The diaphragm is arguably the most important muscle in the body. I say this because, as you know, it’s the muscle that reduces pressure in the chest cavity (along with the muscles between the ribs) causing air to be forced into the lungs. Hence, it allows for breathing. The diaphragm is situated in the lower portion of the ribcage and attaches to the lower six ribs, the xiphoid process (a projection off the bottom of the sternum), and the first three lumbar vertebrae (L1, L2, and L3). Additionally, there is a connection between the diaphragm and two very important muscles involved in low back (lumbar) and pelvic stability; namely the psoas (the main hip flexor) and the quadratus lumborum (QL) (a ribcage and pelvic stabilizer). The connection with these two muscles and the lumbar vertebrae can make uncovering and resolving dysfunction of the diaphragm the key to alleviating low back pain.
It’s fairly simple for a doctor to evaluate for diaphragm dysfunction. The simplest method is for the doctor to place his/her hands on the back of the lower ribcage with the thumbs in the center, next to the spine. The other four fingers should lay on either side of the ribcage. Now, the patient is asked to take a deep breath while the doctor notes for symmetry in the movement of his/her hands. When there is significant dysfunction of the diaphragm, one hand will move away from the spine more than the other. Again, this is the simplest method.
Other clues that may point to diaphragm imbalances are when the patient walks with one foot flared out more than the other during gait or on static postural analysis (indicating possible psoas muscle dysfunction); and/or when the patient walks or stands with the upper body leaning more toward one side (indicating possible QL muscle imbalance). Additionally, the patient may sigh frequently, have difficulty breathing and/or shortness of breath.
OK, now that we know the signs and symptoms, I’ll discuss the possible areas that may need treating.
In order to be truly holistic (at least in a structural sense), the doctor needs to evaluate the entire body. He/she should begin with a basic gait and postural analysis. The imbalances above should be noted in addition to overpronation of either foot. When the foot overpronates (“flattens” too much) it can cause dysfunction in the psoas muscle which can have repercussions on the diaphragm due to its attachments. For more information on overpronation of the feet, click here. Additionally, the psoas and QL should be tested for inherent dysfunction and corrected accordingly.
As mentioned above, the diaphragm attaches to the ribcage, so any dysfunction of rib movement needs to be addressed, usually through chiropractic adjusting. The nerve that supplies the diaphragm (named the phrenic) arises from the third, fourth and fifth cervical (neck) nerves, so any dysfunction of those vertebrae should be corrected – again, usually through chiropractic adjusting. It would also be wise to look at the function of the first three lumbar vertebrae as the diaphragm attaches to those as well. Also from a spinal perspective, the junction of the thoracic and lumbar spine should also be evaluated. The bottom thoracic (12th) and top lumbar (1st) vertebrae need to be assessed, because that’s often the area where movement becomes restricted affecting diaphragm. This area is especially critical in low back pain, because if there is a lack of movement at those segments, the low back will have to compensate and move excessively which can lead to degeneration, instability and lumbar disc herniation. Lastly, the pelvis should always be evaluated because it acts as the base or foundation of the spine. And if the foundation is “cracked”, it’s very difficult for the “floors” above to be stable.
One more thing – sometimes the diaphragm needs to be addressed directly. Recall, it is a skeletal muscle just like any other and can be manipulated through various methods, manually or with the use of a massage-like instrument.
If you’ve been suffering from low back pain without an apparent cause and without relief after trying different methods, consider the diaphragm as the possible culprit – and if it is, AK may be able to help.
Dr. Rob D’Aquila – NYC Chiropractor – Diplomate of the International Board of Applied Kinesiology
Hi after reading your post a lot of things make sense. I also have a pain in my ribs and shoulder blades due to my diaphragm could this all be connected
Hi Chris,
It sure can all be connected as mentioned in the article above. Thanks for reading!
Good luck,
Dr. Rob D’Aquila
I underwent L1-L5 deompression and morphogenic peotein infusion-since my surgery I still have some discomfort in my back still and have since been diagnosed with asthma( I think its more then that) I have trouble breathing all day. I wasn’t having any other heath issues before my surgery.
Thank you. Would singing help? Would a problem with the diaphragm cause a problem with singing?
Hi Rachel,
A diaphragm problem would be a singer’s worst nightmare. I’d first make sure the diaphragm is fine. Then, singing should be helpful because it’s essentially exercising the diaphragm.
Good luck,
Dr. Rob D’Aquila
Do you have any pointers for a professional opera singer who previously had chronic bronchitis and has since suffered from reflux due to the weakness in my diaphragm? I can’t find any helpful exercises online and I’m at a loss as to how I can encourage my diaphragm to act ‘healthily’ again and to get it back to its earlier capacity of strength.
Hi Stefanie,
I’d check out this link and some of the exercises – Dr. Fulford was great with the diaphragm – aspireperformancehealth.com/2012/forms/fulfordexercises.pdf.
Also – I’d find a good chiropractor (preferably an Applied Kinesiologist) who knows what they’re doing when it comes to the diaphragm and everything that could be associated with it.
Best of luck,
Dr. Rob D’Aquila
After reading this, a lot of things make sense. I will try to keep this brief, but I’m hoping that if I explain my situation, maybe I can get some answers.
Sometime in 2008 I made a visit to my local chiropractor for severe neck pain. Initially I thought I had just slept wrong, but when the problem persisted for weeks I followed the advice of a co-worker and made an appointment with our local chiropractor. If I remember my diagnosis correctly, I was told the C5 and C6 discs were herniated, there were compression fractures of the C4-C6, and I had the onset of degenerative arthritis. I was asked if I had ever been in any sort of accident–I hadn’t. What line of work I was in–I work in a warehouse. And then if I’d ever suffered any injury/trauma in the past–back in 2005/2006 I was placed on worker’s compensation for a work-related injury, what the doctor said was a bilateral trapezius strain due to repetitive movement (this was before I took on my warehouse position). My chiropractor said that, based on the symptoms of my prior injury, there was a good chance that it wasn’t anything actually involving the trapezius muscle, but rather was the onset of my cervical spine issues. I received treatment from my chiropractor for the prescribed amount of time, then for a few bouts the following year. I still had some pain from time to time with certain movements, but nowhere near what it was in the beginning, and I felt like I finally had my life back; I could function again without the constant pain.
Cut to the beginning of 2013. I started experiencing bad headaches in January or February. At first they were mild and only a few times a week, but by around August they had gotten progressively worse. I was having headaches every day, all day, and nothing I took would even take the edge off the pain: ibuprofen, aspirin, acetaminophen, even prescription analgesics were eventually ineffective. And the source of my pain seemed to originate from my neck area. My husband scheduled me an appointment with his GP. The doctor prescribed me an antibiotic for a sinus infection, saying that the sinus pressure could be the cause of the headaches, and told me that if the headaches persisted I was to call him back. I took the antibiotics, cleared up the sinus infection, and then called the doctor back to tell him that the headaches had not subsided. I was told to have my vision checked to rule out that possibility. The optometrist said my vision was 20/20 and she didn’t see anything in my eye exam that would explain the headaches.
I went back to the GP. I told him that my vision was fine and that the headaches persisted. He wrote me a prescription for tramadol and set me up to have x-rays done. The results from the x-rays came back days later and the doctor’s nurse called me back to inform me that the x-rays showed that my cervical spine was normal and healthy. So I called the doctor back saying that obviously things weren’t “normal” if my headaches had not subsided, the tramadol wasn’t helping (and I don’t even like taking OTC analgesics), and that an x-ray wouldn’t show herniated discs. So he wrote me a prescription for Zanaflex, a muscle relaxer.
Cut to today, in November. I have found relief for my headaches only in taking two Aleve a day, 12 hours apart, supplementing the hours in between with half a tramadol every 6-8 hours. The Aleve and tramadol does nothing for the neck pain, which is constant even if it’s not excruciating. But now, on top of the neck pain, I’ve been suffering from shortness of breath and constant yawning/sighing. It’s not from fatigue; I feel like I can’t take in a deep enough breath, and the only way to come close to achieving that is through constantly yawning. I yawn probably 2-3 times every couple of minutes.
Could the constanting yawning and shortness of breath be attributed to my cervical spine issues? Issues that I know still exist even if the x-rays did not show them. Back in 2012 I had to see the chiropractor again for lower back pain, and was diagnosed and treated for severe narrowing between L5-S1. And back in 2006, I had to see a physiatrist while I was pregnant: one leg would occasionally turn completely reddish/purplish, with the back of the other leg splotchy with the same discoloration. I was told that I was a “textbook example of sciatica from pregnancy, as well as likely L4/L5 herniation unrelated to pregnancy.” So could any or even all of these issues be the root of my problems?
I apologize for my verbosity. Thank you for your time.
Hi,
Your case sounds fairly complicated. First off, if you were my patient, and I couldn’t relieve the pain and headaches with my treatment, I’d refer you to get an MRI and probably a neurological consult.
It’s possible that you’re not getting a full breath because of your diaphragm, and that could be the result of the c-spine, because the phrenic nerve which originates from C3,4,and 5 innervates the diaphragm. That wouldn’t explain the headaches necessarily though. Frequent yawning can also be a need for thiamine.
I’d get a better, more thorough evaluation if it was me.
Good luck,
Dr. Rob D’Aquila
Hello! I read this article (well, what I could understand out of it) and have a question. I am also an opera singer, and have quite intense pain/stiffness from singing. I often have to bend forward (i.e. touch my toes) to “stretch” out the pain. This pain ONLY happens noticeable when I sing (not when I’m just standing, walking, etc.) I do not have insurance, so a chiropractor is probably not an option for me. Not only do I have this stiffness, but when I support my sound “correctly”, there’s a gnawing pain deep in the right side of my lower back. Do you have any idea what this is?
Thank you so much for your time!
Hi Kelly,
It’s obviously difficult to say without examining you in person. If it were me, I’d rule out a disc herniation/damage as singing could possibly exacerbate a disc issue due to increasing the pressure in the spinal column. It could also be an abdominal issue, as those muscles will naturally become inhibited when the diaphragm contracts during breathing/singing. And it can also be a diaphragm issue due to the fact that you’re using your diaphragm while singing.
Either way – I recommend getting examined and properly diagnosed (and treated if need be) by a competent, licensed medical doctor or chiropractor.
Good luck!
Dr. Rob D’Aquila
I have been having problems with my diaphragam for yrs,recently it has gotten more extreme.my sternum is protruding, the pain behind my left shoulder blade is unbearable. Neither heat or cold,nor advil.or massage are adaquate at this time.Also,experience burping occasionally(,gross).My voice tends to get hoarse also. I do have chiropractor care. What else should I try?
Hi Trish,
I recommend getting examined by another chiropractor and/or medical doctor who is competent and licensed. Not all chiropractors are the same with regards to their knowledge and/or approach to care.
Best,
Dr. Rob D’Aquila
Hi, would like to get your opinion please. I have just read your article above about lower back pain and the diaphragm. Although I regularly attend a chiropractor (once to twice a week) I seem to constantly have trouble with my lower back/hip area and get sciatic pain in the groin area. Occasionally I have trouble getting my breath and find that after my treatment it seems to settle down. I wasn’t sure if it could be the diaphragm causing the problem or actually my back being out of place. Any advice would be appreciated. Many thanks.
Hi Lina,
It’s hard to say what’s going on without examining you obviously, but a few thoughts…
I’m sure you love your chiropractor, as most people do. However, if you’re getting treated once to twice a week for an extended period of time (over 2 months) and you’re not resolving the issue; it sounds like you need a new approach… It’s not normal to have pain simply come and go with treatment. You need to resolve the issue. It’s possible you’ve already explored all options and palliative treatment is the best that can be done for you, but take an honest look at that…
It can go either way with the diaphragm affecting the back or vice versa. Regardless, the ultimate cause of the imbalance needs to be addressed, and that’s usually muscle function. A muscle that’s not firing properly in your foot could even cause imbalances in your diaphragm or back.
Lastly, continue to try to educate yourself and ask friends for advice on exceptional doctors that may be able to help you. It doesn’t sound like you’re being properly educated by your doctor. I sure hope he/she didn’t say you have “sciatic pain” in your groin…
Best of luck in resolving this!
Dr. Rob D’Aquila