This study investigated the effects of a postural breathing training (PBT) intervention on self-reported disability and postural stability in patients with chronic low back pain. 16 participants with chronic low back pain were randomly assigned to either an experimental group that received 30 minutes of PBT or a control group that received 30 minutes of reading. PBT taught diaphragmatic breathing coordinated with tasks. Results showed that the experimental group experienced a significant decrease in self-reported disability one week following PBT compared to the control group, though postural stability did not significantly change. The study suggests PBT may be a beneficial adjunct treatment for chronic low back pain.

1. Postural Breathing Improves Self-Reported Disability in Chronic Low Back Pain
Allan Buccola, SPT, Shin-Yiing Yeung, DPT, Jacqueline Crosser, SPT, Srikant Vallabhajosula PhD
Elon University Elon, North Carolina
FOUNDATION
Figure A: Decreased use of somatosensory
system for balance immediately following
breathing training. *P < 0.05
Figure B: Significant decrease in self-reported
disability at one week follow up for Experimental
group. * P < 0.05
METHODS
SUBJECTS: 16 participants (average age: 47±13.5, average BMI: 24.8±3.1,
history of low back pain: 12.7±11.8 years, and an average VAS-P rating:
1.5/10)
MEASURES: Oswestry Disability Index(ODI) , Back Bournemouth Questionnaire
(BBQ), 30s static postural sway area from force plate (pre, post, F/U).
CONTROL: 30 minutes reading, n=9 (C).
EXPERIMENTAL: N=7, Postural Breathing Training (PBT), teaching breath
initiation, proprioception, and distribution, as well as coordination with a task.
POST & FOLLOW-UP: All participants repeated the balance testing (Post).
Those in the experimental group were cued to “use the postural breathing”
during testing. Afterwards, the Control group was also given PBT. All
participants were asked to practice the breathing for 7 days, and then were
retested for balance, ODI and BBQ (F/U; n=16).
ANALYSES: A time (Pre vs. Post) vs. Group (E vs. C) mixed ANOVA was
performed for sway area. A time (Pre vs. Post vs. F/U) vs. Group (C) mixed
ANOVA was performed for sway area. A time (Pre vs. F/U) vs. Group (E vs. C)
mixed ANOVA was performed for ODI and BBQ.
Left: Participant receives postural breathing training Right: balance testing on foam surface
with eyes closed
CONCLUSION
0.96
0.97
0.98
0.99
1
1.01
1.02
Pre Post
C E
Somatosensory Component of
Balance
DISCUSSIONPURPOSE
A Postural breathing intervention could pose a meaningful, and
inexpensive adjunct in improving clinical outcomes for
patients with chronic low back pain. Sufficient evidence exists
revealing an important functional relationship between the
diaphragm dysfunction and chronic low back pain. It would be
prudent to consider the inclusion of breathing training in existing
treatment protocols for Chronic Low Back Pain.
• After PBT, our cohort experienced a decrease in pain related
disability; however, changes in postural stability did not occur
as anticipated. The PBT also correlated with changes to the
role of somatosensation in balance, although the relationship
is still unclear.
• It is important to know that while respiratory fatigue is shown
to negatively effect postural stability, Lorimer in 2005
revealed that acute back pain immediately changed core
motor patterns. This combination of phenomena sets into
motion a cycle in which CLBP leads to rigidity, leading to
respiratory dysfunction, resulting in altered mechanics,
resulting in more back pain, and so on.
• Based on the data, it is safe to say that respiratory
dysfunction does not result in CLBP, so much as it progresses
with it. With this in mind, it is also safe to say than any
patient experiencing CLBP will likely benefit from PBT. As
disability improves, future studies can investigate whether
postural-stability also improves over time.
LIMITATIONS:
• Short intervention period
• Study design resulted in no Control data at follow-up.
• Cueing postural breathing during data collection
• Low VAS pain rating compared to clinical population.
RESULTS
Investigate the utility of a breathing-based intervention in the
treatment of CLBP, as well as impaired postural stability.
Author & Year Primary Findings
Smith 2006
CLBP more correlated with respiratory dysfunction than
obesity, sedency
Stokes 2010
As intra-abdominal pressure (IAP) increases, spinal
unloading occurs
Hemborg 1985 The diaphragm is the key modulator of IAP
Kolar 2012 Diaphragm is a key postural muscle
Janssens 2013 Diaphragm fatigability is greater in persons with CLBP
Janessens 2010
CLBP associated with rigid postural strategy; decreased hip-
strategy, increased ankle-strategy
Janessens 2010
Diaphragm fatigue in healthy, creates similar postural
strategies to those with CLBP
Wilson 2006
Lumbar muscle fatigue elicits a negative effect on
proprioception
Hodges 2002
Diaphragm mechanics provide proprioception for multi-
segmental righting strategies.
Grimstone 2003
Persons with CLBP compensate poorly for COP displacement
associated with breathing
de la Volpe 2006 Persons with CLBP exhibit altered postural control
Janssens 2010 CLBP correlates with increased postural sway
Janssens 2010
Decreased stability resultant of decreased proprioception
from the dysfunctional diaphragm.
Figure C: Analysis
of contribution of
Somatosensory
system to postural
stability, revealed
no significant
difference when
comparing 3
testing times for
the experimental
group only.
*
*
REFERENCES
ACKNOWLEDGEMENTS
• Brumagne S, Janssens L, Janssens E, Goddyn L. et al. Altered postural control in anticipation of postural instability in persons with recurrent low back pain. Gait
Posture. 2008; 28: 657–662.
• de la Volpe, R. et al. Changes in coordination of postural control during dynamic stance in chronic low back pain patients. Gait Posture. 2006; 24:349-355.
• Grimstone S, Hodges P. Impaired postural compensation for respiration in people with recurrent low back pain. Experimental Brain Research. 2003; 151:218-
224.
• Janssens L, Brumagne S, McConnell AK, Hermans G, Troosters T, Gayan-Ramirez G. Greater diaphragm fatigability in individual with recurrent low back pain.
Respir Physiol Neurolbiol. 2013 Aug 15;188(2):119-23.
• Janssens L, Brumagne S, Polspoel K, Troosters T, McConnell A. The effect of inspiratory muscles fatigue on postural control in people with and without
recurrent low back pain. Spine. 2010; 35 (10): 1088-1094.
• Funding for this presentation was provided by the Elon DPT Graduate Student Funds.