# Effects of breathing exercise and thoracic techniques on pain and disability in low back pain: A systematic review and meta-analysis

## TL;DR

This study finds that breathing exercises and thoracic techniques may help reduce pain and disability in people with low back pain, but more high-quality research is needed.

## Contribution

A systematic review and meta-analysis of thoracic interventions for low back pain, revealing their potential impact on pain and disability.

## Key findings

- Thoracic manual techniques showed larger effects on disability improvement (dppc = -0.71) compared to breathing exercises.
- There was a small effect for pain reduction (dppc = -0.35) with thoracic interventions.
- High heterogeneity (I² > 85%) suggests variability in study results and methods.

## Abstract

The objective of this study was to systematically review the effectiveness of thoracic-focused interventions, including breathing exercises and thoracic manual techniques (mobilization, high-velocity low-amplitude manipulation, and release techniques), on pain and disability in patients with low back pain (LBP).

PubMed, Scopus, Web of Sciences, ProQuest, Ovid, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Clinical Trials (CENTRAL), and Google Scholar were searched without language restrictions. Clinical trials with control groups on pain and disability in low back pain patients focusing on the efficacy of breathing exercises or thoracic technique were included. In total, 31 studies contributed to the meta-analysis for pain and 24 for disability.

Pooled analyses using Morris’ dppc demonstrated a statistically significant, small effect for pain reduction (dppc = −0.35, 95% CI = −0.46 to −0.23) and a large effect for disability improvement (dppc = −0.71, 95% CI = −0.86 to −0.57) when compared with control groups. Thoracic manual techniques showed larger effects on both pain and disability compare to breathing exercises. However, substantial statistical heterogeneity (I² > 85%) persisted in most analyses.

Breathing and thoracic manual techniques may be effective in reducing disability and, to a lesser extent, pain in patients with LBP, but the overall certainty of evidence is low. However, the quality of the evidence is low. Variability in treatment protocols, study quality, blinding, and outcome measures likely contributed to inconsistencies. Further high-quality trials with standardized protocols are needed to confirm these findings and inform clinical practice.