Breathe, Part 1: Exploring the Diaphragm

As a physical therapist specializing in the pelvic floor, I incorporate the same one treatment with everyone who comes through my door, regardless of diagnosis or issue. The treatment? Diaphragmatic breathing. I consider diaphragmatic breathing to be so essential that I had to include it in my name, Breathe and Blossom!

Over the next few weeks I will be diving into the diaphragm, discussing specific ways in which breathing can benefit your pelvic (and overall) health. In this post, I want to introduce you to the diaphragm in all its amazing-ness, and finish with a brief breathing tutorial.

Let’s start with some anatomy. The diaphragm is a dome-shaped muscle that separates the chest and abdominal cavities; it essentially cuts us in half. It has 3 major skeletal attachments: the sternal attachment, the costal attachment at the last 6 ribs, and attachments to the T11-L3 vertebrae. In addition, the diaphragm is attached to the lungs, heart, esophagus, small intestine and ascending colon via ligaments. Muscularly, the diaphragm connects with the transversus abdominis muscle, and lays over the psoas and quadratus lumborum.

The diaphragm has fascial connections with the liver, kidneys, deep cervical muscles, latissimus dorsi, trapezius, gluteus medius and maximus, and external obliques. Finally, the esophagus, aorta, inferior vena cava and vagus nerve pass through openings within the diaphragm, and the lungs, pericardium, stomach, liver, and spleen contact it. If you consider for a moment how well-connected this muscle is, it stands to reason that it would be important to make sure it is working optimally.

So how does it work? The diaphragm is the primary muscle behind breathing. When we inhale, the diaphragm contracts by flattening and descending, which expands the bottom ribs and pushes the abdominal contents downward; this creates a vacuum through which air enters the lungs. The diaphragm is active during all breathing, but typical breathing patterns tend to be shallow, which only mildly engages the diaphragm and only partially inflates the lungs. During periods of stress, chest-breathing patterns predominate, which further decreases the effectiveness of the diaphragm. In addition, most of us spend significant time in hunched, forward-flexed postures, which increases the stiffness of the thoracic spine, reducing the expansion of the ribs which is required during a full diaphragmatic breath.

But why is it important to use our diaphragm when we breathe? It is important because it is the primary mover for breathing. When we chest breathe, we overuse smaller muscles in the neck and chest, which is fatiguing. Diaphragmatic breathing helps engage and strengthen this primary mover, which improves efficiency, especially during exercise. In addition, diaphragmatic breathing improves relaxation and concentration, decreases anxiety, lowers heart rate and blood pressure, and increases the oxygen levels within cells. Most amazingly (to me, anyway), diaphragmatic breathing has a profound influence on your pelvic floor! We will delve into that in a later post…

So now that we have learned a bit about the what and the why, let’s end with the how! There are plenty of diaphragmatic breathing tutorials online, and I encourage you to check them out. I would just like to humbly add a few cues that I have found to be helpful when I use them with my clients.

1. Find a comfortable place to lie down on your back or side, or sit if that is more comfortable. Place your hands on either side of your lower chest and upper abdomen, contacting your lower ribs, as shown in these photos:

2. Breathe SLOWLY, not DEEPLY. Instead of focusing on taking huge breaths to fill the entirety of your lungs, think about elongating your breath, as though you are breathing in and out through a straw. Try to count to 4 on the inhale, then count to 4 on the exhale. This will help you take a full inhalation without feeling like you are straining, or without making you lightheaded.

3. Envision inflating your lower ribs, abdomen AND low back like an inner tube on the inhale. Do NOT just focus on expanding the belly. We want to ensure the diaphragm is engaging fully, and to do that, we must be able to expand in all directions. Feel your ribs, abdomen and back expand into your hands as you inhale.

4. If you are new to this, yes, it will feel strange and difficult. Keep with it, and practice regularly throughout the day. Focus on allowing and elongating the breath, not forcing.

5. If at any time you start to feel lightheaded or short of breath while practicing, stop and return to your normal breathing pattern. Sometimes baby steps are in order, and you should not try to push through these symptoms.

How did that feel? Keep practicing, and stay tuned for next week’s installment, where I will explore common issues that can impact your ability to take a full diaphragmatic breath.

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