The Diaphragm and It’s Role in Low Back Pain

Have you heard the buzz words “belly breathing” or “diaphragmatic breathing”? Sounds like a good idea, but what does it mean? In this blog we will discuss what your diaphragm even is and why it may be the key to resolving your back pain!
Breathing: air comes in and out of our lungs providing our body with all of the oxygen it needs, right? Well, it is a little more complicated than that and there is a super important muscle that we don’t often hear about. The diaphragm. This muscle essentially orchestrates our breathing! The diaphragm is a large, dome-shaped muscle that is located below our lungs and separates the chest cavity from the abdominal cavity. The diaphragm is the primary driver of breathing.
When you inhale, your diaphragm contracts and pulls downward. As a result, air rushes into the lungs. Then the diaphragm relaxes and pushes up into the chest cavity and air is pushed out of our lungs. The diaphragm muscle attaches to our bottom ribs and our spine and therefore provides stability to the spine when lifting and balancing.
Also, as humans are the only upright creatures on the planet, our diaphragm has to pull double duty. Not only is it key for bringing air into our lungs, but it also has a separate roll to stabilize our back independent of breathing. This is complicated to explain, but we will just say for now that the range of positions it’s in helps to activate all the core muscles correctly.
As we age, there are a variety of factors that can affect how the diaphragm works. Poor posture, injury, anxiety or surgery can lead to a diaphragm that does not contract and relax fully leading to a faulty breathing pattern.
Research shows that 75% of patients with low back pain also have dysfunctional breathing. The diaphragm typically sits in a higher position and does not move as much during breathing in people with low back pain. Diaphragms of individuals with low back pain also fatigue more rapidly compared to healthy people.
You have probably heard that it is important to strengthen your “core” to help with low back pain. You may have been given bridges, planks and superman exercises to stabilize your core. These are important, but they don’t target the most active core muscle: THE DIAPHRAGM. The diaphragm serves the dual purpose of constantly working to control airflow for breathing, while also working with the abdominal muscles to stabilize the spine and maintain balance.
As mentioned above, a diaphragm that fatigues quickly can be problematic. Because oxygen is essential for survival, our bodies make sure the diaphragm always has a good blood supply. When we are exercising our body deliberately decreases blood flow to the muscles around the spine and makes sure as much blood as possible is flowing to the diaphragm, because we must breathe! When we are exhausted, there is a significant reduction in blood flow to the muscles around the spine. This decreased blood flow to the spinal muscles significantly impairs muscle coordination in the spine and can lead to low back injury. As you can see, ensuring you have a strong diaphragm that doesn’t fatigue easily is vital in preventing low back injuries.
The great news is that there are diaphragm muscle exercises that take only a few minutes a day to complete. They are very effective in improving strength and proprioception and most importantly, they can help reduce low back pain!
If you have low back pain, Dr. Iodice can evaluate if your diaphragm is playing a role in your pain and develop a treatment plan to strength your diaphragm and normalize your breathing pattern. Breathing exercises done in conjunction with joint and soft tissue mobilization can be very effective in resolving low back pain; as well as, preventing future injuries and relapses! In the meantime, you can begin practicing diaphragmatic breathing at home.

Diaphragmatic Breathing

• Lie on your back with your legs resting up on a chair at 90 degrees.
• Place 1 hand on your belly and 1 hand on your chest.
• Breathe in slowly through your nose so that your stomach moves out, causing your hand to rise. The hand on your chest should remain as still as possible.
• Tighten your stomach muscles, so that your stomach moves in, causing your hand to lower as you exhale through pursed lips. The hand on your upper chest should remain as still as possible.
• Try to keep your legs and neck fully relaxed.

Diaphragmatic breathing offers several additional benefits to your body including reducing blood pressure and heart rate and helping you relax. So put your feet up, take a deep breath and relax!

Sources: Michaud, Tom. The Diaphragm: The Overlooked Core Muscle.
Hardy, Jacob. The Diaphragm’s Role in Breathing
Low Back Pain: Why Your Diaphragm is a Piece of the Solution. Centralmasspt.com