Clinical Changes Following Diaphragmatic Breathing Retraining Added to Conventional Physiotherapy in Mechanical Low Back Pain: A Single-Group Prospective Study With 9- Month Follow-up

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Background: Mechanical low back pain is commonly accompanied by impaired lumbopelvic control. The
diaphragm contributes to respiration and postural stabilization through coordinated regulation of intra-abdominal
pressure. This study examined changes in pain, disability, and core stability after diaphragmatic breathing
retraining was added to conventional physiotherapy.
Methods: A single-group prospective quasi-experimental study enrolled 30 adults aged 20-45 years with
mechanical low back pain of more than 3 weeks' duration from a physiotherapy outpatient department in
Udaipur, India. Participants received supervised diaphragmatic breathing retraining plus conventional
physiotherapy four times weekly for 6 weeks. Outcomes were the Numeric Pain Rating Scale (NPRS), Modified
Oswestry Disability Index (MODI), and a Pressure Biofeedback Unit (PBU)-derived core stability performance
score, recorded at baseline, 6 weeks, and 9 months. Source master-chart data were independently re-entered.
Repeated outcomes were analysed using Friedman tests with Kendall's W and exact Wilcoxon signed-rank tests
with Holm adjustment.
Results: The mean age was 33.33 +/- 7.25 years and 15 participants (50.0%) were women. Mean NPRS scores
declined from 6.50 +/- 1.04 at baseline to 3.50 +/- 1.04 at 6 weeks and 1.50 +/- 1.04 at 9 months. Mean MODI
scores decreased from 43.70 +/- 7.32 to 25.70 +/- 7.32 and 15.70 +/- 7.32, respectively. Mean PBU-derived
scores increased from 4.00 +/- 0.79 to 7.00 +/- 0.79 and 9.00 +/- 0.79. Time effects were significant for all
outcomes (Friedman chi-square=60.0, df=2, p<0.001; Kendall's W=1.00), and every pairwise comparison
remained significant after multiplicity adjustment (p<0.001). From baseline to 9 months, pain decreased by
76.9%, disability by 64.1%, and the PBU-derived score increased by 125.0%.
Conclusion: The combined rehabilitation programme was associated with large and sustained within-group
improvements in pain, disability, and PBU-derived core stability. Because the study lacked a comparator and
included co-intervention with conventional physiotherapy, the independent effect of diaphragmatic breathing
retraining cannot be isolated. A randomized controlled trial with standardized treatment dosage and blinded
assessment is warranted.