The Diaphragm (and shoulders)

I’ve seen a lot of diaphragm issues recently, some linked to anxiety and chest infections, or even gastric problems. Most of them wouldn’t look like diaphragm issues to the untrained eye. From persistent hiccups and lower back pain to nebulous upper back and shoulder pain, the diaphragm has been playing a part.

Diagram to show an anterior view of the diaphragm within the ribcage

The diaphragm is an often forgotten and mistreated muscle. It lies between the lungs and abdominal organs, attaching to ribs and the spine along the way- this means that anything going from one side of the diaphragm to the other has to pass through it- this is where hiatus hernias occur which can lead to acid reflux.

If there’s tightness through the muscle, problems can arise. Poor posture can create uneven forces through the spine and ribcage, predisposing to this, but the biggest effects come from breathing. When you breathe in, your abdomen should come out, as the diaphragm pushes your organs down to give more space to the lungs. Asthma, tight clothes (including elastic or corset-type shapewear), being self conscious of having a tummy, and stress can all consciously or subconsciously lead to an abdomen that doesn’t extend- thus paving the way for a diaphragm that gets tight. If the lungs can’t expand down, the shoulders are probably going to have to work harder to try and let them expand up. This is known as upper rib breathing, and starts to explain where those strange upper back and shoulder pains come from.

The extreme version of this stressful breathing is known as backwards breathing. Essentially, this is when the abdomen does the exact opposite of the ideal movement mentioned above. On breathing in, the abdomen pulls in too, minimising lung capacity and recruiting accessory muscles of breathing that shouldn’t be engaged for long at all. It can be useful, and is utilised in some forms of yoga, but as a default setting it won’t do any good!

An unhappy diaphragm will often respond quickly to direct osteopathic techniques and breathing exercises. I’ve had a handful of patients with a selection of upper back, shoulder, and diaphragm pains that have been almost 100% better after the first treatment and some box breathing.

The “box” in box breathing is a visual tool to help keep the exercise slow and balanced. Each side represents a stage of the exercise, and as you can see in the diagram below, all four stages last the same length of time.

It’s self explanatory: take three seconds to breathe in, hold that breath in for another three, then breathe out over three, and hold out for three. Throughout this, focus on where the air is going- keep your shoulders relaxed and make your tummy move. Over time, you can increase the length of time each side of the box lasts for.

Diaphragm problems tend to come as a secondary symptom of dysfunction elsewhere, so if the box breathing doesn’t solve your symptoms, make an appointment with your osteopath.

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