elevated stress, maladaptive breathing patterns, and reduced functional mobility; however, the independent efficacy of diaphragmatic breathing exercises remains insufficiently examined in outpatient settings. Objective: To determine the effect of a 6-week diaphragmatic breathing exercise program on pain, perceived stress, and functional mobility in patients with chronic non-specific low back pain compared with routine care. Methods: Assessor-blinded, two-arm randomized controlled trial conducted in physiotherapy outpatient departments in Faisalabad, Pakistan. Seventy adults with CLBP ≥12 weeks were randomized to breathing exercises (twice-weekly supervised plus daily home practice) or control (routine advice). Primary outcome was pain intensity (VAS 0–10); secondary outcomes included perceived stress (PSS-10), Timed Up and Go test, respiratory rate, lumbar flexion ROM, and sleep quality, assessed at baseline and 6 weeks. Between-group differences were analyzed using ANCOVA adjusted for baseline values. Results: The breathing group achieved significantly greater reductions in pain (−2.8 vs −0.5 VAS points; mean difference −2.3, 95% CI −2.9 to −1.7), perceived stress (−7.2 vs −1.2 PSS points; mean difference −6.0, 95% CI −8.1 to −3.9), and TUG time (−2.8 vs −0.6 s; p < 0.001 for all). Allocation to breathing exercises independently predicted lower post-treatment stress (β = −5.68, p < 0.001). Conclusion: A structured 6-week diaphragmatic breathing program is an effective, lowcost adjunct therapy for reducing pain, stress, and functional limitations in chronic low back pain.