Combined Effect of Diaphragmatic Breathing Exercise and Pelvic Floor Exercise in Patients with Non-Specific Chronic Low Back Pain.
Life Sciences -Physiotherapy
DOI:
https://doi.org/10.22376/ijlpr.2023.13.4.L88-L100Keywords:
Low back pain, non-specific LBP, breathing exercises, diaphragm, diaphragmatic breathing exercise, pelvic floor muscle exercise, VAS, ODIAbstract
Low back pain (LBP) is more of a symptom than a disease that affects people of all ages and is the leading cause of disability worldwide. Up to 85% of people experience non-specific LBP with no diagnosable underlying pathology. Therefore, healthcare research has focused on understanding the mechanisms underlying the maintenance of pain in chronic non-specific LBP (CNSLBP). We aimed to determine the combined effect of diaphragmatic breathing exercises and pelvic floor exercises in patients with non-specific chronic low back pain. It was an experimental design study, where 30 subjects, both Male and Female, with a primary diagnosis of non-specific chronic low back pain by the physician were recruited into two groups or intervention sequences with 15 subjects in each group. Group-A (Experimental group) received the moist hot pack, diaphragmatic breathing exercise (DBEx), pelvic floor muscle (PFM) exercise, and conventional back exercise. In contrast, Group B (the Control group) received a moist hot pack and conventional back exercise for five sessions per week for a total of 6 weeks. The Outcome measures used were the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). The paired 't'-test was used to analyse both groups' pre-test and post-test results. The study concluded that both Group-A (moist hot pack, diaphragmatic breathing exercise, pelvic floor exercise, and conventional back exercise) and Group-B (moist hot pack and conventional back exercise) showed improvement post-treatment and was found to be significant p < 0.05 in VAS in terms of pain and ODI in terms of disability. However, the mean score of VAS and ODI posttreatment decreased more in Group-A than in Group B. The Group-A treatment protocol resulted better in alleviating the pain and was effective in improving the disability. A suggestion to add DBEx and PFM exercises in physical therapy intervention to manage CNSLBP can be considered.
References
Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S et al. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-67. doi: 10.1016/S0140-6736(18)30480-X. PMID 29573870.
GBD. Disease and injury incidence and prevalence collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2015:2016 Oct 8;388(10053):1545-1602. doi: 10.1016/S0140-6736(16)31678-6. Erratum in: Lancet. PMID: 27733282; PMC ID: PMC5055577. 2017 Jan 7;389(10064):e1.
Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF et al. A consensus approach toward standardizing back pain definitions for use in prevalence studies. Spine (Phila Pa 1976). 2008 Jan 1;33(1):95-103. doi: 10.1097/BRS.0b013e31815e7f94, PMID 18165754.
Bhatnagar G, Sahu M. Comparision of Pelvic Floor Exercises and Conventional Regimen in Patients with Chronic Low Back Pain. Ind Jour of Physioth and Occupation Therapy - An Inter Jour. 2017 Jul-Sep;11(3):38-42. doi: 10.5958/0973-5674.2017.00069.7.
Shah S, Shirodkar S, Deo M. Effectiveness of core stability and diaphragmatic breathing v/s core stability alone on pain and function in mechanical non-specific low back pain patients: a randomized control trial. IJHSR. 2020 Feb;10(2):232-41.
Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017 Feb 18;389(10070):736-47. doi: 10.1016/S0140-6736(16)30970-9. PMID 27745712.
Ronai P, Sorace P. Chronic nonspecific low back pain and exercise. Strength Cond J. 2013;35(1):29-32. doi: 10.1519/SSC.0b013e3182822bb1.
Russo M, Deckers K, Eldabe S, Kiesel K, Gilligan C, Vieceli J, et al. Muscle control and non-specific chronic low back pain. Neuromodulation. 2018 Jan;21(1):1-9. doi: 10.1111/ner.12738. PMID 29230905, PMCID PMC5814909.
Sanderson A, Rushton AB, Martinez Valdes E, Heneghan NR, Gallina A, Falla D. The effect of chronic, non-specific low back pain on superficial lumbar muscle activity: a protocol for a systematic review and meta-analysis. BMJ, (Open). 2019 Oct 31;9(10):e029850. doi: 10.1136/bmjopen-2019-029850, PMID 31676646, PMCID PMC6830713.
Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Res-1530. 2016 Jun 28;5. doi: 10.12688/f1000research.8105.2, PMID 27408698, PMCID PMC4926733.
Gupta, S. & Darokhan, M.A. & Singh, O. & Muzaffar, J.. (2016). LBA is an increasing health problem in India. JK Science. 18. 172-176.
Mathew A, Safar R, Anithadevi T, Banu M, Ravi Shankar S, Rai BK, et al. The prevalence and correlates of low back pain in adults: a cross-sectional study from Southern India. Int J Med Public Health. 2013;3(4). doi: 10.4103/2230-8598.123525.
Hamasaki H. Effects of diaphragmatic breathing on health: A narrative review. Medicines (Basel). 2020 Oct 15;7(10):65. doi: 10.3390/medicines7100065, PMID 33076360, PMCID PMC7602530.
Wyatt BA. The relationship between diaphragmatic breathing and lumbopelvic control in physically active patients with and without chronic low back pain; 2015.
Emerich Gordon K, Reed O. The role of the pelvic floor in respiration: A multidisciplinary literature review. J Voice. 2020 Mar;34(2):243-9. doi: 10.1016/j.jvoice.2018.09.024. PMID 30447797.
Talasz H, Kremser C, Kofler M, Kalchschmid E, Lechleitner M, Rudisch A. Phase-locked parallel movement of the diaphragm and pelvic floor during breathing and coughing-a dynamic MRI investigation in healthy females. Int Urogynecol J. 2011 Jan;22(1):61-8. doi: 10.1007/s00192-010-1240-z. PMID 20809211.
Pravin, Das, Shriya, Pattnaik, Sandeep. Sahu, Lipika & Sarkar, Bibhuti & Kumar. Clin Trials. 2021. Effect of Muscle Energy Technique and Segmental Stabilization Exercise on Pain, Range of Motion and Function in subjects with Chronic Mechanical Low Back Pain A Randomized;8:534-9.
Finta R, Nagy E, Bender T. The effect of diaphragm training on lumbar stabilizer muscles: a new concept for improving segmental stability in the case of low back pain. J Pain Res. 2018 Nov 28;11:3031-45. doi: 10.2147/JPR.S181610, PMID 30568484, PMCID PMC6276912.
Bi X, Zhao J, Zhao L, Liu Z, Zhang J, Sun D, et al. Pelvic floor muscle exercise for chronic low back pain. J Int Med Res. 2013 Feb;41(1):146-52. doi: 10.1177/0300060513475383. PMID 23569140.
Alex B, Anandh S. Prevalence of diaphragm dysfunction concerning breathing pattern in Nonspecific low back pain. IJPHRD. 2020 May 18;11(5):540-4.
Sapsford RR, Hodges PW, Richardson CA, Cooper DH, Markwell SJ, Jull GA. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2001;20(1):31-42. doi: 10.1002/1520-6777(2001)20:1<31::aid-nau5>3.0.co;2-p, PMID 11135380.
Scale VA (VAS) D. Gould et al. Ó. J Clin Nurs. 2001 Blackwell Science Ltd.
Mannion AF, Balagué F, Pellisé F, Cedraschi C. Pain measurement in patients with low back pain. Nat Clin Pract Rheumatol. 2007 Nov;3(11):610-8. doi: 10.1038/ncprheum0646, PMID 17968331.
Fairbank JC, Pynsent PB. The Oswestry disability index. Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940-52; discussion 2952. doi: 10.1097/00007632-200011150-00017, PMID 11074683.
Prahalada Karnati DVN, reddy, kumar RS. Core stabilization program and conventional exercises in the patients with a low back pain-a comparative study. Int J Physiol. 2015Feb.7 [cited 2022Aug.23];2(1):352-60.
Palmer E. Hot packs. Cinahl Inf Syst. 2021 Jan 1.
Jebakani B, Samuel R. Effectiveness of pelvic floor exercises for stress urinary incontinence among the postpartum women. Indian J Physiother Occup Ther Int J. 2017;11(3):46. doi: 10.5958/0973-5674.2017.00071.5.
RATHI M. Effect of pelvic floor muscle strengthening exercises in chronic low back pain. Indian J Physiother Occup Ther Int J, [S.l.]. Dec 2013. ISSN 0973-5674:121-5.
Mohseni-Bandpei MA, Rahmani N, Behtash H, Karimloo M. The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain. J Bodyw Mov Ther. 2011 Jan;15(1):75-81. doi: 10.1016/j.jbmt.2009.12.001. PMID 21147422.
Park SJ, Kim YM, Yang SR. Effects of lumbar segmental stabilization exercise and respiratory exercise on the vital capacity in patients with chronic back pain. J Back Musculoskelet Rehabil. 2020;33(5):841-8. doi: 10.3233/BMR-181202, PMID 31929136.
Kim E, Lee H. The effects of deep abdominal muscle strengthening exercises on respiratory function and lumbar stability. J Phys Ther Sci. 2013 Jun;25(6):663-5. doi: 10.1589/jpts.25.663. PMID 24259823, PMCID PMC3805012.
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