Effect of Diaphragmatic Breathing Exercises on Stress, Pain Perception, and Functional Mobility in Chronic Low Back Pain
Keywords:
chronic low back pain, diaphragmatic breathing, perceived stress, functional mobility, randomized controlled trialAbstract
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.
References
1. Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012;64(6):2028–37.
2. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet 2017;389(10070):736–47.
3. Chaitow L, Bradley D, Gilbert C. Recognizing and treating breathing disorders. 2nd ed. Edinburgh: Churchill Livingstone; 2014.
4. Oliveira DS, Ferreira AA, Oliveira JJS, et al. Association between perceived stress and low back pain in adults: a systematic review. Pain Med 2022;23(5):921–33.
5. Roussel N, Nijs J, Meeus M, et al. Central sensitization and altered central pain processing in chronic low back pain. Clin J Pain 2013;29(1):75–84.
6. Martires J, Zeidler M. The value of mindfulness meditation in the treatment of chronic pain. Pain Med 2020;21(12):3403–11.
7. Busch V, Magerl W, Kern U, et al. The effect of deep and slow breathing on pain perception and autonomic outflow. Pain 2012;153(3):637–44.
8. Mehling WE, Hamel MB, Acree M, et al. Randomized controlled trial of breath therapy for patients with chronic low-back pain. Altern Ther Health Med 2005;11(4):44–52.
9. Anderson BE, Bliven KCH. The use of breathing exercises in the treatment of chronic, nonspecific low back pain. J Sport Rehabil 2017;26(5):452–8.
10. Sorensen L, Stochkendahl MJ, Hartvigsen J, et al. Breathing exercises as treatment for chronic low back pain: a randomised controlled trial. Eur J Pain 2019;23(4):735–46.
11. Ostelo RW, de Vet HC. Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol 2005;19(4):593–607.
12. Cramer H, Lauche R, Haller H, et al. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain 2013;29(5):450–60.
13. Wang X, Li P, Pan C, et al. Effects of mind-body exercises on chronic low back pain: a meta-analysis. Complement Ther Med 2021;60:102754.
14. Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations. JAMA 2016;315(12):1240–9.
15. Jerath R, Edry JW, Barnes VA, et al. Physiology of long pranayamic breathing: neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Med Hypotheses 2006;67(3):566–71.
16. Russo MA, Santarelli DM, O’Rourke D. The physiological effects of slow breathing in the healthy human. Breathe (Sheff) 2017;13(4):298–309.
17. Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol 2003;13(4):361–70.
18. Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000;85(3):317–32.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Junaid Alvi, Zeeshan Ali, Sara Mubeen (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright is retained by the Author(s). Published in JPMHR under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Unrestricted reuse is permitted with proper attribution to the author(s) and source.
