Breathe Away Low Back Pain

Breathing. Seemingly, the most innate skillset you have as a human being. So innate that it’s used as a benchmark for being a healthy newborn and your first time taking in a breath happens within 10 seconds of entering the world. Fast forward to adulthood and you’re breathing an average of 12 to 20 times per minute without a single thought. With all that practice, we must be pretty good at it; right? Not exactly. Stress, lifestyle choices, and mechanics all play a huge role in how we breathe, and all breath is not created equal.

Just like any skill, practice makes perfect, and I routinely see the opposite. I constantly see people who can only breathe into their chest, who don’t know how to take appropriate deep breaths, and who have no control over their diaphragm. This is a problem for many reasons and let me tell you why.

First and foremost, deep breathing has profound effects on your autonomic nervous system. Your autonomic nervous system includes your sympathetic and parasympathetic nervous systems which control your fight-or-flight responses and your rest-and-digest responses, respectively. In the world we live in, it’s easy to feel the weight of stress - stress from your job, driving in traffic, relationships, finances, etc. Here’s the crazy part though: our brain can’t decipher between the stress of being chased by a bear and the stress of being behind for an important work deadline. To the brain, stress is stress and breathing short, shallow breaths is one of the main ways our brain interprets stress.

All this to say that shallow breathing is both a cause of increased stress and a symptom of increased stress responses, creating a vicious negative feedback loop leading people to live in a chronically stressed state of mind. No bueno. Not only are there serious cardiac, mental, and metabolic diseases linked to chronic stress, but chronic stress can also put you at a higher risk of injury AND slow down your rate of recovery from current injuries.

Here’s the good news though: Something as simple as taking longer, deeper breaths using your diaphragm has been demonstrated time and time again to not only prevent the effects of chronic stress, but also significantly decrease non-specific mechanical low back pain. But don’t take my word for it:

1. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain (https://www.ncbi.nlm.nih.gov/pubmed/27632818)
2. Athletes who suffered from lumbopelvic pain presented a reduced diaphragm thickness compared to healthy matched-paired athletes. Therefore, these novel findings may suggest that diaphragm reeducation could be a main focus of intervention related to athletic performance, prevention and rehabilitation (https://www.ncbi.nlm.nih.gov/pubmed/30954705)
3. Positive correlations were found to be fairly significant regarding respiratory muscle strength. The findings of this study indicated altered respiratory characteristics in the non-specific low back pain patients, and suggested that they would improve through respiratory exercises. (https://www.ncbi.nlm.nih.gov/pubmed/29421851)
4. Because individuals with low back pain (LBP) show greater susceptibility to diaphragm fatigue, it is reasonable to hypothesize that LBP, diaphragm dysfunction, and proprioceptive use may be interrelated (https://www.ncbi.nlm.nih.gov/pubmed/24870567)
5. Our results suggest that diaphragm training has an effect also on the thickness of other active stabilizers of the lumbar spine, such as transversus abdominis and lumbar multifidus muscles. (https://www.ncbi.nlm.nih.gov/pubmed/30568484)

Training your diaphragm is relatively easy. Below I’ve listed my three favorite drills to do so. While doing these drills, I’ll often have my patients perform something called an “apnea breathing” pattern, which is designed to slow down your breathing, increase your parasympathetic nervous system, and decrease your levels of chronic stress.

• Apnea Breathing
  • Cadence: 1-4-2 (ex: inhale for 10 seconds - hold for 40 - exhale for 20 seconds)
• 90/90 Diaphragm Breathing 
• Diaphragm reset against in Quadruped
• Diaphragm Self Release

In review, taking deep, long breaths could be an effective treatment option for you if you’re dealing with low back pain and, at a minimum, will help your live a healthier life. However, diaphragmatic breathing is just a piece of the ever elusive puzzle.

​If you’re dealing with low back pain, reach out with any questions. We design and implement programs to help people just like you, whether you’re someone who doesn’t know where to start or has had an unsuccessful rehab experience. It is our goal for the people we work with to get out of pain and return to their sport or activity performing better than they did before.

Thanks for reading,

Dr. Jake, PT, DPT, CSCS