Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
Low back pain can be a debilitating condition leading to fear and pain with movement leading to reduction in strength, motor control, and coordination. Those with chronic lower back pain often experience diaphragm fatigue. Studies suggest respiratory muscle training could decrease pain, and improve balance, physical function, and overall quality of life, especially in those with subacute and chronic low back pain. This article strives to review a compilation of articles that study the effects of respiratory muscle training on lower back pain symptoms.
Methods
Studies included in the review consisted of patients with LBP for more than 4 weeks. Interventions consisted of inspiratory and expiratory muscle training, combined, and various modalities and devices with a minimum training session of 4 weeks. Outcomes included pain intensity, fear avoidance behaviors, disability, and respiratory muscle function. All studies included were randomized control trials accessed through various databases by two independent reviewers.
Results
The review included 11 studies with over 400 participants and majority of the studies included strength training. Ten studies included an experimental group who performed respiratory muscle training/program. Researchers found low-quality evidence from four studies who concluded that respiratory muscle training increased postural control and a decrease in lumbar disability. They also found that nine studies with low-quality evidence concluded respiratory muscle training decreased lumbar pain intensity, however five studies with moderate quality evidence found no significant difference in reduction in pain related fear avoiding behaviors. Additionally, the review revealed respiratory muscle training significantly increased expiratory muscle strength without effect on inspiratory muscle strength.
Discussion
Findings suggest that there is low quality evidence to support RMT on postural control, lumbar disability, and pain intensity in those with sub-acute or chronic low back pain. However, there is moderate quality evidence to suggest RMT’s improvement of MEP and FVC. The idea of RMT for lower back pain is supported by the fact that the majority of those with lower back pain show some form of fear of movement and increasing abdominal pressure takes stress off the paraspinal muscles. By training the diaphragm and other abdominal muscles, respiratory muscle training could improve recruitment pattern of abdominals and improve lumbar stability. The analysis found that combination of RMT and strength training is more effective at reducing disability and pain intensity of LBP.
Conclusion
More high-quality studies/trials are necessary to determine the effectiveness of RMT on lumbar disability, pain intensity, etc. in sub-acute/chronic LBP population. At best, this analysis concludes that RMT can improve expiratory muscle strength and FVC in those with subacute or chronic LBP.
Reference
Fabero-Garrido, R., Rodriguez-Marcos, I., del Corral, T., Plaza-Manzano, G., & Lopez-de-Uralde-Villanueva, I. (2024). Effects of Respiratory Muscle Training on Functional Ability, Pain-Related Outcomes, and Respiratory Function in Individuals with Low Back Pain: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 13(3053), 1-18. https://doi.org/10.3390/jcm13113053