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The diaphragm is obviously the primary muscle of respiration, however, it serves a secondary role as a core stabilizer. Dysfunction of the diaphragm is an important factor in back and sacroiliac joint pain. Patients who suffer from lumbosacral pain often exhibit early fatigue of the diaphragm. There is also a close relationship between a reduction in the movement of the diaphragm and the intensity of LBP. (1)

A 2016 article published in the Journal of Pain Research (2) attempts to link failed back surgery syndrome with diaphragmatic dysfunction.

“Failed back surgery syndrome (FBSS) is a term used to define an unsatisfactory outcome of a patient who underwent spinal surgery, irrespective of type or intervention area, with persistent pain in the lumbosacral region with or without it radiating to the leg. The possible reasons and risk factors that would lead to FBSS can be found in distinct phases: in problems already present in the patient before a surgical approach, such as spinal instability, during surgery (for example, from a mistake by the surgeon), or in the post-intervention phase in relation to infections or biomechanical alterations. The dysfunction of the diaphragm muscle is a component that is not taken into account when trying to understand the reasons for this syndrome, as there is no existing literature on the subject. The diaphragm is involved in chronic lower back and sacroiliac pain and plays an important role in the management of pain perception.”

Borden and Morelli highlight possible mechanisms by which diaphragmatic dysfunction contributes to FBSS, specifically implicating: decreased proprioceptive abilities, decreased mobility of the lumbar vertebrae, reduction in core stabilization, and altered pain perception.

The authors focus on the relationship between diaphragmatic dysfunction and FBSS, but breathing dysfunction certainly contributes to low back pain long before surgery.

Effective care requires recognizing the clinical problem, treating it effectively, and changing the habits, environment, and posture leading to that person’s condition. We are uniquely suited to help failed back surgery patients, but more importantly, we can identify and correct dysfunction before it necessitates surgery in the first place.

This study is an example of the emerging literature shift from pathoanatomical diagnoses (structural) to more logical pathophysiological (functional) considerations. Check out this 15 minute webinar to learn more about breathing diaphragm dysfunction.

  1. Vostatek P, Novák D, Rychnovský T, Rychnovská S. Diaphragm postural function analysis using magnetic resonance imaging. PLoS One. 2013;8(3)
  2. Bruno Bordoni and Fabiola Marelli. Failed back surgery syndrome: review and new hypotheses J Pain Res. 2016; 9: 17–22

About the Author

Dr. Tim Bertelsman

Dr. Tim Bertelsman


Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board.

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