Breathing Exercises for Chronic Back Pain

Last week we talked about whether lifting weights is necessary to heal back pain. This week, something a little different.

Breathing exercises can reduce chronic low back pain. Yes, you read that right. A 2025 analysis of 17 randomized trials and 633 people found that structured breathing techniques (diaphragmatic, slow-deep, or forced-exhalation work, for 2 to 12 weeks) lowered pain intensity, improved daily function on the Oswestry Disability Index, and reduced fear-avoidance beliefs in people with chronic non-specific low back pain [1]. The catch worth flagging up front: the evidence isn’t exactly high certainty. The signal is there but the confidence around it is not. Still, the size of the pain effect was larger than what is usually reported for exercise alone, so it’s worth looking into [2].

What the research actually found

All of the available studies that examined breathing exercises were gathered and examined. The headline numbers:

• Pain intensity dropped with an average reduction of -1.11 on a 10-point scale
• Oswestry Disability Index scores improved by -0.56
• Fear-avoidance beliefs (FABQ) dropped by -0.56
• Transverse abdominis activation went up
  • this is the muscle that stretched horizontally across your torso - like a built in weight belt

Effects were more pronounced in athletic populations. Five of the 17 trials included carried high risk of bias, making the confidence in the findings low [1].

Some of that you can take to the bank. Some of it should be interpreted with a grain of salt. Let’s assume that there’s a real effect here an explore it further.

Why breathing changes pain (the mechanism)

The diaphragm is not just a breathing muscle. Connective tissue links your diaphragm, transverse abdominis, and pelvic floor, and the three together form the deep core that helps stabilize your spine. The actions of the three muscles are coordinated by the nervous system and provide some spinal stability as a result. When breathing goes shallow and chesty, which happens under stress or pain, the diaphragm-deep core relationship is disrupted and stability may be altered.

Slow nasal breathing also nudges your nervous system toward the parasympathetic side of the parasympathetic/sympathetic relationship. The parasympathetic system is associated with bringing arousal down; basically sending calming signals throughout the body. Shifting more towards parasympathetic activation, instead of the fight-or-flight effects of sympathetic activation, can lower pain sensitization in people with chronic pain. This is because pain that has become centralized (when a nervous system gets MORE sensitive to pain over time regardless of tissue healing or lack thereof), turns the volume up in response to sympathetic inputs. This is why some of you may have noticed your back pain intensity raising during times of stress. Pain has a volume knob and your nervous system can turn it up or down.

I have good news, though: we aren’t just passive observers of this process. Yes, stress can feel automatic and uncontrollable, believe me, I know, but there are practical techniques that you can try.

How to shift the balance

Here is a protocol drawn from the trials that showed the largest effects. Start with this once a day for a couple weeks before adding anything fancier:

1. Lie on your back, knees bent, feet flat, one hand on your chest and one on your belly
2. Inhale through your nose for 4 seconds, letting the belly hand rise first and the chest hand stay still
3. Exhale through your mouth for 6 seconds, letting the belly hand sink
4. Try 10 breaths
5. Repeat as desired.

The exhale being longer than the inhale is important to parasympathetic activation, so make sure to take your time before inhaling again. If you cannot get the belly hand to rise without the chest hand rising too, you are still chest breathing. Work on that pattern before adding more breathing.

Here’s another technique to try once you’ve figured out how to breathe deeply, and this is my personal favourite:

1. Sitting or lying, inhale deeply through your nose, letting your belly expand
2. when you feel like you can’t inhale any further, stop and take another quick inhale
3. Pause briefly and then let the air out slowly as if it were draining from a balloon

This is called “sigh breathing” and you’ll notice why. There is often a sigh that escapes people’s mouths when they release the pressure of their inhale. Just a couple of these can noticeably increase relaxation. Give it a try and remember to not rush the exhale - just like the first technique. I’ve used this technique myself before public speaking, my PhD defence, and when sitting at my desk if I feel overwhelmed. It has my sticker of approval.

Where this fits in a recovery plan

Breathing is not a replacement for a properly designed back pain rehab approach. The wider evidence base still points to graded exercise as the most reliable intervention for chronic back pain [2]. Breathing work belongs alongside that, not instead of it.

If pain or fear is high enough that you avoid movement, breathing gives you a way to start regulating stress associated with your back pain. Once movement and loading is tolerable, breathing becomes a technique you can use cool down after exercise or when your pain is flaring up.

Want to know which back pain pattern matches you? Take my free 2-minute quiz and find out which approach is best for your pain.

As always, have a great weekend.

Best,

Mitch

Disclaimer: this content is educational only and does not constitute medical advice. See a practitioner if you suspect serious spinal trauma from a fall or accident, or if you experience any of the following red flag symptoms: loss of bowel or bladder control, numbness in the groin or saddle area, rapidly worsening leg weakness, back pain with fever or feeling generally unwell, or unexplained weight loss with back pain.

References

[1] Chen et al., 2025 — 10.1177/10538127251374357. Can breathing exercises effectively treat people with chronic non-specific low back pain? A systematic review with meta-analysis. Journal of Back and Musculoskeletal Rehabilitation, 39(2), 389-409.

[2] Hayden et al., 2021 — 10.1002/14651858.CD009790.pub2. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, 9(9), CD009790.