Does The Way You Breathe Affect Your Low Back Pain?

Feb 16, 2018

If you’re suffering from low back pain, you know it’s not unusual to feel stiffness and shooting pain – but how about the difficulty to take a full and healthy breath?

This seems true as studies have found that those who have had low back pain breathe more shallowly, hold their breath, or have poor breathing patterns when doing a physical task.

Even more, there appears to be a connection between low back pain and respiratory disorders.

The Diaphragm and Its Role in Respiration and Posture

According to 2006 research by Calais-Germain, the main vessel of inhalation is not the lungs. Instead, it’s the diaphragm because it works like a pump at the base of the lungs.

Inspiratory muscles, such as the diaphragm, play an important role in both respiration and spinal control, which is why dysfunctions in the diaphragm are often related to low back pain.

The diaphragm helps stabilise the spine by adding to intra-abdominal pressure and spinal stiffness.

Janssens et al. found that as the inspiratory muscles load, the use of proprioceptive signals, crucial for controlling balance, is reduced in people with low back pain and patients with COPD. Additionally, people with low back pain appeared to be at higher risk of diaphragm fatigue compared to healthy people.

Respiratory Disorders and the Incidence of Low Back Pain

Beeckmans et al performed a systematic review of the relation between respiratory disorders and low back pain. They found a significant correlation between the presence of low back pain and the presence of respiratory disorders such as dyspnea, asthma, different forms of allergy and respiratory infections.

On dyspnea, it was noted that people with dyspnea had a significantly higher prevalence of pain than those without it (64% vs. 18%).

On asthma, the probability of having a history of asthma is higher when low back pain is reported in the past year. Vice versa, the probability of reporting low back pain in the past year is higher in a patient with a history of asthma.

On allergy, it was found that hay fever and allergic contact dermatitis were significantly more common in patients with low back pain compared to those without it. Also, allergic urticaria and food allergies were more common in people with low back pain than their healthy counterparts. Furthermore, the chance of developing low back pain is 50% higher if a person has some form of allergy in the past or present.

On respiratory infections, a correlation was found between upper respiratory infections in general and low back pain in all female age groups (25-44 years old, 45-64 years old and 65-74 years old) and a male subgroup aged 45-64 years old. Also in the female subgroup aged 25-44 years, a correlation between specific respiratory infections (such as laryngitis) and low back pain was found compared with people without it.

Factors Behind Respiratory Disorders and Low Back Pain

Immunological, biomechanical, psychosocial and socioeconomic factors might account for the link between respiratory disorders and low back pain. Smoking is also a likely contributor, but more studies are needed to dig deeper to find the exact cause.

Respiratory conditions such as asthma and allergy involve inflammation and immune reactions. An infectious event or a physiological stressor could affect the immune system and turn it into a more pro-inflammatory state. Pro-inflammatory cytokines play a crucial role in the response of the nervous system to harmful (or potentially harmful) stimuli. For instance, tumour necrosis factor-a plays a role in the pathophysiology of low back pain and sciatica.

A respiratory disorder can also change a breathing pattern. For example, when you try to work your trunk-stabilising muscles, more likely than not, you may exhibit a different breathing pattern. Some people tend to favour the diaphragm’s postural function and compromise respiration, which results in an altered breathing pattern.

Moreover, if you have low back pain, the diaphragm doesn’t function as well as it does when you’re not in pain. When respiratory muscles are loaded, the diaphragm doesn’t help well with controlling posture. And poor posture is a big factor in sub-optimal breathing.

Training your inspiratory muscles can help increase strength and postural control. Going back to the study by Janssens et al, the group of researchers found that targeted training of inspiratory muscles in people with low back pain can improve posture and reduce the severity of the pain.

If you’re suffering from low back pain and breathing problems or a respiratory disorder at the same time, perhaps it’s best to pay a visit to a physiotherapist. Or even if you have one of these problems, don’t hesitate to seek help from the experts at Happy Physio.

Call us today on 9272 7359!



  • Calais-Germain, B. (2006) Anatomy of Breathing. Seattle, WA:  Eastland Press.
  • 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.
  • Janssens L, Brumagne S, Polspoel K, Troosters T, McConnell A. The effect of inspiratory muscles fatigue on postural control in people with and without recurrent low back pain. Spine 2010;35(10):1088e94.
  • Janssens L, Brumagne S, McConnell AK, Hermans G, Troosters T, Gayan-Ramirez G. Greater diaphragm fatigability in patients with recurrent low back pain. Respir Physiol Neurobiol 2013a;188(2):119e23.

Janssens L, Brumagne S, McConnell AK, Claeys K, Pijnenburg M, Burtin C, et al. Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease. PLoS One 2013b;8(3):e57949.

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(1):12e9