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Low back pain and respiratory disorders

Researchers in Belgium reported an association between respiratory disorders and low back pain in a recent article published in the journal Manual Therapy.[1] Analyzing data collected from 16 clinical trials, investigators concluded a significant relationship existed between dyspnea, asthma, some allergies, respiratory infections and low back pain. No relationship was found between chronic obstructive pulmonary disease and low back pain.

Several theories may help explain this relationship. First, because some respiratory disorders are inflammatory in nature (asthma, allergy, chronic bronchitis), the presence of these conditions may predispose a pro-inflammatory state, which can play a role in low back pain. Second, smoking mediates respiratory function and contributes to several respiratory disorders. Smoking has previously been associated with low back pain in many studies. The mechanisms by which smoking can contribute to LBP include increased risk for osteoporosis, reduced intervertebral disc perfusion, and pain amplification through increasing pro-inflammatory cytokines. Smoking also changes breathing patterns, potentially contributing to LBP by altering diaphragm function.

The authors also discussed diaphragmatic dysfunction in individuals with respiratory disorders and the potential for influencing low back pain. Some research suggests diaphragm function is suboptimal in persons with low back pain by exhibiting smaller excursions during inspiration and earlier fatigue. This suggests the possibility of reduced postural assistance from the diaphragm. As evidence for this link, the authors cite a recent study reporting participants with low back pain who gained inspiratory muscle control after a specific training program.[2] Participants also experienced reduced low back pain severity.

This study was not designed to determine whether low back pain or respiratory disorders are causally related. No causal relationships were found or claimed. However, there appears to be sufficient evidence suggesting some potential physiological links between respiratory disease and low back pain are plausible in some circumstances.

Reference List
1. Beeckmans N, Vermeersch A, Lysens R, Van WP, Goossens N, Thys T et al.: The presence of respiratory disorders in individuals with low back pain: A systematic review. Man Ther 2016, 26: 77-86.
2. Janssens L, McConnell AK, Pijnenburg M, Claeys K, Goossens N, Lysens R et al.: Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc 2015, 47: 12-19.

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