Low back pain and breathing problems

The muscles used for breathing are connected to the lumbar vertebrae. There is evidence to suggest a link between breathing and low back pain.

A review study by Anderson et al. (2017) found moderate evidence to support the use of breathing exercises in the treatment of patients with chronic nonspecific low back pain. Another study (Michelle, 2006) found that the presence of a respiratory disease was a predictor of low back pain. A systematic review (Beeckmans, 2016) found a significant correlation between low back pain and breathing pattern disturbances, including both pulmonary pathology and nonspecific breathing pattern disturbances. Suboptimal coordination of the postural and respiratory muscles of the trunk has been proposed as an explanation for this association. A case-control study (Roussel, 2009) found that patients with chronic low back pain had significantly more altered breathing patterns during motor control tests.

Clinically Relevant Anatomy

The rib cage is formed by the spine, ribs and corresponding muscles. While the spine and ribs form the sides and top of the rib cage, the diaphragm forms the bottom. The muscles that connect the twelve pairs of ribs are called the intercostal muscles, and the muscles that run from the head and neck to the sternum and first two ribs are called the sternocleidomastoid and scalene muscles. The diaphragm is also directly connected to the spine.

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Epidemiology/Etiology

Breathing disorders are multifaceted. Dysfunctional breathing is defined as chronic or recurrent changes in breathing patterns that cannot be attributed to a specific medical diagnosis, and cause respiratory and non-respiratory complaints.

People with breathing problems are less able to exercise due to breathing difficulties and therefore lead a more sedentary lifestyle. Therefore, it is possible that these patients will experience back pain. Some studies also point to the special role of sedentary lifestyle, including mechanical factors such as prolonged exposure to poor posture leading to exhaustion and weakness of postural muscles, and chronic muscle spasm resulting from psychological stress, which plays a special role in the etiology of chronic pain. in the lower back.

Predisposing factors

Allergic bronchitis, the symptoms of which in adults and children are almost identical, usually proceeds according to a certain pattern. Penetration of a foreign allergen protein into the body provokes an inadequate immune response, which is manifested by profuse lacrimation, sneezing, and coughing. If the irritant is not promptly eliminated and the symptoms progress, reserve protection is activated, accompanied by hyperspasm of the bronchial tree and swelling of the ciliated mucosa that lines the internal respiratory organs.

As a result of constant irritation, the lung tissue begins to produce thick mucus, which gradually accumulates in the alveoli and becomes a source of bacterial infection. Stagnation and infection of mucus in the bronchi is the main cause of allergic bronchitis.

If a person has a strong immune system and good health, infection of bronchial tissues rarely occurs. The defense system quickly destroys the infection, preventing it from actively multiplying and spreading to healthy structures. But if the immune system is weakened and a person is prone to allergies, then under the influence of predisposing factors the risk of developing allergic bronchitis increases significantly.

Reasons that provoke the development of bronchitis of an allergic nature:

abuse of bad habits;
congenital or acquired immunodeficiency;
unbalanced diet;
passive smoking;
living in an unfavorable environmental environment;
uncontrolled use of drugs;
lack of competent treatment for allergic diseases;
inactive lifestyle;
use of bedding with natural fillings: down, feathers;
work with industrial hazards, involving constant contact with chemical or organic substances.

For a long time, the immune system can suppress a foreign irritant that regularly penetrates the body, so a person will not suspect a tendency to allergies. But at a certain point, all the predisposing factors converge at one point, as a result of which a serious disease begins to progress sharply, the consequences of which sometimes have to be fought throughout life.

Clinical picture

Tone of the diaphragm and transverse abdominis are key factors in core stability, however it has been noted that a decrease in the support provided to the spine by the trunk muscles can occur if there is both stress on the lower back and breathing problems.

It has been demonstrated that after approximately 60 seconds of hypercapnia, postural (tonic) and phasic functions of the diaphragm and transverse abdominis muscles are reduced. Restoring respiratory function offers the potential to reduce the negative impacts that result from disrupted breathing patterns. Other research suggests that breathwork may enhance proprioception and may therefore be a suitable adjunctive intervention, especially for patients with back pain.

Symptoms of a breathing pattern disorder may include:

Dizziness.
Chest pain.
Feelings of depersonalization and panic attacks.
Nausea.
Reflux.
General fatigue.
Difficulty concentrating.
Neurological/emotional/gastrointestinal and musculoskeletal changes.
Shortness of breath with normal lung function.
Exercise-induced shortness of breath
Frequent yawning.
Hyperventilation.

Treatment of allergic bronchitis

Allergic bronchitis symptoms and treatment in adults is carried out after a comprehensive diagnostic examination. The diagnosis is made on the basis of an initial examination of the patient, a detailed study of the medical history, and laboratory and instrumental diagnostic examinations.

To identify the inflammatory process in the bronchi, the doctor gives directions for the following procedures:

general blood analysis;
bacteriological culture of sputum;
chest x-ray;
spirometry.

It is also important to identify the allergen, because without eliminating it, drug treatment will not bring the desired results and upon subsequent contact with the irritant, the disease will recur.

To identify the pathogen, the following procedures are prescribed:

allergy tests;
blood test for immunoglobulins;
immunoblotting.

A person prone to allergic reactions must exclude from life all factors that provoke an acute immune response:

dust;
animals;
clothes made from natural wool;
bedding with fillings such as down and feathers;
some products, for example, honey, citrus fruits, chocolate, etc.;
aggressive hygiene and washing products;
some medicines.

If the allergen is no longer present in a person's life, the risk of recurrence of allergic bronchitis will be minimized. To prevent exacerbations, it is important to follow the rules of a healthy lifestyle:

give up bad habits such as alcohol, cigarettes;
improve nutrition;
give preference to active pastime to a sedentary lifestyle;
undergo sanatorium-resort treatment once a year;
eliminate the stress factor.

To relieve the pathological symptoms of bronchitis of an allergic nature, certain groups of medications are prescribed:

Antihistamines. They block the histamine receptor, stopping the acute immune response to a foreign protein.
Expectorants, mucolytics. The drugs dilute the secretion and accelerate its removal from the bronchi. Mucoltics are used to thin the cough, and after the cough becomes productive, the doctor prescribes expectorants. There are new generation medications that combine the effects of mucolytics and expectorants.
Glucocorticoids. They are prescribed only in exceptional situations when attacks of allergic bronchitis cannot be controlled with the above medications. Drugs in this group have anti-inflammatory and antiallergic effects, help relieve swelling, and reduce vascular permeability. The course of therapy and dose are determined by the doctor individually. Including glucocorticosteroids into your treatment regimen on your own is fraught with negative consequences and complications.
Sedatives. Some patients who have experienced attacks of allergic bronchitis are terrified of their recurrence. They are worried about the fear of death from suffocation, panic attacks at the slightest breathing problems. To make you feel better and reduce psycho-emotional stress, the doctor will prescribe sedatives.

In order for drug therapy to give the most positive effect, it is recommended to additionally follow simple measures to prevent the disease:

change bed linen daily and do wet cleaning of the room;
try to completely eliminate contact with allergens, including aggressive hygiene products, powders, and detergents;
ventilate the room several times a day;
remove objects that collect dust from the room: carpets, upholstered furniture and toys, books, curtains;
try not to contact pets.

A healthy lifestyle, proper nutrition, giving up bad habits and eliminating irritating factors will help avoid exacerbation of allergies, the development of allergic bronchitis and its complications.

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Differential diagnosis

Abnormal breathing patterns and low back pain may occur with more serious medical conditions, including cardiorespiratory or gastrointestinal diseases.

Other differential diagnoses for abnormal breathing include:

brain stem injury;
stroke;
asthma;
gastrointestinal disorders;
heart diseases;
other respiratory diseases.

There are criteria for recognizing and diagnosing breathing pattern disorders:

Anxiety (type A, “neurotic”).
"Air hunger."
Frequent sighs.
Fast swallowing speed.
Poor breath holding time.
Poor lateral expansion of the lower chest during inspiration.
Raising the shoulder girdle while inhaling.
Visible “cord-like” sternocleidomastoid muscles.
Rapid breathing.
Apparent paradoxical breathing.
Positive Nijmegen test result (23 or higher).
Low CO2 levels as assessed by capnography (below 35 mmHg).
A range of symptoms have been reported, such as fatigue, pain (especially in the chest, back and neck), anxiety, brain fog, irritable bowel or bladder syndrome, paresthesia, cold extremities.

Rating scales

There are no standardized outcome measures for the treatment of low back pain and respiratory dysfunction.

The VAS scale can be used to assess pain intensity.
The Roland Morris 24-item scale can also be used to assess functional disability specific to low back pain.
The Short Form-36 (SF-36) assesses functional general health status.

Measuring postural stability at baseline and immediately after therapy may provide some indication of whole-body proprioception and body awareness. This can be done using computerized dynamic posturography or a traditional static force plate, on which patients stand and try to maintain balance while in a neutral position. Patients' ability to integrate visual, vestibular, and proprioceptive components of balance (eyes closed, static or dynamic platform, static or moving environment) can then be assessed.

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Inspection

Respiratory rhythm disturbances are diagnosed using a physical assessment, a validated questionnaire (Nijmegen) and a capnometer, which measures the level of carbon dioxide in the respiratory tract.

Capnography has been shown to have good validity compared with arterial carbon dioxide measurements. Previous respiratory therapy studies have not included capnography in their experiments. Therefore, it is difficult to say anything about the validity of the device for therapy.

The Nijmegen Questionnaire is a non-invasive test with high sensitivity (up to 91%) and specificity (up to 95%). This easy-to-use, internationally validated diagnostic questionnaire is the simplest and most accurate indicator of acute and chronic hyperventilation.

His questions concern the following symptoms and their intensity:

chest tightness (feeling of tightness in the chest)

shortness of breath, fast or deep breathing, inability to breathe deeply, feeling tense, tightness around the mouth, stiffness in the fingers or hands, cold hands or feet;

tingling in fingers;
feeling of bloating;
attacks of dizziness;
blurred vision;
feeling confused or out of touch with the environment.

Treatment

Lower back pain

The most commonly prescribed drugs for low back pain are nonsteroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants.

A review by the American Pain Society and the American College of Physicians shows that several of the drugs reviewed in this report are effective for short-term relief of acute or chronic low back pain, although each is associated with a unique set of risks and benefits. There is evidence that NSAIDs, muscle relaxants (for acute low back pain) and tricyclic antidepressants (for chronic low back pain) are effective for short-term symptom relief. For mild to moderate pain, a trial of Acetaminophen (Paracetamol) may be a reasonable option, as it may have a more favorable safety profile than NSAIDs, which are used for more severe pain. For very severe, disabling pain, although there are some potential risks, opioids can be used to achieve adequate pain relief and improve function. For all drugs included in this review, evidence of beneficial effects on functional outcomes is limited and further research is required.

For low back pain caused by a herniated disc, spondylolisthesis, or stenosis, surgery may be recommended. In a large study of patients with spondylolisthesis and concomitant spinal stenosis, one group of patients received surgical treatment and the other nonsurgical treatment. The results of this study showed that the group treated with surgery maintained significantly greater pain reduction and improvement in function over four years. Another study of patients with a herniated disc concluded that after 4 years, patients who had surgery for a herniated lumbar disc achieved greater improvement than those treated without surgery.

Respiratory disorders

The most commonly used medication to treat asthma in children and adults is beta-agonists. These medications are the most powerful bronchodilators. The use of these drugs helps to increase the caliber of the airways, suppress inflammation and quickly relieve asthma symptoms. Beta-agonists are taken by inhalation as inhalation is preferred over other routes due to a better dose-response relationship and faster effect.

Another study determined whether the worsening of bronchodilator treatment with an inhaled corticosteroid could be slowed in patients with asthma or COPD. The study was a 4-year prospective study in which patients received bronchodilator therapy alone for the first two years of treatment and additional corticosteroid treatment for the final two years. This study showed that adding a corticosteroid to treatment slowed the adverse progression of asthma or COPD. In patients with asthma, this effect was most apparent.

Physical therapy

Respiratory rehabilitation has the potential to reduce the negative impact on low back pain caused by breathing disorders.

Through verbal guidance and skilled manual therapy, physical therapists help patients develop the skills to fully experience breathing movements in areas of pain. The results of one study suggest that breathing therapy may improve proprioception and may therefore be a suitable adjunctive intervention, especially for patients with back pain.

Patients suffering from breathing problems can be treated by physical therapists. This treatment helps relieve shortness of breath, control symptoms, improve or maintain mobility and function, clear the airways, and improve or maintain cough. Physical therapy may also be useful for musculoskeletal dysfunction and/or postural dysfunction and pain, as well as for improving airway patency during coughing and forced expiratory maneuvers.

Methods include:

Exercise testing.
Selection of exercises.
Clearing the respiratory tract.
Positioning methods.
Breathing techniques.

These basic principles are common to most physical therapy treatment protocols:

Training in the pathophysiology of the disease.
Observing your own breathing.
Restoration to an individually adapted basic physiological breathing pattern: relaxed, rhythmic naso-abdominal breathing.
Appropriate tidal volume.
Perception of stress and tension in the body.
Postura.
Breathing while moving or doing any physical activity.
Breathing while talking.
Breathing while eating.
Breathing during sleep.
Breathing during an acute attack.

The effectiveness of physical therapy in patients with asthma was studied in a randomized clinical trial. Asthma is a functional breathing disorder, and this study shows a clinically significant improvement in quality of life after a brief physiotherapy intervention.

The British Thoracic Society has developed guidelines for the physiotherapy treatment of patients with respiratory dysfunction.

Research has shown that eight weeks of inspiratory muscle training in people with low back pain with a resistance of 60% of 1RM results in significant improvements in inspiratory muscle strength, a more multisegmental postural control strategy, and a decrease in low back pain intensity.

Mehling et al. compared the effect of respiratory therapy with the effect of standard physical therapy. They found that changes in low back pain intensity and disability were comparable to changes induced by long-term physical therapy. Each group received one 60-minute introductory assessment session and 12 individual therapy sessions of equal 45-minute duration over 6–8 weeks. Breathing therapy was provided by 5 certified respiratory therapists. Physical therapy was provided by experienced teachers from the Department of Physical Therapy and Rehabilitation.

The ball and ball bridge exercise was designed to restore proper alignment of the attachment area and the spine so that the diaphragm can optimally perform its respiratory and postural functions. Promoting optimal posture and neuromuscular control of the deep abdominal muscles, diaphragm and pelvic floor, this therapeutic exercise would be desirable for patients with breathing problems and low back pain. This exercise is performed by lying on your back, feet on the wall, hips and knees at a 90-degree angle, with a ball between the knees. This passive 90˚ hip and knee flexion position results in relative lumbar spine flexion, posterior pelvic tilt, and internal rotation/depression of the ribs, which serves to optimize the attachment zone and inhibit lumbar/anterior pelvic extension.

According to McLaughlin et al., breathing retraining can improve ETCO2, pain, and function in most patients complaining of neck or back pain. Patients with neck or back pain were found to have poor respiratory profiles: high respiratory rates, low CO2 levels, chaotic irregular patterns, and upper chest breathing.

Breathing exercises

Cost of treatment for allergic bronchitis

The cost of treatment for allergic bronchitis for each patient is calculated individually, taking into account factors such as:

degree of neglect of the pathology;
presence of associated complications
duration of therapy, etc.

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