Breathing therapies in patients with spinal pain: a systematic review

Abstract

Introduction Spinal pain is often associated with alterations in respiratory functioning, such as greater diaphragm fatiguability, more pronounced thoracic breathing, and decreased ventilation. Although beneficial effects of breathing interventions on spinal pain may be presumed, their clinical effectiveness remains unclear.

Aim We aimed to investigate the effect of breathing interventions on pain and disability in individuals with spinal pain.

Methods After study registration (CRD42020199471), six databases were searched until August 2023. Studies investigating the effect of breathing interventions, whether or not compared with a control group, on pain or disability in individuals with spinal pain were included. Risk of bias was assessed with the Downs and Black checklist. Both within- and between-group differences were extracted.

Results Fourteen studies related to low back pain (LBP) and six to neck pain (NP). Seventeen of them received a fair to good quality score (50-85%). Breathing interventions included, but were not limited to, slow deep breathing, inspiratory muscle training, and breathing awareness. In the LBP population, breathing interventions significantly decreased pain and disability in respectively 13/13 and 8/10 studies. When compared with an intervention group, pain and disability significantly decreased in respectively 5/12 and 4/11 studies. In the NP population, breathing interventions significantly decreased pain and disability in respectively 6/6 and 3/4 studies. When compared with an intervention group, pain and disability significantly decreased in respectively 4/4 and 1/2 studies.

Relevance Breathing therapies may be a beneficial treatment modality for LBP and NP.

Conclusion Breathing interventions may decrease pain and disability in individuals with LBP and NP, but it remains inconclusive whether breathing interventions are more effective than routine physiotherapy or other control treatments in LBP and NP.

Implications By December 2023, we aim to elucidate which components of breathing interventions (e.g., rate, volume, resistance) determine their clinical effectiveness in individuals with spinal pain.