Inspiratory Muscle Training in Rehabilitation of Low Back Pain: A Randomized Controlled Trial

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $76.00

1 year online subscription

USD  $101.00

Student 2 year online subscription

USD  $144.00

2 year online subscription

USD  $192.00

Context: People with chronic low back pain (CLBP) suffer from weaknesses in their core muscle activity and dysfunctional breathing. Inspiratory muscle training (IMT) was recently developed to treat this condition. Objectives: The present study was conducted to investigate the effect of IMT on core muscle activity, pulmonary parameters, and pain intensity in athletes with CLBP. Design: This study was designed as a single-blind, randomized, controlled trial. Setting: Clinical rehabilitation laboratory. Participants: A total of 23 male and 24 female athletes with CLBP were randomly divided into the experimental and control groups. Main Outcome Measures: The experimental group performed IMT for 8 weeks, 7 days per week and twice daily, using POWERbreathe KH1, beginning at 50% of maximum inspiratory pressure with a progressively increasing training load. The surface electromyography muscle activity of the erector spinae, multifidus, transverse abdominis and rectus abdominis, respiratory function and Visual Analogue Scale score were also measured before and after the intervention in both groups. The repeated-measures analysis of variance and 1-way analysis of covariance were further used to compare the intragroup and intergroup results following the intervention. Results: The findings of the study revealed that multifidus and transverse abdominis activity, as well as respiratory function, increased significantly in the IMT group (P < .05). Moreover, a descending trend was observed in the Visual Analogue Scale score in the experimental group (P < .05). Conclusion: The results showed that IMT can improve respiratory function, increase core muscle activity, and, consequently, reduce pain intensity in athletes with CLBP.

Ahmadnezhad, Yalfani, and Gholami Borujeni are with the Department of Sport Injury and Corrective Exercise, Bu-Ali Sina University, Hamadan, Iran. Yalfani is also with the Department of Corrective Exercises and Sport Injury, Faculty of Physical Education and Sport Sciences, Bu-Ali Sina University, Hamedan, Iran.

Yalfani (aliyalfani2019@gmail.com) is corresponding author.
  • 1.

    Psycharakis SG, Coleman SG, Linton L, Kaliarntas K, Valentin S. Muscle activity during aquatic and land exercises in people with and without low back pain. Phys Ther. 2019;99(3):297310. PubMed ID: 30690522 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Bono CM. Low-back pain in athletes. J Bone Joint Surg Am. 2004;86(2):382396. PubMed ID: 14960688 doi:

  • 3.

    d’Hemecourt PA, Gerbino PG II, Micheli LJ . Back injuries in the young athlete. Clin Sports Med. 2000;19(4):663679. doi:

  • 4.

    O’sullivan K, O’Keeffe M, Forster BB, Qamar SR, van der Westhuizen A, O’sullivan PB. Managing low back pain in active adolescents. Best Pract Res Clin Rheumatol. 2019;33(1):102121. doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Djordjevic O, Konstantinovic L, Miljkovic N, Bijelic G. Relationship between electromyographic signal amplitude and thickness change of the trunk muscles in patients with and without low back pain. Clin J Pain. 2015;31(10):893902. PubMed ID: 25380224 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Hamaoui A, Do MC, Poupard L, Bouisset S. Does respiration perturb body balance more in chronic low back pain subjects than in healthy subjects? Clin Biomech. 2002;17(7):548550. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Berlowitz DJ, Tamplin J. Respiratory muscle training for cervical spinal cord injury. Cochrane Database of Syst Rev. 2013;(7):CD008507.

  • 8.

    Rakobowchuk M, Tanguay S, Burgomaster KA, Howarth KR, Gibala MJ, MacDonald MJ. Sprint interval and traditional endurance training induce similar improvements in peripheral arterial stiffness and flow-mediated dilation in healthy humans. Am J Physiol Regul Integr Comp Physiol. 2008;295(1):R236R242. PubMed ID: 18434437 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Vasconcelos T, Hall A, Viana R. The influence of inspiratory muscle training on lung function in female basketball players—a randomized controlled trial. Porto Biomed J. 2017;2(3):8689. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Oh D, Kim G, Lee W, Shin MM. Effects of inspiratory muscle training on balance ability and abdominal muscle thickness in chronic stroke patients. J Phys Ther Sci. 2016;28(1):107111. PubMed ID: 26957739 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175191. PubMed ID: 17695343 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Boonstra AM, Preuper HR, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014;155(12):25452550. PubMed ID: 31759327 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    de Oliveira TS, Candotti CT, La Torre M, et al. Validity and reproducibility of the measurements obtained using the flexicurve instrument to evaluate the angles of thoracic and lumbar curvatures of the spine in the sagittal plane. Rehabil Res Pract. 2012;2012:186156. PubMed ID: 22619723

    • Search Google Scholar
    • Export Citation
  • 14.

    Glass SC, Albert RW. Compensatory muscle activation during unstable overhead squat using a water-filled training tube. J Strength Cond Res. 2018;32(5):12301237. PubMed ID: 28557850 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Ng JK, Richardson CA, Parnianpour M, Kippers V. EMG activity of trunk muscles and torque output during isometric axial rotation exertion: a comparison between back pain patients and matched controls. J Orthop Res. 2002;20(1):112121. PubMed ID: 11855379 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Fontes AE, de Andrade L, Feitosa LA, et al. Acute effects of incremental inspiratory loads on compartmental chest wall volume and predominant activity frequency of inspiratory muscle. J Electromyogr Kinesiol. 2013;23(6):12691277. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Mok NW, Yeung EW, Cho JC, Hui SC, Liu KC, Pang CH. Core muscle activity during suspension exercises. J Sci Med Sport. 2015;18(2):189194. PubMed ID: 24556020 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Hislop H. Daniels and Worthingham’s Muscle Testing: Techniques of Manual Examination and Performance Testing. 9th edRiverport, MD: Elsevier; 2013.

    • Search Google Scholar
    • Export Citation
  • 19.

    Vezina MJ, Hubley-Kozey CL. Muscle activation in therapeutic exercises to improve trunk stability. Arch Phys Med Rehabil. 2000;81(10):13701379. PubMed ID: 11030503 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    McDonald T, Stiller K. Inspiratory muscle training is feasible and safe for patients with acute spinal cord injury. J Spinal Cord Med. 2019;42(2):220227. PubMed ID: 29400990 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Charususin N, Gosselink R, Decramer M, et al. Inspiratory muscle training protocol for patients with chronic obstructive pulmonary disease (IMTCO study): a multicentre randomised controlled trial. BMJ Open. 2013;3(8):e003101. PubMed ID: 23921069 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Janssens L, McConnell AK, Pijnenburg M, et al. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc. 2015;47(1):1219. PubMed ID: 24870567 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Meziat Filho N, Santos S, Rocha RM. Long-term effects of a stabilization exercise therapy for chronic low back pain. Man Ther. 2009;14(4):444447. PubMed ID: 19026587 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Macedo LG, Latimer J, Maher CG, et al. Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2012;92(3):363377. PubMed ID: 22135712 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Hodges PW, Eriksson AM, Shirley D, Gandevia SC. Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech. 2005;38(9):18731880. PubMed ID: 16023475 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Urquhart DM, Barker PJ, Hodges PW, Story IH, Briggs CA. Regional morphology of the transversus abdominis and obliquus internus and externus abdominis muscles. Clin Biomech. 2005;20(3):233241. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Marshall PW, Desai I, Robbins DW. Core stability exercises in individuals with and without chronic nonspecific low back pain. J Strength Cond Res. 2011;25(12):34043411. PubMed ID: 22080309 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Danneels L, Coorevits P, Cools A, et al. Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain. Eur Spine J. 2002;11(1):1319. PubMed ID: 11931058 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Chiu LZ, Fry AC, Schilling BK, Johnson EJ, Weiss LW. Neuromuscular fatigue and potentiation following two successive high intensity resistance exercise sessions. Eur J Appl Physiol. 2004;92(4–5):38592. PubMed ID: 15185085 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Pryor JA, Prasad AS. Physiotherapy for Respiratory and Cardiac Problems: Adults and PaediatricsEdinburgh, UK: Elsevier Health Sciences; 2008.

    • Search Google Scholar
    • Export Citation
  • 31.

    Perrin C, Unterborn JN, Ambrosio CD, Hill NS. Pulmonary complications of chronic neuromuscular diseases and their management. Muscle Nerve. 2004;29(1):527. PubMed ID: 14694494 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Rathinaraj LA, Irani A, Sharma SK, Ng B, Sreeja MT. Forced Expiratory Volume in the first second [FEV1] in patients with chronic low back pain. J Res Med Den Sci. 2017;5(1):2732. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33.

    Almeida VP, Guimarães FS, Moço VJ, Menezes SL, Mafort TT, Lopes AJ. Correlation between pulmonary function, posture, and body composition in patients with asthma. Rev Port Pneumol (English Edition). 2013;19(5):204210. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Kim E, Lee H. The effects of deep abdominal muscle strengthening exercises on respiratory function and lumbar stability. J Phys Ther Sci. 2013;25(6):663665. PubMed ID: 24259823 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Teixeira-Salmela LF, Parreira VF, et al. Respiratory pressures and thoracoabdominal motion in community-dwelling chronic stroke survivors. Arch Phys Med Rehab. 2005;86(10):19741978. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Comerford MJ, Mottram SL. Movement and stability dysfunction–contemporary developments. Man Ther. 2001;6(1):1526. PubMed ID: 11243905 doi:

  • 37.

    Key J, Clift A, Condie F, Harley C. A model of movement dysfunction provides a classification system guiding diagnosis and therapeutic care in spinal pain and related musculoskeletal syndromes: a paradigm shift—part 1. J Bodyw Mov Ther. 2008;12(1):721. PubMed ID: 19083651 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 2133 2133 186
Full Text Views 60 60 2
PDF Downloads 48 48 2