Diaphragmatic breathing has become a popular recommendation among Physical Therapists, Personal Trainers, Healthcare providers, and Fitness Instructors alike.  The connection between breathing dysfunction and the development or presence of low back pain has been found time and time again in multiple studies as well as the link between deep breathing and stress reduction by way of vagus nerve stimulation.  It is no wonder that ‘just take a deep breath’ is a phrase uttered by so many people throughout the day — it truly is medicine! 

As a Physical Therapist who specializes in pelvic health, I love teaching patients how to breathe for even more great benefits in addition to helping with low back pain and stress. Breathing strategies are great for reducing urinary urgency (it is a great urge control technique), helping with soft tissue mobility during pregnancy (meaning less low back pain during pregnancy and after), and regaining bladder and bowel control (less leakage all because of better breath control).  

The reason for this blog post though is that somewhere along the way of teaching diaphragmatic breathing, the message got translated into ‘belly breathing’ instead. What I see clinically is folks thinking they are performing diaphragmatic breathing, but instead filling their belly up as much as possible with little to no movement in their chest or ribs. While this is the right idea, it unfortunately only achieves some of the benefits of deep breathing. Worse yet, for people who have a diastasis recti, low back pain, pelvic pain, or mid back pain, it actually could be contributing to their problem rather than helping it. 

So let’s talk about how to do diaphragmatic breathing the correct way. First of all, instead of thinking about taking a diaphragmatic breath, think about taking a ‘360 Degree’ breath.  Let’s talk anatomy for a second: 

Your diaphragm (your breathing muscle) is a dome shaped muscle on the bottom of your rib cage underneath your lungs. When you take a deep breath in, your lungs expand and the diaphragm actively moves down toward your pelvis to make room for those lungs to take in all that air.  As your lungs expand, your ribs should move quite a lot! Your ribs are attached to your spine in the back and your sternum (chest bone) in the front. These little joints are meant to move with every single breath. This means with every breath your ribs are expanding outward in all directions like a bulging barrel.

When your diaphragm moves downward with your inhale, what also happens is the pressure increases in your abdomen, or belly. This is where ‘belly breathing’ came to be! Your belly should definitely rise when you inhale, but your soft sides below the level of your ribs should also expand as well as your low back. That’s a ‘360 Degree’ breath. 

Try a 360 Degree Breath: 

-Sitting or laying on your back, make a ‘C’ shape with your hands and place them on the sides of your lowest ribs. 

-Inhale and feel your chest and belly rise about equally. 

-You should feel pressure and expansion into the web space of your hands as well as pressure in your fingers in the front and your thumb towards your back. If you aren’t feeling this, keep trying to breathe into those areas and feel that expansion. 

-Exhale slowly and feel everything return to the starting position.

-Try to inhale for about 4 seconds if you can and pause for a half second at the end of your inhale without tensing your neck or shoulders. Exhale for as long as possible with the goal of about 7 seconds. 

Perform this type of breathing for just a few minutes each day. As I mentioned before it can help greatly with stress, low back pain, and various pelvic floor dysfunctions including urine leakage, pain with sex, prolapse, postpartum pain, and urinary urgency and frequency. ‘Just take a deep breath’ but let’s do it right!   

If you have lower back pain, pain with sex, pain with urination or urinary hesitancy, or any of the above symptoms mentioned in this blog post, then schedule time with a physical therapist. If you live in Oregon please call Life’s Work PT at 503 295 2585 or send us a message at info@lifesworkpt.com. For more information on how to find a good physical therapist in your area read our blog How to Find a Good PT or visit aaompt.org.

Resources

Anderson BE, Bliven KC. The use of breathing exercises in the treatment of chronic, nonspecific low back pain. Journal of sport rehabilitation. 2017 Sep;26(5):452-8.

Brown RP, Gerbarg PL. Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part I—Neurophysiologic Model. The Journal of Alternative and Complementary Medicine. 2005;11(1):189-201. doi:10.1089/acm.2005.11.189

Roussel et al., “Altered breathing patterns during lumbopelvic motor control tests in chronic low back pain: a case–control study”, European Spine Journal, 2009, 18.7: 1066-1073.

Smith, M.D., Russell, A., Hodges, P.W., 2006. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust. J. Physiother. 52 (1), 11–16.