Tending to the diaphragm may relieve chronic low back pain

Is treating the diaphragm the key to relieving chronic pain in the lower back? Researchers set out to investigate, conducting the first ever clinical trial to test the efficacy of special osteopathic techniques tending to the diaphragm for easing chronic low back pain.

According to the 2015 Global Burden of Disease Study, back pain is now the leading cause of disability in most countries worldwide.

In the United States, approximately 80 percent of adults have had low back pain at least once in their lives.

If the pain lasts for longer than 12 weeks, it is considered to be chronic.

According to the National Institutes of Health (NIH), chronic low back pain is the third most burdensome condition in the U.S. "in terms of mortality or poor health as a result of disease."

Treatments for low back pain are not always successful. In some cases, the pain persists even after surgery or other forms of medical treatment.

But could a particular form of osteopathy be the key to relieving chronic low back pain? Scientists at CEU Cardenal Herrera University in Valencia, Spain, compared manual osteopathic techniques that paid special attention to the diaphragm with techniques that did not.

The researchers' findings were deemed one of the three best studies to have been presented at the International Osteopathy Congress 2018, held in Madrid, Spain.

The paper was published in the journal Archives of Physical Medicine and Rehabilitation. Mireia Martí-Salvador, of the Department of Physiotherapy at CEU, is the first author of the study.

Diaphragm techniques to treat low back pain

For their trial, Martí-Salvador and colleagues recruited 66 participants aged 18–60 who had been diagnosed with chronic non-specific low back pain that lasted at least 3 months.

Thirty-three of the participants were randomly assigned to an osteopathic manipulative treatment that included techniques focused on the diaphragm.

Meanwhile, the remaining 33 participants benefited from the same osteopathic treatment but with a sham diaphragm intervention.

Both protocols involved five sessions over a period of 4 weeks. The participants' pain and anxiety levels, as well as their depression, pain catastrophization, and fear-avoidance beliefs, were evaluated at the beginning of the study, after 4 weeks, and after 12 weeks.

'Significant, clinically relevant improvements'

Overall, these interventions brought significant improvements in both groups. However, the largest improvement was noted in the group that received diaphragm-specific interventions.

In fact, the new study revealed "a statistically significant reduction" of pain in the intervention group compared with the sham group.

The diaphragm-centered techniques produced "significant and clinically relevant improvements in pain and disability" that could be seen both at week 4 and 3 months after the intervention.

Martí-Salvador and colleagues conclude:

"[O]ur results suggest that the addition of intervention specifically aimed at the diaphragm muscle within a protocol of osteopathic manual therapy adds clinically relevant benefits compared to the isolated application of the protocol, which is already effective by itself in patients with chronic non-specific low back pain."