Influence of the diaphragm muscle on postural control, proprioception and low back pain
DOI:
https://doi.org/10.33233/rbfe.v18i4.3111Keywords:
diaphragm; low back pain; proprioception; postural balanceAbstract
Introduction: Breathing is a complex biomechanical activity involving the trunk and the appendicular skeleton. This may suggest involvement of the respiratory muscles as the diaphragm in the pathomechanism of human movement. Objective: To systematically review observational studies on the influence of the diaphragm muscle on postural control, proprioception and low back pain in adult individuals with low back pain and asymptomatic. Methods: Systematic review based on the PRISMA recommendations, performed in the databases: Ebisco, Lilacs, Medline, Pedro, Scopus, Pubmed and Scielo, until December 2018. The descriptors were: Diaphragm, Low Back Pain, Proprioception and Postural Balance. We considered eligible: observational studies, with asymptomatic adults, or with low back pain. Results: The searches identified 230 studies, however, only 11 were included. The studies evaluated 421 subjects of both sexes, aged between 18 and 71 years. In asymptomatic, the activation of the diaphragm precedes the movements of the trunk and appendicular skeleton. Already in the low back pain, there is diaphragmatic and respiratory discoordination, when compared to the asymptomatic volunteers. An association between respiratory muscles and proprioception has also been demonstrated. Conclusion: The results demonstrate that the diaphragm exerts influence in the biomechanics of the spine, in postural control, proprioception and its dysfunction is associated with the genesis of low back pain.
References
Hodges PW, Butler JE, McKenzie DK, Gandevia SC. Contraction of the human diaphragm during rapid postural adjustments. J Physiol 1997;505(Pt2):539-48. doi: 10.1111/j.1469-7793.1997.539bb.x
Janssens L, Brumagne S, McConnell AK, Hermans G, Troosters T, Gayan-Ramirez G. Greater diaphragm fatigability in individuals with recurrent low back pain. Respir Physiol Neurobiol 2013;188(2):119-23. doi: 10.1016/j.resp.2013.05.028
Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther 2012;42(4):352-62. doi: 10.2519/jospt.2012.3830
Bordoni B, Marelli F, Morabito B, Sacconi B. Manual evaluation of the diaphragm muscle. Int J Chron Obstruct Pulmon Dis 2016;11:1949-56. doi: 10.2147/COPD.S111634
Ostwal PP, Wani SK. Breathing patterns in patients with low back pain. Int J Physiother Res 2014;2(1):347-53.
Teixeira MJ, Shibata MK, Pimenta CAM, Corrêa CF. Dor no Brasil: estado atual e perspectivas. In: Teixeira MJ, Corrêa CF, Pimenta CAM, eds. Dor: conceitos gerais. São Paulo: Limay; 1995.
Maetzel A, Li L. The economic burden of low back pain: a review of studies published between 1996 and 2001. Best Pract Res Clin Rheumatol 2002;16(1):23-30. doi: 10.1053/berh.2001.0204
Janssens L, Brumagne S, McConnell AK, Claeys K, Pijnenburg M, Burtin C et al. Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease. PLoS One 2013;8(3):e57949. doi: 10.1371/journal.pone.0057949
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097
Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Diretrizes metodológicas: elaboração de revisão sistemática e metanálise de estudos observacionais comparativos sobre fatores de risco e prognóstico/ Ministério da Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Ciência e Tecnologia. Brasília: Ministério da Saúde; 2014.
Hodges PW, Heijnen I, Gandevia SC. Postural activity of the diaphragm is reduced in humans when respiratory demand increases. J Physiol 2001;537(Pt3):999-1008. doi: 10.1111/j.1469-7793.2001.00999.x
Janssens L, Brumagne S, Polspoel K, Troosters T, McConnell A. The effect of inspiratory muscles fatigue on postural control in people with and without recurrent low back pain. Spine 2010;35(10):1088-94. doi: 10.1097/BRS.0b013e3181bee5c3
Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV, et al. Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment. J Appl Physiol 2010;109(4):1064-71. doi: 10.1152/japplphysiol.01216.2009
Roussel N, Nijs J, Truijen S, Vervecken L, Mottram S, Stassijns G. Altered breathing patterns during lumbopelvic motor control tests in chronic low back pain: a case-control study. Eur Spine J 2009;18(7):1066-73. doi: 10.1007/s00586-009-1020-y
Kweon M, Hong S, Jang GU, Ko YM, Park JW. The neural control of spinal stability muscles during different respiratory patterns. J Phys Ther Sci 2013;25(11):1421-4. doi: 10.1589/jpts.25.1421
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):663-5. doi: 10.1589/jpts.25.663
Park JW, Kweon M, Hong S. The influences of position and forced respiratory maneuvers on spinal stability muscles. J Phys Ther Sci 2015;27(2):491-3. doi: 10.1589/jpts.27.491
Vostatek P, Novák D, Rychnovský T, Rychnovská S. Diaphragm postural function analysis using magnetic resonance imaging. PLoS One. 2013;8(3):e56724. doi: 10.1371/journal.pone.0056724
Cavaggioni L, Ongaro L, Alberti G. Diaphragm, core stability & low back pain: a rehabilitative-preventive perspective. MOJ Orthop Rheumatol 2017;7(5):00285. doi: 10.15406/mojor.2017.07.00285
Janssens L, McConnell AK, Pijnenburg M, Claeys K, Goossens N, Lysens R et al. Inspiratory muscle training affects proprioceptive use and low back pain. Med Sci Sports Exerc 2014;47(1):12-9. doi: 10.1249/MSS.0000000000000385
Published
Issue
Section
License
Copyright (c) 2020 Juliana Eleticia Silva Barbosa, Laize Pacheco dos Santos Almeida, Mariana Pereira de Oliveira, Marvyn de Santana do Sacramento, Vinicius Afonso Gomes, Jefferson Petto, Alan Carlos Nery dos Santos
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms: Authors retain the copyright and grant the journal the right of first publication, with the work simultaneously licensed under the Creative Commons Attribution License which allows the sharing of work with acknowledgment of authorship and initial publication in this magazine; Authors are authorized to assume additional contracts separately, for non-exclusive distribution of the version of the work published in this journal (eg, publish in an institutional repository or as a book chapter), with acknowledgment of authorship and initial publication in this journal; Authors are allowed and encouraged to publish and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this can generate productive changes as well as increase impact and citation of published work (See The Effect of Open Access).
