This blog will explore the diaphragm, its functions and explain why I frequently utilise its breathing role during osteopathic treatment and rehabilitation.
The diaphragm is an unusual muscle as it does not directly move any joints. It separates the chest from the abdomen and its main function is to help us breathe. As we inhale the diaphragm contracts flattening its dome shape, increasing space in our chest and helping draw air into the lungs. When we exhale the diaphragm relaxes, returning to its dome shape, helping the lungs deflate.
Involuntary contraction of the diaphragm causes air to rush into the lungs and the vocal cords to shut resulting in a hiccup.
The diaphragm attaches to the inside of the lower six ribs, inner sternum and to the upper two or three lumbar spine vertebrae. It also has connections to the outer layer of the heart (pericardium), lungs (pleura), liver, spleen, colon and to muscles which stabilise the spine; quadratus lumborum and psoas major.
The diaphragm’s movements as we inhale and exhale fluctuates internal pressure within the chest and abdomen resulting in a broad range of secondary functions:
Returning blood to the heart: A large vein called the inferior vena cava passes directly through the diaphragm, as we inhale pressure in our chest decreases helping move blood towards the heart.
Prevent reflux– The oesophagus (a tube which food travels within before entering our stomach) passes through the diaphragm muscle, as we inhale the diaphragm compresses the tube preventing acid reflux from the stomach.
Lymphatic drainage- The diaphragm acts as a lymphatic pump, its movements and pressure fluctuations aid in lymphatic drainage.
Abdominal pressure increases as the diaphragm contracts, this helps to stabilise the lumbar spine. Increased abdominal pressure also assists in defecation, urination and vomiting.
Injury or disease to any of the muscles, nerves or organs that help us breathe or alterations to our posture (pregnancy/post-surgery/bodyweight fluctuations) can affect the diaphragms workload, strength, position and ability to function optimally. This can result in other muscles that assist breathing and spinal stability to work harder, creating increased tension around joints which can cause pain.
Treatment – Whilst providing hands-on treatment for my patients I often utilise muscle activation techniques, working alongside my patients, stretching their muscles in-between them breathing into their diaphragm. There are two main reasons for this:
1. Deep breathing increases the amount of oxygen within the body, creating a more relaxed state, this helps to reduce muscle tension and allows me to physically increase the stretch within their tight muscles.
2. Deep breathing utilising the diaphragm creates greater rib cage expansion, this naturally stretches muscles that attach to the ribs.
Rehabilitation – I regularly prescribe exercises and stretches to help my patients improve joint movement and reduce pain. Diaphragmic breathing whilst carrying out these stretches/movements, can make the exercises more effective by increasing the length of the muscle during each stretch. I also frequently encourage my patients to take up exercise classes that incorporate deep breathing techniques, such as yoga and Pilates, these type of classes can improve overall physical and mental wellbeing, reducing the probability of future muscle and joint problems.