Can Breathing Exercises Effectively Treat People with Chronic Non-Specific Low Back Pain? A Meta-Analyses

This meta-analysis aims to evaluate the impact of respiratory interventions on pain reduction and functional capacity in individuals with lower back pain. Other secondary outcomes were also assessed. The secondary objective was to understand the current evidence of the effectiveness of breathing exercises on non-specific LBP.

PubMed, Medline & CINHAL, EMBASE, Web of Science, PEDro, and Airiti Library databases were systematically searched until September 17, 2024. Randomised controlled trials (RCT) comparing the effects of breathing exercises with and without for individuals with non-specific LBP on their pain intensity or functional capacity were included. Random-effects models computed the end-trial standard mean difference (SMD) and 95% confidence interval (CI). Subgroup analysis was performed to explain possible heterogeneity. The risk of bias was assessed using the Cochrane risk of bias tool 2(ROB 2).

Out of 885 studies, 19 met the inclusion criteria, with 720 participants included. The meta-analysis revealed a significant reduction in pain intensity following respiratory interventions compared to controls. (SMD -1.1, 95% CI -1.7 to -0.51), enhance functional capacity, such as Oswestry Low Back Pain Disability Questionnaire (SMD -0.56; 95% CI -0.88 to -0.25) and Roland-Morris Disability Questionnaire (SMD -0.98; 95% CI -1.9 to -0.03), and improve respiratory function in Forced Expiratory Volume in the First Second (SMD 0.43; 95% CI 0.14 to 0.72), Forced Vital Capacity (SMD 0.46; 95% CI 0.18 to 0.74) and Maximal Voluntary Ventilation (SMD 0.34; 95% CI 0.02 to 0.66). Subgroup analysis revealed inhalation as the focused phase in breathing exercises and breathing as the supplementary treatment can significantly decrease pain (Inhalation: SMD -0.82; 95% CI -2.3 to -0.6) and (Supplementary: SMD -1.3; 95% CI -2.0 to -0.62). Based on the ROB2 assessment, seven were rated as having a high risk of bias, mainly in the domain of deviations from the intended interventions.

Breathing exercises demonstrate effects supported by moderate-quality evidence on chronic non-specific LBP. Prioritising inspiratory techniques in a supplementary form within the treatment regimen is recommended. Further research is recommended to confirm these results.

Respiratory interventions should be integrated as complementary treatments for non-specific LBP, focusing on inhalation techniques to improve pain management and functional capacity. Physiotherapists can incorporate these exercises into routine rehabilitation for a holistic approach addressing musculoskeletal and respiratory aspects.