Are you sitting down? Good. Now, take a deep breath.
No, I’m not preparing you for bad news — I’m inviting you to explore the movement of your own diaphragm (Figure 1).
First, slouch down and lean forward a little (Figure 2), as if you’re furiously typing away on a laptop. Do you feel how that position can immobilize your diaphragm, crowd your solar plexus, compress your abdomen, and make your breath shallower?
Then, try the opposite: sit up, with your pelvis under you on your seat, and your feet on the floor. Let your shoulders relax, and breathe into your entire torso. Compare those sensations to breathing with a crowded midsection. When our diaphragm is free to move, our unrestricted breath billows in and out, rising and falling like gentle ocean waves.
Now, put your hands on your costal arch for your next few breaths. Feel how the ribcage expands and contracts. Imagine the diaphragm, attached all around the lower rim of the bell-like ribcage, moving up and down inside. The diaphragm opens and closes like a slow-motion umbrella (Figures 3 and 4). As you inhale, the diaphragm contracts, and the umbrella flattens, widens, and moves downward. As you exhale, the diaphragm relaxes, and the umbrella narrows and moves upward into a high dome. Feel this for a few breaths: diaphragm contracting downwards with inhalation; relaxing upwards with your exhalation.
Lastly, compare the front and back of your diaphragm. If you allow your belly to move while you inhale, you’ll feel more activity in the front of your diaphragm. Can you do the same with your back? Imagine the posterior, back part of your diaphragm expanding in the same way. As Ashtanga Vinyasa yoga teacher Richard Freeman says, [you] can let your kidneys be like miniature wings, expanding and contracting with the breath [endnote 1].
Put one hand behind you, if it’s hard to feel your breath in this area from the inside out.
Besides its central role in breathing, the diaphragm can contribute to lumbar and low back pain (Figure 5). As the largest spinal muscle, the diaphragm attaches to the anterior side of the upper three lumbars through its tendinous crura (or “legs”), and along the shafts of the twelfth ribs in the small of the back. Teaching your clients to find and use the posterior part of the diaphragm when breathing helps refine interoception and proprioception in an area that is often stiff, immobile and troublesome.
Costal Arch/Diaphragm Myofascial Technique
The respiratory diaphragm’s attachments are deep inside the costal arch. Since the diaphragm wraps around the liver, stomach, pancreas, and spleen, its close relationship with these delicate structures makes direct manipulation of the diaphragm inadvisable without specialized in-person training. The liver in particular is vulnerable to bruising or tissue damage; its tissues are so delicate that surgeons removing a lobe of the liver can simply pinch portions of it off with their fingers. [endnote 2]
Instead of digging under the ribs for the diaphragm, you can safely use the bony edge of the costal arch to open up the umbrella of the diaphragm in a very effective way, without endangering the fragile viscera that the diaphragm surrounds.
Begin the technique by standing at your supine client’s side, at the level of their hips. Palpate the edge of the costal arch on the opposite side of the body (Figure 6). Don’t attempt to go under the edge of the costal arch where the diaphragm’s actual attachments are. Instead, stay on the bony lower (inferomedial) edge of the costal arch, using a broad, firm, but soft touch to apply gently outward (superolateral) pressure to the very rim of the ribcage. Some people’s costal arch is very narrow here; if this is the case, use caution around the sensitive xiphoid process at the end of the sternum.
By reaching across to work the opposite side of your client’s body, the angle of your pressure encourages the lower ribs to widen laterally. Wait for your client’s breath; on their inhalation, follow the natural widening of the ribcage in order to open and slightly flattening the dome-shaped diaphragm.
Then, when exhalation begins, use your soft but firm touch to hold the costal arch in this widened position, against the pull of the diaphragm from inside. This gently stretches the diaphragm wider as you resist the attempted narrowing of the lower ribcage with exhalation. Feel for the stretch of the diaphragm pulling back at you from inside. By sensitively softly resisting the diaphragm’s narrowing on the exhale, we show the diaphragm what it’s like to open a little more with each breath. Repeat this in several places along the costal arch, making sure your touch is comfortable to the client. Any discomfort is a sign that you need to use a different depth or placement. Repeat on the opposite side (Figure 7).
Working the diaphragm in this way is an extremely effective way to increase both mobility and proprioception, while being non-invasive and comfortable.
Does the Diaphragm Stabilize the Core?
Do we want the diaphragm to relax, or tighten? Doesn’t a soft “core” contribute to back pain? It’s true that contraction of the diaphragm can contribute, at least temporarily, to lumbar stability by acting as a lid on the “core” abdominal space. An example of this is the Valsalva maneuver, where forced exhalation is pressed against a closed airway. This technique is used (both intentionally and unintentionally) by weightlifters to add additional support during a heavy lift by increasing intra-abdominal pressure, which temporarily stiffens the lumbar segment. Electromyographic studies show the diaphragm also contracts to support shoulder movements [endnote 3], and [in] its central position in the body, it likely acts as a stabilizer in many other motions as well.
However, since we can’t hold our breath all the time, some writers argue that asking the diaphragm to constantly act as a core stabilizer inhibits the responsiveness and flexibility needed in its role as a continually expanding and contracting structure. [endnote 4]. A diaphragm that lacks movement flexibility is not an asset — think of hiccups, or even worse, the immobility of having the wind knocked out of you. Both are examples of the diaphragm in a spasm of contraction. By contrast, a flexible, responsive diaphragm allows the breath to move freely and fully. Increased mobility and proprioception (our twin goals of the Myofascial Techniques approach) allow the diaphragm to more fully respond to the changing demands placed on it: stability and strength at those moments when they are needed, and flexibility and adaptability as its resting state.
Excerpted and adapted with permission from Volume 2 of Advanced Myofascial Techniques (Handspring, 2016).
About the Author
Til Luchau is a Certified Advanced Rolfer and a member of the Advanced-Trainings.com faculty, which offers online learning and in-person seminars throughout the U.S. and abroad. He is a regular contributor to MASSAGE Magazine and is also a MASSAGE Magazine All-Star (massagemag.com/all-stars). He invites questions or comments via firstname.lastname@example.org or @TilLuchau on Facebook, Twitter or Instagram.
Figure 1 The diaphragm attaches all along the lower rim of the bell-like ribcage, as well as to the front of lumbar vertebra 1-3.
Figure 2 Compression and crowding of the anterior diaphragm and the midsection of the thorax.
Figures 6.3 and 6.4 The diaphragm opens and closes with respiration, flattening and widening on inhalation, raising and narrowing with exhalation.
Figure 5 The diaphragm can be involved in low back pain through its direct effects on the lumbars, as well as its role as an antagonist to quadratus lumborum at the twelfth rib.
Figures 6 and 7 In the Diaphragm/Costal Arch Technique, we avoid endangering the delicate viscera by working solely with the bony rim of the costal arch, rather than trying to touch the diaphragm’s attachments inside the ribcage. Work across the body, following the costal arch as it widens inhalation, then maintaining that width with gentle pressure as exhaling stretches the diaphragm.
Figure 8: The movement of the diaphragm in breathing can
be much like the undulating opening and closing of a jellyfish.