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Literature Low Down: Belly Breathing and Low Back Pain

By: Dr. Chase Davidson, DC

The Literature Low-Down

This segment is meant to give you the skinny; the short and simple; the low-down on a noteworthy scholarly article from a number of different scientific journals to give you the knowledge and power to take your health into your own hands (within reason).

The Literature

Today we are going to go over “Effect of exhalation exercise on trunk muscle activity and Oswestry disability index of patients with chronic low back pain” written by Jeong-Il Kang, PT Ph.D. at the Department of Physical Therapy, at Sehan University, in South Korea, along with his colleagues Dae-Keun Jeong, PT, Ph.D., and Hyun Choi, PT, Ph.D.

It was published in the Journal of Physical Therapy Science on 06/28/2016. The Journal of Physical Therapy Science has an average impact factor of around 0.75. The impact factor basically gives you an estimation of how popularly cited the articles in the journal are and by proxy its reputation in the academic community. The most popular journal in the world, The New England Journal of Medicine, has an impact factor of around 70. It is important to note, the impact factor does not tell you anything about the content or validity of each of the articles written in the journal, just its popularity. Just like social media, the more popular journals have more reach and publicity than less popular journals.

This means that this information in this article might not be known by your healthcare provider due to the lack of reach this Asian journal has. With those caveats out of the way, let’s dive into it.

The Low-Down

Low back pain is one of the leading causes of disability around the world. It is estimated that 80% of adults will experience low back pain once in their life and the cost to society can be almost $19,000 per person. This then is no surprise why low back pain cost Americans more than 100 billion dollars in 2009, two-thirds of that from lost wages and productivity. Without adding to this stat, how can reduce low back pain for free and with something you do every day. This study looked at how breathing, to exercise your trunk muscles, reduced patients back pain.

Study Design

20 male subjects with chronic low back pain (pain lasting longer than 12 weeks) were recruited from a hospital in Jeollanamdo, South Korea. From there they were split up into two groups. One received a standard core and pelvic stability exercise prescription; 30 minutes a day, 4 days each week for 6 weeks. The other received the same exercise prescription but added a simple breathing exercise.

The 10 patients with breathing exercises had a belt around their waist and could tell them how much pressure was being applied from their breath. They would have to create intra-abdominal pressure in their cores to reach the targeted set by the biofeedback system. They would perform for the same 6 weeks, 20 minutes a day for 5 days each week.

They measured the patient’s muscular activation via electromyography (EMG’s) to see if the muscles were being activated more as well as an Oswestry Disability Index (ODI) which is a gold standard low back pain and disability questionnaire before and after the interventions.


To no one's surprise, both groups had better activation of their core musculature but interestingly only those who had the breathing exercises had improvements in the activation of the transverse abdominis. The Transverse abdominis in the deepest abdominal muscle and has been called the “corset” muscle due to its job with stabilization via attachments to the thoracolumbar fascia and ability to help create abdominal pressure. Another surprise was that the breathing group had significantly better decreases in ODI scores as compared to just rehab exercises!


Seeing that a human roughly takes around 17,000-30,000 breaths a day, we have many opportunities to apply the findings of this study into practice. Breathwork has become one of my favorite tools as a clinician. Not only can we tone down the sympathetic nervous system and fuel your mitochondria better but now we can start adding core stability to the laundry list of benefits.

In this study, patients spent 20 minutes on their breathwork each day and that is only 1/48th of your waking day. If we start to bring a combination of mindfulness breathing and this style of neuromuscular facilitation during breathing, I believe the results seen in this study could be achieved much quicker. Even if you aren't currently working through some sort of core stability prescription adding this to your breathing practice and everyday life can prove some massive benefits.

Having a plan on how to best support you develop your core strength and stability should be something you discuss with your healthcare provider. If you or someone you know is dealing with low back pain or core stability issues, share this blog and spread the knowledge. For access to the article Click Here. If you have any other questions or comments, please leave a comment so a discussion can take place and those answers can help other people.


This article

Kang, J. I., Jeong, D. K., & Choi, H. (2016). Effect of exhalation exercise on trunk muscle activity and oswestry disability index of patients with chronic low back pain. Journal of physical therapy science, 28(6), 1738–1742.

Other supporting articles

- Ferguson, S. A., Merryweather, A., Thiese, M. S., Hegmann, K. T., Lu, M. L., Kapellusch, J. M., & Marras, W. S. (2019). Prevalence of low back pain, seeking medical care, and lost time due to low back pain among manual material handling workers in the United States. BMC musculoskeletal disorders, 20(1), 243.

- Crow WT, Willis DR. Estimating Cost of Care for Patients With Acute Low Back Pain: A Retrospective Review of Patient Records. J Am Osteopath Assoc 2009;109(4):229–233.

Chase Davidson, DC is a Board Eligible Chiropractic Neurologist and specializes in concussion and sports rehab, as well as functional medicine and immunology. He is the founder of Action Potential - Sports and Neurological Rehab. He also is a member of the International Association of Functional Neurology and Rehabilitation (IAFNR). Stay connected with Dr. Davidson on Linkedin @dr-davidson or on Instagram @washparkchiro or @thatneurologyguy.


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