The Effectiveness of Manual Therapy on Musculoskeletal and Respiratory Parameters in Patients with Chronic Low Back Pain: A Systematic Review

摘要

Patients with chronic low back pain (CLBP) exhibit respiratory dysfunction. Dysfunction in motor control of trunk muscles (diaphragm included) negatively affects the mechanics and biochemistry of breathing. The aim of this systematic review was to analyze evidence from randomized controlled trials (RCTs) investigating the effect of manual therapy on musculoskeletal and respiratory parameters in patients with CLBP. Systematic search and selection of RCTs was performed using specific keywords in three scientific databases (Medline, Scopus, and the Physiotherapy Evidence Database, or PEDro) from inception to March 2021. Relevant studies published in English were extracted, evaluated, and independently rated for methodological quality by two assessors using the PEDro scale. Data extraction and methodological ratings were inspected by a third assessor. Out of 943 initially collected studies, 922 were excluded (did not meet inclusion criteria or were duplicates). Twenty-one clinical trials were finally included, though they were characterized by moderate methodological quality (PEDro scale). Meta-analysis was not performed due to differences in techniques utilized (targeting spinal joints or trunk or respiratory muscles) and the outcomes were assessed across studies. Overall, there was evidence, of moderate methodological quality, that manual therapy on the low back joints or trunk stabilization exercises, diaphragmatic release techniques, and respiratory exercises significantly improve musculoskeletal as well as respiratory parameters in patients with CLBP. More and higher-quality RCTs are required, especially those that will utilize respiratory reeducation and exercise of the respiratory muscles as therapeutic interventions contributing to the holistic management of patients with CLBP.