Diaphragmatic Training for Nonspecific Low Back Pain: A Systematic Review and Meta-analysis.

Area of Science:

• Rehabilitation Medicine
• Musculoskeletal Disorders
• Respiratory Physiology

Background:

• Non-specific low back pain (NLBP) is a prevalent condition causing significant disability.
• Diaphragmatic dysfunction has been implicated in the pathophysiology of NLBP.
• Diaphragmatic training aims to improve respiratory muscle function and core stability.

Purpose of the Study:

• To systematically review and synthesize evidence on the effectiveness of diaphragmatic training interventions for adults with NLBP.
• To evaluate the impact of diaphragmatic training on pain intensity, functional disability, and diaphragmatic thickness.

Main Methods:

• A comprehensive systematic search of multiple databases (PubMed, Embase, Web of Science, etc.) was conducted up to December 2025.
• Inclusion criteria focused on randomized controlled trials involving adults with NLBP and diaphragmatic training interventions.
• Data extraction and risk of bias assessment were performed independently by multiple reviewers, with GRADE certainty ratings applied.

Main Results:

• Thirteen studies with 626 participants were included in the meta-analysis.
• Diaphragmatic training demonstrated a moderate-certainty effect in reducing pain intensity (SMD -0.60) and improving functional disability (SMD -0.71).
• Subgroup analyses indicated optimal pain outcomes with 2-3 training sessions per week; evidence on diaphragmatic thickness was of very low certainty.

Conclusions:

• Diaphragmatic training is a promising adjunct therapy for managing NLBP, effectively reducing pain and enhancing function.
• Moderate-certainty evidence supports its consideration in rehabilitation protocols for adults with NLBP.
• Further research with longer follow-up is warranted to elucidate effects on diaphragmatic thickness and optimal training parameters.