The respiratory diaphragm, a large, dome-shaped muscle nestled within the chest cavity at the base of the lungs, is a crucial yet often overlooked element of our health and well-being. This under-appreciated treasure trove of healing has the power to transform and support so much within the body-mind. Unfortunately, many frequently resort to upper chest breathing rather than properly utilizing the diaphragm, the primary muscle of respiration. Stress shortens the breath and can cause breath-holding, locking individuals in a cycle of stress, tension, and anxiety. 

Diaphragmatic breathing,often confused with belly breathing, involves a separate and distinct movement pattern. When breathing diaphragmatically, on inhalation, the low ribs should expand 360º with an emphasis on lateral expansion of the low ribs. When this happens, the diaphragm contracts by pressing downward, placing pressure on the digestive organs and causing the belly to expand. On the exhalation, the low ribs draw inward as the diaphragm draws in and up to its resting position within the rib cage. Some people don’t utilize their diaphragm during belly breathing and instead press their belly outward, creating instability in the lower back.

I often observe altered breathing patterns coinciding with digestive imbalances in my private practice. When the diaphragm is allowed to do its job, it presses downward on the inhalation, putting pressure on organs such as the stomach and liver, aiding in digestion. A recent randomized controlled trial (RCT) showed improvements in gastroesophageal reflux disease (GERD) symptoms after four weeks of diaphragmatic breathing practice (Hosseini et al., 2022). My clients who utilize diaphragmatic breathing regularly report that it relieves constipation, gas, and even menstrual discomfort. 

Diaphragmatic breathing can support many health conditions, including positive psychological and physiological benefits for adults with hypertension due to the calming effect on the autonomic nervous system (Yau & Loke, 2021). The diaphragm is also a vital part of our structural support. Some research suggests that diaphragmatic breathing matches or surpasses pelvic floor exercises for urinary incontinence (Toprak et al., 2022). This study highlights the role of the diaphragm in managing intra-abdominal pressure and stabilization of abdominal and pelvic regions.

Diaphragmatic breathing also contributes to the reduction of chronic pain. Clients routinely tell me they feel their lower back calm and release following breathing this way. Research suggests adding diaphragmatic breathing to core strengthening exercises helps improve chronic low back pain outcomes better than core strengthening exercises alone (Masroor et al., 2023). Emerging evidence links chronic neck pain to altered breathing patterns that underutilize the diaphragm (Colak et al., 2024). This research mirrors a pattern I frequently observe - clients with neck, shoulder, jaw, or upper back pain that are upper chest breathing or breathing very shallowly.

Stress and trauma can compromise healthy breathing patterns, causing the diaphragm to become weak, tight, tender, and barely movable, contributing to a myriad of physical and emotional symptoms. Trauma-exposed individuals have sometimes spent their entire lives dissociated from their bodies, necessitating a gradual approach toward conscious breathing and full expression of the diaphragm and rib cage movement. However, empowerment frequently comes from transforming breathing patterns  - granting a sense of control over an aspect of the body-mind. If you are new to conscious breathing and feel you breathe shallowly, begin by working slowly toward inhaling four exhaling four - using the diaphragm.

Notice how your breath and sense of embodiment have changed while reading this article.

References

Colak, G. Y., Ozyurek, S., Sengul, Y. S., & Kalemci, O. (2024). Differences of diaphragmatic muscle contraction between female patients with chronic neck pain and asymptomatic controls: A case-control study based on ultrasonography. Musculoskeletal Science and Practice, 69, 102894. https://doi.org/https://doi.org/10.1016/j.msksp.2023.102894 

Hosseini, A., Shorofi, S. A., Jackson, A. C., Dehghan, M. F., Salmanpour, A., Sadeghi, Z., Haghani, S., & Bahramnezhad, F. (2022). The effects of diaphragmatic breathing training on the quality of life and clinical symptoms of patients with gastroesophageal reflux disease: A randomized controlled trial. Advances in Integrative Medicine, 9(2), 103-109. https://doi.org/https://doi.org/10.1016/j.aimed.2022.03.002 

Masroor, S., Tanwar, T., Aldabbas, M., Iram, I., & Veqar, Z. (2023). Effect of Adding Diaphragmatic Breathing Exercises to Core Stabilization Exercises on Pain, Muscle Activity, Disability, and Sleep Quality in Patients With Chronic Low Back Pain: A Randomized Control Trial. Journal of Chiropractic Medicine, 22(4), 275-283. https://doi.org/https://doi.org/10.1016/j.jcm.2023.07.001 

Toprak, N., Sen, S., & Varhan, B. (2022). The role of diaphragmatic breathing exercise on urinary incontinence treatment: A pilot study. Journal of Bodywork and Movement Therapies, 29, 146-153. https://doi.org/https://doi.org/10.1016/j.jbmt.2021.10.002 

Yau, K. K.-Y., & Loke, A. Y. (2021). Effects of diaphragmatic deep breathing exercises on prehypertensive or hypertensive adults: A literature review. Complementary Therapies in Clinical Practice, 43, 101315. https://doi.org/https://doi.org/10.1016/j.ctcp.2021.101315