Breathing interventions for spinal pain: A systematic review and meta-analysis

Abstract

Objective: Individuals with spinal pain often show breathing dysfunctions. Although the effects of breathing interventions in general have been studied, no distinctions regarding types of breathing interventions were made. Therefore, we summarized the effects of different types of breathing interventions on spinal pain and disability. Data sources: PubMed, Web of Science, PEDro, Cochrane, PsycArticles, and Embase were systematically searched till September 2, 2025. Review methods: Studies that described therapies using active instructions to modulate breathing or increase breathing awareness in adults with spinal pain were eligible. Breathing interventions were categorized into slow deep breathing, respiratory resistive breathing, and breathing awareness. Effects were subdivided into additional (breathing intervention + other intervention vs. other intervention) and comparative effects (breathing intervention vs. other intervention). The Downs and Black checklist was used to assess methodological quality. Meta-analyses were performed with standardized mean differences, and certainty of evidence was evaluated based on the GRADE assessment. Results: Twenty studies involving 814 participants were included. Seventeen were of fair to good quality, three of poor quality. Meta-analyses revealed that slow deep breathing positively affected spinal pain (n = 223; SMD =-1.03; low certainty of evidence) and disability (n = 132; SMD =-1.34; very low certainty of evidence) when added to other interventions. Moreover, respiratory resistive breathing decreased spinal pain compared to other interventions (n = 75; SMD =-1.31; low certainty of evidence). Conclusion: Breathing interventions may be valuable for the management of patients with spinal pain. Clinicians should be aware of, and consider, the various types of breathing interventions and their underlying mechanisms to tailor them to the treatment goals of their patients.