Effects of combining diaphragm training with electrical stimulation on pain, function, and balance in athletes with chronic low back pain: a randomized clinical trial

Khadijeh Otadi,Noureddin Nakhostin Ansari,Hadi Sarafraz,Shahriar Sharify,Amir Aria,Omid Rasouli,Zahra Fakhari

doi:10.1186/s13102-021-00250-y

Abstract

BackgroundIt is unknown how diaphragm training combined with electrical stimulation affects pain, function, static stability, and balance in athletes with chronic low back pain (CLBP). This study aimed to explore the effects of combining diaphragm training with electrical stimulation on pain, function, static stability, and dynamic balance in athletes with nonspecific CLBP.MethodsThe design was a randomized clinical trial. A total of 24 amateur athletes (12 women, 12 men, mean age: 35.2 ± 9.8) with nonspecific CLBP were randomly allocated into two groups. The experimental group (n = 12) received diaphragm training plus Transcutaneous Electrical Nerve Stimulation (TENS), while the control group (n = 12) received TENS alone. Both groups underwent 12 sessions over a four-week period. Static stability, dynamic balance, pain, and function were measured pre- and post-intervention.ResultsAnalysis of variance 2 × 2 revealed greater improvements in pain (p < 0.001), static stability (p < 0.001), and dynamic balance (p < 0.01) in the experimental group compared to the control group. Function was improved in both groups following the interventions (p < 0.001), and there was a trend of a larger improvement in the experimental group than the control group (p = 0.09). Fisher’s exact test showed that the experimental group reported ≥50% improvement only in the pain score, not function, compared to the group that received TENS alone (p = 0.005).ConclusionsPain, function, static stability, and dynamic balance were improved in both groups following 12 intervention sessions. However, pain, static stability, and dynamic balance were improved to a greater extent in diaphragm training plus TENS than TENS alone in amateur athletes with CLBP. Therefore, it seems beneficial to add diaphragm training to the rehabilitation program for athletes with nonspecific CLBP.Trial registrationThe trial was retrospectively registered in the Iranian Registry of Clinical Trials (www.irct.ir) on September 10, 2020 as IRCT20090228001719N8.

Highlights

It is unknown how diaphragm training combined with electrical stimulation affects pain, function, static stability, and balance in athletes with chronic low back pain (CLBP)
A significant interaction of time ×group for dynamic balance (SEBT) was found only on the left side in the anterior direction (η2p = 0.3, p = 0.01). These findings indicate greater improvements for dynamic balance in the experimental group compared to the control group (Table 3)
This study investigated whether combing diaphragm training with electrical stimulation improves pain, function, static stability, and dynamic balance in amateur

Summary

Introduction

It is unknown how diaphragm training combined with electrical stimulation affects pain, function, static stability, and balance in athletes with chronic low back pain (CLBP). Another study demonstrated that 8 weeks of diaphragm training resulted in increased diaphragm thickness and other stabilizer muscles in the lumbar region [10] These novel findings indicate that diaphragm training may be an additional useful intervention for athletic performance, prevention of injury, and rehabilitation to improve respiratory capacity, torso stability, and balance. These improvements might reduce LBP occurrence [5, 11,12,13,14]

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