The Almighty Diaphragm Pt. 1

This is the 1st in a 3 part series about the diaphragm.


The diaphragm is the main respiratory muscle in the body attaching underneath your rib cage, behind your xiphoid process and to your upper lumbar spine.  Along with it’s respiration function, it has two other functions including postural stability and acting as a sphincter.  The latter two functions have a lot to do with the regulation of intra-abdominal pressure or IAP.  Depending on what you are doing at the time your body will “choose” which function is optimal for survival.  It’s instinct, it’s subconscious,  primitive, etc.  The physical demands of your day to day activity, sport, job and current health status, one of the 3 Diaphragmatic Functions will dominate.  For example, a desk jockey who sits for 8 hours, a person suffering from “acid reflux” with a history of hiatal hernias and an athlete or a weightlifter all have different demands.  Certainly, one can make an argument that any of these examples, could have a couple Diaphragmatic Functions that dominate.  The purpose of this 3 part series is review the anatomy of the diaphragm and structures that attach and anchor into it and to discuss each of the 3 functions, how you can test these functions and how you can correct these functions.

The Diaphragm:

Origin – Vertebral:crura from bodies of L1, 2 (left), L1-3 (right). Costal: medial and lateral arcuate ligs, inner aspect of lower six ribs . Sternal: two slips from posterior aspect of xiphoid

Insertion – Central aponeurotic tendon

Action – Inspiration and assists in raising intra-abdominal pressure(IAP)

**Source: Loyola University Medical Education Network

What attaches and/or anchors into the Diaphragm?

diaphragm psoasdiaphragm abs

The better question might be what doesn’t attach to it, because if it is a muscle(either large or small) in the abdominal, trunk, core region it does! How is this possible you ask? Mainly through fascial attachments that anchor into it.  This doesn’t just include the front of the body either, as structures on back of the body can also anchor into it due to their proximity.  Some big players involved from the muscular system are the Psoas Major, Quadratus Lumborum, Rectus Abdominis, Transverse Abdominis, External Obliques and the Internal Obliques.  These muscles are commonly associated with conditions affecting the back, hip, groin and knee. Whether it be pain, stiffness, tightness, sprain, strain, any -ITIS, etc. the underlying problem can be “linked” back to the DIAPHRAGM.

Breathing - CookPhoto Credit: Functional Movement Systems™

How can this be? To put it simply, consider the Diaphragm as the foundation of your house.  How functional would your house be if it wasn’t sturdy, or stable, supporting all the bricks and mortar(muscles and bones) that are built upon it…it would break down or collapse rather quickly!  Hmm, maybe the tightness in your psoas(hip flexor) or your lower back pain is because your diaphragm isn’t functioning properly.  Speaking of functional, let’s get into the 3 Diaphragmatic Functions.

Function #1 – RESPIRATION

How to test if you are breathing with your Diaphragm?

The simplest test is this = when you breathe in does your chest move toward your shoulders and do your shoulders move towards your ears? If so, you’re not doing a diaphragmatic breath.  Those who really need to train breathing with their diaphragm will struggle to break this poor habit.  What should be happening when we “breathe in” is a movement of your abdomen/belly button away from your spine.  This should reverse when we “breathe out”.

Steps to help break this habit:

1.) Place one hand on your chest and one hand on your abdomen and perform “BELLY BREATHING” by breathing into the hand on your abdomen and monitor that your hand on your chest doesn’t migrate towards your head.

2.) While BELLY BREATHING, try to breathe in through your nose and out through your mouth.

3.) Also, focus on increasing the amount of time you are breathing out because a lot of times we aren’t fully expiring!  This can lead to us being stuck in a state of inhalation a.k.a an over-extended posture.  I’m jumping ahead a little bit here as this relates to the postural function of the diaphragm, but it is so important!
diaphragm breathing


4.) Perform this corrective exercise. Place your feet on the wall so that your knees and hips are at 90 degrees. Breathe in through your nose and out through mouth. Use your hands to assist/mobilize the rib cage downward when you breathe out.  Perform 15 full respirations per set, roughly 3-4x/day for those performing this for the first time.

**The purpose for the rib cage mobilization is to correct the postural dysfunction of the anterior rib cage that typical presents in an individual who needs to train the respiratory function of the diaphragm.**


In closing, the Diaphragm plays a pivotal role in respiration.  There is a favorite quote of mine a lot of us rehabilation/exercise specialists, Chiropractors, Physical Therapists, etc live by – “IF YOU DON’T OWN BREATHING, YOU DON’T OWN MOVEMENT”.  This is a quote from Karl Lewit, a pioneer in the realm of physical manual medicine who developed many fundamental principles.

This is just the beginning of the series, the next part of this series we will dive into the postural component of the Diaphragm, where we will discuss more corrective exercise strategies. Stay tuned!

Yours in Health,

Dr. G


**All photos found on Google Images**

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