Low Back Pain Causes Part 2: Core stability and the diaphragm
Last week we focused on the concept of spinal stability as an integral component to improved spinal function and reduced injury. Today, I will discuss another culprit that decreases spinal stability; the diaphragm. This muscle attaches at the thoracolumbar junction, and extends across the bottom of the rib cage. It separates the thoracic and abdominal cavities and is commonly responsible for expanding initiating inspiration by expanding the lungs.
The diaphragm also has a role in postural function. This is due to the fact that the contraction of the diaphragm increases intra-abdominal pressure (IAP) in a hydraulic manner.[i] Think of your core as a closed pop can. The pressure in the can keeps the can stiff, but once you open it, the can is easily bent. The diaphragm is similar to the top of the pop can. When working properly, it keeps the pressure in the abdomen and allows the core to remain stable. When dysfunctional, it may be a weak link in the core and can lead to compromised stability. There is also evidence that the diaphragm is dysfunctional in chronic low back pain patients, compared to healthy individuals.[ii] Thus this muscle is a clear contributor to low back disorders and should be addressed for proper recovery.
So lets go over how you can check your diaphragm function. First get in front of a mirror and keep an eye on your shoulders. Next take 10 normal breaths. If your shoulders elevated towards your ears with each breath, then it signifies that your diaphragm is NOT doing its job. If you want an indication on how you should be breathing, just watch an infant breathe. Their abdomens move up and down effortlessly and their diaphragm is doing all the work.
To help fix this issue, there are a couple exercises you can do to retrain yourself to breath properly. The first exercise is done lying on your back with your knees bent. Place one hand on your chest and the other on your lower abdomen. When you breathe in, focus on breathing into the lower hand. The hand on the chest should not move during the inspiration. This is by no means an easy task, especially if this has been dysfunctional for a long time. One trick that helps is to imagine you are inflating your abdomen like a balloon with your inspiration. Once you can do this with consistency, you may progress to performing the same exercise while sitting and standing. This is more difficult and will some repetition and practice. It is also important to break the habit of breathing incorrectly. One trick that has helped my patients, is to get a pack of yellow stickers and place them on the 10 most common things you look at each day (ie. Rear view mirror, cell phone, TV, etc). Use the sticker as a reminder to check your breathing and catch yourself breathing incorrectly. Within a few weeks, this will help you improve your breathing patterns.
Check out the video below
[i] Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):352-62. doi: 10.2519/jospt.2012.3830. Epub 2011 Dec 21. PubMed PMID: 22236541.
[ii] Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV, Kriz J, Kobesova A. Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment. J Appl Physiol (1985). 2010 Oct;109(4):1064-71. doi: 10.1152/japplphysiol.01216.2009. Epub 2010 Aug 12. PubMed PMID: 20705944.
Dr. Mike Rumeo is chiropractor with a passion for improving the health of his community and pain management. He primarily utilizes chiropractic, medical acupuncture and rehabilitation to help his patients. He is the owner of the Oakville Optihealth Clinic, a multidisciplinary clinic located at Fourth Line and South Service Rd W, in Oavkville ON. To contact Dr. Rumeo, please email him at email@example.com or call at 905.465.0202.