Lower back pain in relation to breathing and thoracic spine mechanics

Bolečina v križu je ena najpogostejših zdravstvenih težav sodobne družbe. Izvorov bolečine v ledveni hrbtenici je veliko in so predvsem kompleksne narave. V zadnjem času se vedno več raziskav osredotoča na vlogo dihanja in prsne hrbtenice na delovanje ledvene hrbtenice. Več raziskav je poročalo o spremenjenih vzorcih dihanja, spremembah v mehaniki trebušne prepone in kapaciteti pljuč pri osebah s kronično, nespecifično bolečino v križu, vključno s spremembami v aktivaciji mišic trupa, dihalnih vzorcih ter funkciji pljuč. Ugotovitve teh raziskav kažejo na možno povezanost dihalne funkcije, vzorcev dihanja in stabilnosti trupa z bolečinami v križu. Namen magistrskega dela je predstavitev vpliva dihanja ter prsne hrbtenice na bolečine v ledvenem delu hrbtenice, predstaviti teste za preverjanje dihalnih vzorcev, vaje namenjene vzpostavljanju normalnega dihalnega vzorca ter predstaviti izbor in izvedbo vaj namenjenim izboljšanju mobilnosti prsne hrbtenice in prsnega koša. V uvodu so za boljše razumevanje problematike predstavljeni zgradba, osteokinematika in artrokinematika prsne hrbtenice, ledvene hrbtenice in prsnega koša ter mišična aktivnost med dihanjem. Glavni del naloge predstavlja pregled raziskav in predstavitev vpliva dihanja (trebušne prepone) na delovanje prsne hrbtenice in ledvene hrbtenice, vpliv prsne hrbtenice na ledveno hrbtenico, dihalni vzorci pri osebah z bolečinami v ledveni hrbtenici, učinek dihalnih vaj na bolečine v hrbtenici ter povezanost dihanja in telesne drže. V končnem delu naloge je predstavljeno ocenjevanje dihanja, dihalne vaje, ter ocenjevanje prsne hrbtenice in prsnega koša in vaje za mobilnost prsne hrbtenice. Informacije za reševanje zastavljene problematike so bile pridobljene iz domačih in tujih virov različnih medijev ter lastnih izkušenj pri obravnavi vadečih z bolečinami v ledvenem delu hrbtenice. Na osnovi pregledane literature in raziskav smo mnenja, da bi bilo potrebno v program vadečega z bolečinami v ledvenem delu hrbtenice vključiti tudi obravnavo dihanja, ter vaje za mobilnost prsne hrbtenice in prsnega koša, če je to potrebno.Lower back pain is one of the most common medical issues of modern society. There are various complex reasons for lower back pain. Treatment options are mostly conservative and they include physical exercises. Recently a lot of research was done on finding the connection between breathing and thoracic spine and the functioning of the lumbar spine. Several studies reported changes in breathing patterns, diaphragm dynamics and lung capacities in patients with nonspecific chronic lower back pain. The results of those studies often indicate that lower back pain might be associated with changes in lung function, breathing patterns, torso stability and thoracic spine mobility. The purposes of this master\u27s thesis are: to present the impact of breathing and thoracic spine on lower back pain, to present tests for evaluating breathing patterns and to define exercises designed to establish a normal breathing pattern. Furthermore it also presents the selection and execution of exercises designed to improve mobility of the thoracic spine and chest. In order to get a better understanding of the problem, introduction first explains the structure, osteokinematics and arthrokinematics of the thoracic spine, lumbar spine, thorax and also muscular activity during respiration. The main part of my thesis is meant to review the research, to present the influence of breathing (diaphragm) on the functioning of the thoracic and lumbar spine, to reveal the association between thoracic and lumbar spine, to understand breathing patterns in people with lower back pain as well as the effect of breathing exercises on lower back pain and lastly, to emphasize the connection between breathing and body postures. The final part of the thesis presents the assessment of breathing and breathing exercises. Last but not least, it also includes the evaluation of the thoracic spine and exercises for thoracic spine mobility. Information for discussing the topic was obtained from domestic and foreign sources of various media and our own experience in dealing with people suffering from lower back pain.Based on the reviewed literature and research, we believe that the evaluation of breathing patterns as well as exercises to mobilize the chest and thoracic spine should be included in the treatment process in a person with lower back pain