{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:48:08Z","timestamp":1789638488287,"version":"4.0.0"},"reference-count":89,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The objective of this study was to systematically review the effectiveness of thoracic-focused interventions, including breathing exercises and thoracic manual techniques (mobilization, high-velocity low-amplitude manipulation, and release techniques), on pain and disability in patients with low back pain (LBP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Scopus, Web of Sciences, ProQuest, Ovid, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Clinical Trials (CENTRAL), and Google Scholar were searched without language restrictions. Clinical trials with control groups on pain and disability in low back pain patients focusing on the efficacy of breathing exercises or thoracic technique were included. In total, 31 studies contributed to the meta-analysis for pain and 24 for disability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Pooled analyses using Morris\u2019 dppc demonstrated a statistically significant, small effect for pain reduction (dppc\u2009=\u2009\u22120.35, 95% CI\u2009=\u2009\u22120.46 to \u22120.23) and a large effect for disability improvement (dppc\u2009=\u2009\u22120.71, 95% CI\u2009=\u2009\u22120.86 to \u22120.57) when compared with control groups. Thoracic manual techniques showed larger effects on both pain and disability compare to breathing exercises. However, substantial statistical heterogeneity (I\u00b2\u2009&gt;\u200985%) persisted in most analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Breathing and thoracic manual techniques may be effective in reducing disability and, to a lesser extent, pain in patients with LBP, but the overall certainty of evidence is low. However, the quality of the evidence is low. Variability in treatment protocols, study quality, blinding, and outcome measures likely contributed to inconsistencies. Further high-quality trials with standardized protocols are needed to confirm these findings and inform clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0339263","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T18:27:57Z","timestamp":1768415277000},"page":"e0339263","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of breathing exercise and thoracic techniques on pain and disability in low back pain: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0753-3307","authenticated-orcid":true,"given":"Tahere","family":"Seyedhoseinpoor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramin","family":"Jafari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zohreh","family":"Shafizadegan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Abbaszadeh-Amirdehi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"pone.0339263.ref001","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jot.2021.07.005","article-title":"Global, regional and national burden of low back pain 1990-2019: a systematic analysis of the Global Burden of Disease study 2019","volume":"32","author":"S Chen","year":"2021","journal-title":"J Orthop Translat"},{"issue":"10137","key":"pone.0339263.ref002","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1016\/S0140-6736(18)30480-X","article-title":"What low back pain is and why we need to pay attention","volume":"391","author":"J Hartvigsen","year":"2018","journal-title":"Lancet"},{"key":"pone.0339263.ref003","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1146\/annurev.pu.12.050191.001041","article-title":"Cost, controversy, crisis: low back pain and the health of the public","volume":"12","author":"RA Deyo","year":"1991","journal-title":"Annu Rev Public Health"},{"issue":"8","key":"pone.0339263.ref004","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1123\/jsr.2019-0231","article-title":"Inspiratory muscle training in rehabilitation of low back pain: a randomized controlled trial","volume":"29","author":"L Ahmadnezhad","year":"2020","journal-title":"J Sport Rehabil"},{"issue":"3","key":"pone.0339263.ref005","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.csm.2008.02.005","article-title":"Neuromuscular consequences of low back pain and core dysfunction","volume":"27","author":"RR Hammill","year":"2008","journal-title":"Clin Sports Med"},{"issue":"10","key":"pone.0339263.ref006","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/j.pmrj.2011.06.002","article-title":"A comparison of trunk muscle activation amplitudes during gait in older adults with and without chronic low back pain","volume":"3","author":"EY Hanada","year":"2011","journal-title":"PM R"},{"issue":"1","key":"pone.0339263.ref007","article-title":"Is there a relationship between lumbar proprioception and low back pain? 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