The effectiveness of breathing interventions on pain and disability in individuals with spinal pain: a systematic review

Abstract

Background Increased diaphragm fatiguability, more pronounced thoracic breathing, and decreased ventilation are often reported in individuals with spinal pain. Given these alterations in respiratory function, beneficial effects of breathing interventions on spinal pain may be presumed. However, their clinical effectiveness remains to be determined. Purpose The aim of this systematic review was to provide a comprehensive overview of the literature regarding the effect of breathing interventions on pain and disability in individuals with spinal pain. Methods Following the study registration (CRD42020199471), multiple 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 eligible for inclusion. Breathing interventions comprised interventions using active instructions to modulate breathing or to increase breathing awareness. The Downs and Black checklist was used to assess risk of bias. Both within- and between-group differences were extracted and synthesized narratively, due to high heterogeneity of both breathing and control interventions. Results Fourteen studies related to low back pain (LBP), and six related to neck pain (NP) were included. Seventeen of them received a fair to good quality score (50-85%). Slow deep breathing, respiratory resistance training, and breathing awareness exercises were, amongst others, included as breathing interventions. 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. Conclusion Although breathing interventions appear to decrease pain and disability in individuals with LBP and NP, it remains unclear whether breathing interventions are more effective than routine physiotherapy or other control treatments for LBP. For NP, preliminary evidence suggests that breathing interventions may be more effective compared to routine treatment. Implications By July 2024, we aim to elucidate which components of the breathing interventions (e.g., breathing rate, volume, resistance) determine their clinical effectiveness in individuals with spinal pain.