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  • Priti Prabhu, BPT, MSPT

The Diaphragm: An often neglected Superstar for core and spinal stability for seniors


(An article contributed to Capital City Nurses for their newsletter and blog)

In spite of the Diaphragm being one of the most important muscles in our body, it is often neglected and at times added to our exercise program as an afterthought.

Diaphragm is a large dome shaped muscle that completely separates the thoracic cavity (heart and lungs) from the abdominal cavity. It is attached to the sternum, the lower 6 ribs, and the top 2 to 3 lumbar vertebra.

The Diaphragm is one of the 4 deep stabilizers of the spine along with the pelvic floor, Transversus Abdominis (deep abdominal muscle) (TA), and the multifidus (back extensors).

The contraction of the diaphragm causes pressure changes in both the cavities. When the diaphragm contracts, it moves down into the abdominal cavity. This creates an increased intra-abdominal pressure (IAP) which is countered by the resistance of the pelvic floor on the bottom, the TA in the front and the multifidus in the back- thus stabilizing the spine. “Without proper diaphragm contraction the increased IAP will not reach all the way down to the lower lumbar spine, where the loading is most prominent” (Hans Lindgren, 2011).

Our trunk can be compared to a soda can to understand how the diaphragm contributes to spinal stability. A soda can by itself is not strong, what makes it strong is the simple physics of pressure. It is not possible to smash a soda can when it is full and unopened because of the positive pressure from inside being exerted on the atmospheric pressure and gravity. However, once you pop the can open, it is easy to crush the can. “The skeletal support of the trunk is not inherently strong. The trunk of the body uses a concept similar to the soda can to prevent being “smashed” by external forces”. The 4 deep core muscles, diaphragm, pelvic floor, TA and back extensors (multifidus) help to increase and provide positive intra-abdominal pressure to stabilize the spine and counter the compressive forces of gravity, (Massery 2012).

Conclusion

  • Core stabilization starts with the proper function and activation of the diaphragm.

  • It is necessary to strengthen all the 4 deep core muscles – Diaphragm, TA, pelvic floor and multifidus to allow the diaphragm to support the simultaneous needs of respiration and trunk stabilization.

  • Without the regular pressure changes within the thorax and abdomen provided by the diaphragm- hypotension, constipation, ineffective bladder drainage, and poor respiratory function can result (Massery 2012)

  • Proper functioning diaphragm is necessary for better posture, better balance, decreased low back pain, spinal mobility, and overall improved function and performance.

  • The effects of aging, shallow breathing and disease may negatively impact your ability to use your diaphragm and cause dysfunctional breathing patterns.

  • Dysfunctional breathing patterns are a common contributing factor for stiffness and pain in the neck, low-back and it is often a strong predictor of back pain (Smith et al 2006).

Refer to this link for an example of a Diaphragmatic breathing exercise.

To learn more or to work on your diaphragm, contact Mobility & More Inc. to have an in-home customized fitness program or physical therapy session.

Bordoni B, Zanier E (2013) Anatomic connections of the diaphragm: Influence of respiration on the body system. Journal of Multidisciplinary Healthcare. 6;281-291

Courtney Rosalba (2009) the Function of Breathing and It’s Dysfunction and their Relationship to Breathing Therapy. International Journal of Osteopathic Medicine. 12; 78-85

Massery M (2012 Multisystem clinical implications of impaired breathing mechanics and postural control. In: Frownfelter D, Dean E, eds. Cardiovascular and Pulmonary Physical therapy: Evidence to Practice. 5ed. St, Louis, MO: Elsevier-Mosby

Smith MD, Russell A, Hodges PW. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust J Physiotherapy 2006; 52;11-16


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