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

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