Is your neck pain coming from your Diaphragm?

Our breathing habits affect a number of aspects of our body’s physiology and function. However, most of the time breathing is automatic and unconscious, going on in the background hundreds of times a day unnoticed.

Occasionally your attention is brought to your breathing such as lying in a yoga class and being asked to take a deep breath into your belly, or with an injury such as a fractured rib and you can barely gasp a breath without pain or wading into the cold ocean and suddenly you begin taking deeper breaths.

The diaphragm is a large muscle that sits deep in the torso separating the thorax from the abdomen and is the main muscle of respiration. It is shaped like a dome, attached to the internal surface of the lower 6 ribs and converging centrally deep in the middle to form the central tendon. Piercing the tendon are three openings for the oesophagus to the stomach, aorta and vena cava – large blood vessels to and from the lower body. Despite being in the middle of the body, the nerve that controls the contraction of the diaphragm originates in the neck from the cervical levels 3 to 5 called the phrenic nerve.

In normal respiration when you take an in breath the diaphragm contracts, flattens out and moves down towards the lower body increasing intra-abdominal pressure. This motion of the diaphragm has been described as being like that of a piston. As this happens the pelvic floor is meant to relax and lengthen, the lower abdominal muscle is meant to relax and expand slightly but the upper abdominals are meant to contract slightly. 

Diaphragm illustration

This all happens in coordination and outside our awareness assuming there has been no interruption to this pattern through previous injury or bad habits of posture and breathing, shock or trauma, holding patterns of clenching or gripping.
The out breath is a mostly passive motion. It is the relaxation and letting go and releasing of the diaphragm that causes it to move up to its lengthened ‘dome’ shape. At this point the transverse abdominals and pelvic floor should contract to help maintain some intra-abdominal pressure on the out breath. The ability of the diaphragm to move between the two phases of that of a dome and relatively flattened shape is important for a number of reasons.

Aside from maintaining breathing, the diaphragm helps maintain a negative pressure differential between the chest and abdomen which has quite a vital function in keeping the organs in the abdomen ‘sucked up’ against the diaphragm. Think organs like the liver, stomach, spleen among many. All our organs have a ligament or fascial* anchor which attaches them to some part of our bony structure but technically our organs don’t solely hang off them like pegs attached to a clothes line. It’s actually the presence of this negative pressure differential across the diaphragm that creates a suction effect that keeps the organs battling against gravity.

This pressure differential goes on to impact efficient fluid flow. This works through the suction effect of drawing the fluid back to the heart against gravity as fluid flows from high pressure (abdomen) to relatively low pressure (chest) and the diaphragm is the structure that allows this difference to exist. This applies to large blood vessels mentioned but also the return of lymph from the lower half of the body which again is important reducing congestion, clearing waste and keeping the tissues healthy.

Osteopathically treating the diaphragm is like treating the pelvis, it is so central and a part of how we work with you no matter what you present with. We can go direct or indirect, can get in under the front of the rib-cage and do a direct release without fingers to a more direct fascial* unwind; following for ease and motion. The end goal is to increase the range of the expansion/ contraction and release/ relaxation to help not only with respiration which affect energy levels, nervous system regulation (rest and digest), but also the fluid flow effect that occurs across the pressure differential above and below this structure as well as keeping the lower thoracic spine and rib-cage mobile.

So as you sit here place on hand on you chest, one on your abdomen, take awareness to your pelvic floor and as you breath in visualise your diaphragm contracting, flattening, pushing down and as this happens relax your pelvic floor imagine it is also moving down (a relaxed state) and you feel your lower abdominal muscles expand.

As you breathe out, notice your diaphragm relax and here you can contract your pelvic floor slightly up towards your abdomen along with slightly contracting across the lower abdomen – to bring your attention to this region.

Repeat for 4-6 breath cycles. This is basic breath awareness that you can bring into your day at any time. Bring your awareness to your neck that midsection, C 3, 4, 5 remembering that phrenic nerve that begins here and how breathing is from neck to pelvis.

Good breathing habits and an elastic resilient diaphragm not only keeps mid back pain and stiffness managed, it has a vital role to play in abdominal organ position, efficient lymphatic drainage and optimal pelvic floor function.

*Fascia refers to the connective tissue structure primarily composed of collagen that is invested in and around everything throughout the body.