Clinical trial NCT07022132: Comparison of Physiotherapy Methods Applied To The Diaphragm In Chronic Low Back Pain
Official title: Effects of Diaphragm Manual Therapy and Abdominal Hyporesive Exercises in Chronic Low Back Pain
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Low Back Pain
Lead sponsor: Medipol University
Sponsor class: OTHER
First posted: 2025-06-15
Enrollment: 66
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The aim of this study was to compare the effects of conservative treatment with diaphragmatic myofascial release (DMR) and abdominal hypopressive exercise (AHE) technique added to conservative treatment in chronic low back pain.

Detailed description: Low back pain is one of the most common health problems in all societies and is a problem encountered by most individuals at some point in lifetime. Epidemiologic studies have shown that 70-80% of people complain of low back pain at some point in their lives. Low back pain, which ranks first in terms of chronic pain, causes pain, decreased normal joint movements, joint stiffness, loss of flexibility and activity limitations in individuals. These problems also cause difficulties in activities of daily living, decreased physical activity level, fear of movement and psychological stress, loss of work and performance, increased health expenditures and increased costs for employers.

Low back pain is often managed as a disease limited to isolated lumbar structures, but it often occurs in association with respiratory dysfunction, suggesting that low back pain is not an isolated musculoskeletal problem. Interestingly, the association between low back pain and respiratory disorders appears to be even stronger than the association with obesity and physical activity.

Due to its complex structure, the diaphragm has an important place in the postural chain. In addition to respiratory function, the diaphragm also plays an important role in stabilizing the spine during posture, balance and load-bearing activities, and therefore it is reasonable to assume that diaphragmatic dysfunction may also trigger low back problems.

Passive myofascial techniques are used to restore normal movement of the diaphragm and improve its function. It creates a greater pressure gradient between the thorax and abdomen and increases the expiratory phase. The biomechanical relationship between the diaphragm and other structures indicates that diaphragm techniques may have an effect on distal structures such as the Hamstring muscles, contributing to motor control and stabilization through activation of core stabilization muscles.

Training the muscles that form trunk stability can help improve low back pain. One of these training methods is the increasingly popular abdominal hypopressive exercises. The abdominal hypopressive exercise (AHE) technique was proposed by Marcel Caufriez in the 1980s for the treatment of pelvic floor disorders. The hypothesis of this method, which combines respiratory technique with abdominal contraction maneuvers, is that it relaxes the diaphragm, lowers intra-abdominal pressure and activates the abdominal muscles and pelvic floor simultaneously. Thus, it is suggested that urinary incontinence and pelvic organ prolapse can be reduced and that it can produce direct activation of the Transversus Abdominis muscle, which can strengthen the abdominal wall and stabilize the spine, increase the flexibility of the lumbar spine and Hamstring muscles, and reorganize body posture.

The aim of this study was to compare the effects of abdominal hypopressive exercise technique and myofascial diaphragm relaxation technique on pain, pressure pain threshold, functional status, range of motion, chest wall mobility, spinal mobility, flexibility and pelvic floor muscle activity in chronic low back pain.

Eligibility criteria: Inclusion Criteria:

* Experiencing low back pain for at least 12 weeks
* To be between the ages of 18-65

Exclusion Criteria:

* Pregnancy
* Severe osteoporosis
* Less than 1 year history of abdominal and/or thoracic surgery
* Having an additional disease such as severe coronary artery disease, uncontrolled hypertension, COPD that prevents exercise,
* Difficulty in co-operation
* History of malignancy
* History of lumbar spinal surgery
* Spondylolisthesis, scoliosis, other spinal deformities and congenital malformations
* Radiculopathy
* Systemic inflammatory diseases
* Corticosteroid injection in the last 3 months

Primary outcomes:
measure: Pain intensity (Visual Analogue Scale)
timeFrame: 6 weeks
Secondary outcomes:
measure: Pressure pain threshold (algometer)
timeFrame: 6 weeks
measure: Range of motion (goniometer)
timeFrame: 6 weeks
measure: Hamstring flexibility (The Popliteal Angle Test)
timeFrame: 6 weeks
measure: Spinal mobility (modified Schober test)
timeFrame: 6 weeks
measure: Chest wall mobility (a tape measure)
timeFrame: 6 weeks
measure: Functional status (Roland Morris Disability Questionnaire)
timeFrame: 6 weeks
measure: Quality of life (Nottingham Health Profile)
timeFrame: 6 weeks
measure: Pelvic floor muscle activity
timeFrame: 6 weeks
Other outcomes:
Locations:
city: İstanbul
country: Turkey
facility: Istanbul Medipol University
Study officials:
affiliation: Medipol University
name: Hatice Hümeyra Akıl
role: PRINCIPAL_INVESTIGATOR
References: