Diaphragmatic Training for Nonspecific Low Back Pain: A Systematic Review and Meta-analysis
HaiWei Li1, Chen Jia1, YuXiang Yang1
1School of Physical Education, Shanxi Normal University, Taiyuan, China.
Objective:
To investigate the effectiveness of diaphragmatic training interventions in adults with nonspecific low back pain.
Data Sources:
PubMed (MEDLINE), Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and China National Knowledge Infrastructure databases were systematically searched from inception to December 2024, with an updated search conducted through December 2025.
Study Selection:
Inclusion criteria included the following: (1) adults (≥18y) with nonspecific low back pain; (2) interventions involving diaphragmatic training, either as a standalone treatment or in combination with other therapies; (3) any comparator; (4) pain intensity and functional disability as primary outcomes and diaphragmatic thickness as a secondary outcome; and (5) randomized controlled trial designs. Two reviewers independently screened the studies.
Data Extraction:
Data were extracted independently by 2 reviewers. The Cochrane Risk-of-Bias assessment and Grading of Recommendations, Assessment, Development, and Evaluation certainty ratings were conducted by 4 reviewers.
Data Synthesis:
Thirteen studies (626 participants) were included. Diaphragmatic training likely reduced pain intensity compared with control interventions (standardized mean difference=-0.60; 95% confidence interval=-0.86 to -0.34; 11 trials, n=465; moderate-certainty evidence). It also likely improved functional disability (standardized mean difference=-0.71; 95% confidence interval=-0.90 to -0.53; 9 trials, n=469; moderate-certainty evidence). Evidence for changes in diaphragmatic thickness was of very low certainty. Subgroup analyses suggested that better pain outcomes typically occurred with 2-3 sessions/wk.
Conclusion:
Moderate-certainty evidence suggests that diaphragmatic training may be considered as an adjunct to rehabilitation to reduce pain intensity and improve functional disability in adults with nonspecific low back pain. Prespecified trials with longer follow-up are needed to clarify effects on diaphragm thickness and the influence of training parameters.
