Effects of Three Sessions of Diaphragmatic Myofascial Release on Pain, Balance, and Quality of Life in Patients With Chronic Nonspecific Low Back Pain (A Regional Interdependence Model): Protocol of a Randomized Clinical Trial Publisher



Hejazi Yekta S ; Malmir K ; Fereydounnia S ; Otadi K ; Ehtesham F
Source: Journal of Rehabilitation Sciences and Research Published:2025

Abstract

Background: Chronic nonspecific low back pain (CNLBP) is a prevalent cause of disability, despite advancements in management. The diaphragm, a key respiratory muscle crucial for adjusting intra-abdominal pressure and maintaining lumbar spine stability, often exhibits dysfunction in chronic LBP. Improving diaphragm function may yield positive effects on chronic LBP. Therefore, the main aim of the present study is to assess the addition of myofascial release of the diaphragm to traditional treatment on pain, balance, and quality of life in patients with chronic nonspecific LBP. Methods: A prospective, double-blind, randomized controlled clinical trial will include 24 participants with CNLBP, randomly assigned to a control group (sham diaphragm myofascial release) or an interventional group (diaphragm myofascial release). All patients will receive three sessions of either the main release or sham interventions, followed by the application of Transcutaneous Electrical Nerve Stimulation (TENS). Outcome measures will be assessed at baseline, after the third session (post-treatment), and after one week (follow-up). Pain will be measured using the Visual Analogue Scale (VAS), disability using the Roland-Morris Questionnaire, static balance via the single-leg stance test, dynamic balance using the functional reach test, lumbopelvic mobility via the tip-to-floor test, and chest expansion with a tape measure. This study is the first to investigate the effects of diaphragm myofascial release in individuals with chronic low back pain. Considering the diaphragm's potential role in postural control and interdependence of body regions, this intervention may offer benefits beyond pain relief, including improved balance and function. The randomized controlled design enhances the reliability of findings. Although blinding and objective diaphragm assessment were limited, the results may support the inclusion of this safe and simple technique as an adjunct in managing chronic LBP. Results: Repeated measures ANOVA will be used for data analysis after collection. Conclusion: This trial will examine the effects of diaphragm myofascial release compared with sham diaphragm myofascial release on pain, balance, chest expansion, lumbopelvic mobility, and disability in individuals with chronic nonspecific LBP. Potential implications for clinical practice and future research will be discussed, and the limitations of the study will also be considered. © 2025 Elsevier B.V., All rights reserved.