Why is Diaphragmatic Breathing Important?

Whether a patient comes to me with neck or back pain, is pregnant and preparing for labor and delivery, or is postpartum and beginning to rehab, we almost always start treatment with diaphragmatic breathing. There are many reasons why learning how to breathe well with your diaphragm is important, and in this blog post I’m going to explain what diaphragmatic breathing is and why you could benefit from working on breathing.

What is the Diaphragm?

The diaphragm is a large, dome shaped muscle that sits at the bottom of your rib cage separating the chest cavity from the abdomen. The diaphragm plays an important role in respiration. As you inhale, the diaphragm descends and flattens, creating a vacuum that pulls air into the lungs. As you exhale, the diaphragm relaxes and returns to its dome shape. The diaphragm contracts rhythmically and involuntarily, but can be voluntarily contracted during deep breaths, to hold your breath, or on exertion. The diaphragm also plays a role in bowel and bladder function, as well as lymphatic drainage.

So if breathing is automatic, why do I need to work on it?

There are many reasons why someone may not be using their diaphragm optimally. Prolonged postures can lead to using accessory breathing muscles (such as your scalenes, which are muscles that attach from your neck to your upper ribs) for breathing. This is often referred to as chest breathing or shallow breathing. Chest breathing is also common during pregnancy due to the diaphragm having less space to descend during an inhale, and can create a breathing pattern that sticks around postpartum. Chest breathing can lead to neck tightness, jaw pain and dysfunction, back pain, and more.

Another important consideration in diaphragmatic breathing is the role of the diaphragm in your core. Your “core” is a cylinder (picture a soda can) – the top is the diaphragm, the bottom is the pelvic floor muscles, and the cylinder is made up of the abdominal and back muscles. This cylinder works as a pressure system. When you inhale, your diaphragm descends and your pelvic floor lengthens. When you exhale, your diaphragm ascends and pelvic floor lifts (like a piston!). Understanding and optimizing this pressure system can alleviate back, SI joint, and hip pain, urinary dysfunction (such as urinary incontinence, urgency, and more), bowel dysfunction, and even sexual dysfunction.

And finally, diaphragmatic breathing can be a game changer when it comes to your nervous system. We often live in a “fight or flight” state. When we are in a fight or flight state, that means our sympathetic nervous system is activated. Sympathetic nervous system activation is not a bad thing, but if we live there all the time it can take a major toll on our health and wellbeing. Diaphragmatic breathing helps to activate our “rest and digest”, or parasympathetic nervous system. Having the tools to use breath to tap into our parasympathetic system can be beneficial in so many ways.

What diaphragmatic breathing is (and what it is not)

What I’m going to share in this section is going to include some of my own bias as a provider and the types of cues I have seen work well for patients, and what hasn’t worked well. I’m also going to discuss some patterns I frequently see. Because of the anatomy and biomechanics of the diaphragm and lungs, the ribs expand as we inhale. That means the chest will rise, but the lower ribs also need to expand. As the ribs expand, the belly will also rise.

The two most common issues I see with breathing are:

1) Chest breathing – chest breathing is the shallow breath I discussed briefly in the previous section. When you breathe only with the chest, the front of the chest will rise and shoulders will lift, while the lower ribs stay fairly still.

2) Belly breathing – “breathe into your belly” is a common cue I have heard to try to improve diaphragmatic breathing. If you google belly breathing, you will see a lot of articles stating belly breathing and diaphragmatic breathing are the same thing. However, what I often see with this cue is that patients will get a large rise in their belly without rib expansion, so they are really using their abdominal muscles rather than their diaphragm. This increases intra-abdominal pressure, which can increase pressure on the pelvic floor muscles and does not improve the coordination of the diaphragm and pelvic floor the way true diaphragmatic breathing does.

Still not sure? Check out this video on diaphragmatic breathing.

What symptoms and diagnoses can benefit from diaphragmatic breathing?

So again this may show a bit of my bias as a provider, but I genuinely believe that any and all orthopedic and pelvic floor conditions can benefit from diaphragmatic breathing. Your core works to stabilize your body during all movements and activities, and good breath technique is the foundation of good core stability.

So really my answer is: any symptoms or diagnoses I treat can benefit from improving diaphragmatic breathing. But, here is a quick list of some specific things I have seen improve by addressing breathing mechanics:

1. Neck pain

2. Headaches

3. Shoulder pain, shoulder impingement

4. Pelvic pain, urinary incontinence, constipation, and other pelvic health diagnoses (to see all the pelvic health diagnoses we treat, click here)

5. Low back, pelvic, and SI joint pain

6. Hip pain

Breathing is obviously something I am passionate about as a provider. If you’re interested in learning more about working with me, you can set up your free 15-minute discovery call here.

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS