The Relationship Between Diaphragmatic Breathing and Lumbopelvic Control in Physically Active Patients With and Without Chronic Low Back Pain
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Context: Lumbopelvic hip complex control is an essential component to function. The trunk stabilizers exhibit altered recruitment patterns and postural changes in patients with chronic low back pain (LBP). Limited research has been conducted to understand the role that the diaphragm plays on trunk stability in physically active patients with LBP. Objective: This study had three objectives: to determine the effect of diaphragmatic breathing (DB) on lumbopelvic control, differences in DB patterns in participants with and without chronic LBP, and differences in lumbopelvic control in participants with and without chronic LBP. Design: Case control design. Setting: Controlled laboratory setting. Participants: Twenty-one participants with LBP (n=21; age=20.19 ± 1.33; height=68.18 ± 4.38; weight= 167.33 ± 34.32) and 21 healthy participants (n=21; age= 19.71 ± 1.10; height= 68.48 ± 4.25; weight= 166.76 ± 30.87). Participants were between 18-30 years old and were involved in competitive sports. The LBP participants had LBP for at least 3 months, a score of 2 or greater on a VAS, and met nociceptive LBP criterion. Interventions: The independent variables were group assignment (LBP versus healthy participants) and breathing styles (DB versus non-DB). At rest, breathing was examined with the Hi-Lo Breathing Assessment (HLBA), a clinical tool used to assess the relative movement of the ribcage and abdomen during respiration. Breathing pattern was characterized dichotomously as DB or non-DB based on the relative excursion of the abdominal and thoracic areas during breathing. Main Outcomes Measures: The dependent variables were 2 lumbopelvic motor control test scores for each limb: the active straight leg raise (ASLR) and knee lift abdominal test (KLAT). Reliability for the ASLR (ICC = 0.61-0.98) and KLAT (ICC >0.85) have been established. Participants repeated each test 3 times and a pressure biofeedback unit (PBU) inflated to 40 mmHg, was used to determine pressure variation. Independent samples t-tests and Chi Square analysis with ana-priori value of p<0.05 were used to answer the research questions. Results: Baseline VAS scores [t (38) = 8.04, p<.001] and mODI scores [t (32.7) = 7.48, p<.001] were significantly different with LBP participants demonstrating moderate levels of pain and disability when compared to the healthy controls. Breathing pattern and LBP history did not significantly affect motor control test performance. In addition, participants with LBP did not demonstrate significantly different breathing patterns compared to healthy controls. Conclusions: The results of the study revealed that physically active patients with chronic LBP display correct breathing patterns and have similar lumbopelvic stability when compared to healthy participants. Future research should consider more challenging lumbopelvic stability tests and investigate populations with greater levels of disability.