Breathing and low back pain

In some people with low back pain a bracing pattern is used throughout many movements. Many don’t realise they do it and there are a multitude of reasons why they do, many a related to beliefs that their back is damaged and it needs protecting. Essentially, they try to freeze the movement through the area in the same way you might limp and reduce movement through your ankle if you thought you had damaged your ankle. One clue that people are using this as a strategy is through breath holding.

Listening as you watch a patient move is quite telling, a sharp exhalation of breath as they sit or stand can be a cue that they are bracing. When you brace, you recruit your trunk musculature indiscriminately, front and back. This is further workload for the back, particularly if it is a part of many movements a person completes day to day. This also acts a way to restrict fluency of movement. I use the their hands to explain this. By clenching their fist and me trying to move their hand, it is restricted, as soon as they relax their hand, full movement is restored. Breathing is the same as relaxing their hand.

I used to spend lots of time on abdominal versus chest breathing and coaching the difference between the two. Now I find that if I just focus on there just being some breath passing in or out as they move, then this seems to serve just as well. By increasing awareness of this as a habit it becomes possible to make changes in behaviour. I then use this in their lifting emphasising breathing while moving.

Neil Welch

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