Diaphragm and Back related painsThe diaphragm is the primary muscle used in the process of inspiration, or inhalation. It is a dome-shaped sheet of muscle that is inserted into the lower ribs. Lying at the base of the thorax (chest), it separates the abdominal cavity from the thoracic cavity.

The Diaphragm has attachments to both Thoracic (T7-T12) and Lumbar (L1-L3) vertebrae and also attaches to the inner xiphoid process (lower sternum). Therefore it’s not rocket science that if the diaphragm becomes dysfunctional then this can have a great effect on back pain.

When we breathe we never really think about it as an exercise as we just automatically do it, we would never even think that we could breathe incorrectly, I mean it’s just taking air in and out right? What we don’t understand is that breathing is both an autonomic response to living and also a key player in neck, upper / lower back and even hip related pains. That’s right, with breathing dysfunction it can basically affect the whole spine and therefore the muscle structures surrounding it.

Myers discovered several connections that can influence the body when we have dysfunction in the diaphragm, with separate attachments of the crus tendon on both right and left side L1 L2, this means they can act independently of each other and bring issues separately or together. The crus tendon attaches fascially to the anterior longitudinal ligament, it also shares attachments with quadratus lumborum, psoas major and has nerve roots innervated by C3-C5 in the cervical spine. As well as musculoskeletal attachments the diaphragm shares connections with kidneys liver and can affect the adrenal glands and even digestion. That’s a whole lot more than just something to take air in and out the body, in fact it seems like breathing dysfunction can pretty much have an effect on the whole body.

Breathing is automatically driven by our nervous system and like any system this can become lazy, injured or adapt to its environment. When we bend to pick something up we need adequate lumbar stability to prevent injury, therefore the diaphragm will exert an upward tension while the psoas major exerts a downward force, this is a balance between static and dynamic restraints driven by a co-contraction of small segmental stabilisers and large abdominal musculature. If our diaphragm is not functioning properly our body will then pressure the other musculature making them work harder which in turn can lead to a less stable environment, which over time can lead to dysfunction and or pain.

Our bodies almost always naturally adapt to our environments, in cases of lower back pain we can easily see altered stability and mobility of the diaphragm. When diaphragmatic contraction decreases, the crus tendon can increase in tension, due to its attachment’s this can result in an increased tension and reduced motion around lumbar segments (L1-L3), with this restraint the lower segments (L4-L5) will become hypermobile and therefore less stable, to prevent anterior glide of these segments the nervous system will shorten the illio-lumbar ligaments and therefore restrict motion at sacroiliac joints (SIJ). The end result is a partially fixated and dynamically unstable lumbar spine, increasing likelihood of pain in these areas due to increased load and movement dysfunction.

How can we help? Our therapists are educated in certain release techniques such as a diaphragm pull or release from under the rib cage. We can also educate our patients on correct breathing habits ; in conjunction with manual manipulation of the spine, we can reset and relearn certain poor habits and replace them with better ones that alleviate and avoid pain. Sometimes the smallest things make the biggest change. Overall, you can expect a reduction in neck, mid-back and low-back pain as well as improved performance whether in sports or in life.

Paul Morana


  1. Dan says:


    Could this be the cause of my SI joint & thoracic back pain?

    • Michael says:

      Hi Dan,

      Each individual is unique and we would have to evaluate you to determine the cause of your pain, but if your diaphragm doesn’t function properly it can refer pain to the lower thoracics or cause more apical breathing which results in increased neck pain.

      Healthiest Regards

  2. Tim armstrong says:

    Hi there. A chiropractor did a diaphragm release with me. After doing it a couple times I developed pain in the abdominal muscle along the rub line on one side where the release took place and it’s caused a number of issues including muscle loss and pain. Is it possible the so called release did this as it follows.the exact line she took.cheers

    • Michael says:

      Hello Tim,
      Many thanks for your comment.
      We have never heard of this happening. Diaphragm releases are supposed to be conservative and no muscle loss should ever occur from simple release because there is no trauma to any nerve supply. In that case, please follow up with another specialist to understand why there is residual pain.
      Wishing you all the best 🙂

  3. miles price says:

    Hi there,
    I had chiropractor do a diaphragm release with me about 4 weeks ago, it was tight she said, and the treatment was pressing hard under my ribs on both left and right sides and it was painful. within 48 hours, I started developing breathing problems. I was getting short of breath, like I couldn’t take a deep breath, this developed into anxiety which I now have a problem with. Have you had any cases like this, I’m struggling to resolve this issue, and my chiropractor doesn’t have any answer to help me with.
    many thanks

    • Michael says:

      Hello 🙂
      Many chiropractors perform a diaphragm release but this is just like stretching a muscle. We have never heard of a patient struggling with difficulty breathing after or anxiety! This is a first!! Please don’t worry! Focus on mobilizing the mid back and performing many extension stretches and work with your breathing patterns to help release this! Wishing you were closer to visit us!

  4. Aru says:

    Hi. I sometimes develop a squeezing pain below the chest that feels like going out from the back. It generally gets over in 15-20 mins and sometimes more. After reading your article I tried long inhalation and exhalation that provided me some relief but still unsure of the cause. Can you tell what this situation is and how can i get it tested?

    • Michael says:

      We cannot diagnose a condition over the internet, but your symptoms sound characteristic of a possible rib joint fixation or irritation of the joint or intercostal muscles. We recommend visiting a practitioner for proper assessment, diagnosis and treatment. It may require fascial therapy or mobilization depending on the case.

  5. Michelle says:

    Hi, I see you are in Dubai. Do you know of any doctors or specialists I could contact in South Africa? I have been experiencing middle back pain as well as as spasm just under my rib cage ever since my pregnancy four years ago! I have been to numerous doctors ranging from physios to chiros, accupuncturists, biokineticsts and even an osteapath and just today a pilates instructor pointed out to me it might be my diaphragm rather that my back, and having read this article, this started to make sense to me. How do I get treatment? I have been in pain every single day for the last 4 years. I would appreciate any feedback you could provide me. Thanks in advance.

  6. Janet Powers says:

    Do you have an article on strengthening our breathing? I am having pain around the center of my rib cage (front and back) as well as tightness in my diaphram. I’m wondering if breathing exercises will help after reading this article. Thanks for your input.

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