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

Area of Science:

• Physiotherapy
• Rehabilitation Medicine
• Pain Management

Background:

• Spinal pain is frequently associated with dysfunctional breathing patterns.
• Previous research has broadly examined breathing interventions but lacked specific categorizations.
• Understanding the differential effects of various breathing techniques is crucial for targeted treatment.

Purpose of the Study:

• To systematically review and summarize the effects of different types of breathing interventions on spinal pain and disability.
• To categorize breathing interventions into slow deep breathing, respiratory resistive breathing, and breathing awareness.
• To assess both additional and comparative effects of these interventions.

Main Methods:

• Systematic literature search across multiple databases (PubMed, Web of Science, etc.) until September 2025.
• Inclusion of studies involving adults with spinal pain receiving active breathing instruction or awareness training.
• Categorization of interventions, quality assessment using Downs and Black checklist, and meta-analysis with GRADE certainty evaluation.

Main Results:

• Twenty studies with 814 participants were included; most were of fair to good quality.
• Slow deep breathing, when added to other interventions, showed positive effects on spinal pain (SMD = -1.03) and disability (SMD = -1.34) with low to very low certainty of evidence.
• Respiratory resistive breathing demonstrated a significant decrease in spinal pain compared to other interventions (SMD = -1.31) with low certainty of evidence.

Conclusions:

• Breathing interventions show potential value in managing spinal pain and associated disability.
• Clinicians should consider the specific type of breathing intervention and its mechanisms to optimize patient treatment.
• Further research may be needed to strengthen the certainty of evidence for these interventions.