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Take a breath! – The importance of the diaphragm and the benefits of diaphragmatic breathing

The diaphragm is a dome-shaped muscle that is situated below the lungs. Through its attachments to the sternum and lower ribs, the diaphragm serves as the primary muscle of respiration by changing the pressure within the chest cavity. Furthermore, due to its close relationship with the heart and visceral organs, as well as its attachments to the lumbar spine, the diaphragm also influences cardiac and autonomic function, as well as posture and lower back mechanics. This article aims to discuss some of the benefits of diaphragmatic breathing, as well as how to perform this exercise.

Diaphragmatic breathing is intended to optimize use of the diaphragm through prolonging and deepening respiration. The larger excursions of the diaphragm are suggested to have several cardiorespiratory benefits such as improving ventilation and gas exchange. Furthermore, through a phenomenon known as cardiorespiratory coupling – the relationship between heart rate, blood pressure and respiration – regular diaphragmatic breathing may positively influence blood pressure and facilitate venous return. (1,2)

In addition to its respiratory function, the diaphragm is also considered a deep stabilizer of the lumbar spine (3). This is evident in populations with low back pain as low back pain patients often present with altered breathing patterns. When compared to healthy individuals, patients with low back pain have been shown to have different positioning of the diaphragm within the trunk (4,5), reduced contractile strength and altered contractile patterns (5), smaller diaphragmatic excursion during respiration (4), as well as increased susceptibility to diaphragm fatigue (6). Diaphragmatic dysfunction may compromise other trunk muscles contributing to spinal stability and lead to the development, or recurrence, of low back pain (3,6).

Conversely, regular diaphragmatic breathing can lead to increased core muscle stability (7). Furthermore, slow, deep breathing has also been suggested to increase pain thresholds, reduce tension, anger and depressive feelings (8) as well as improve autonomic balance (9).

How to perform diaphragmatic breathing

At first, practice this breathing exercise for 5-10 minutes 3-4 times per day. Gradually increase the amount of time until you can perform 15-30 minutes consecutively.

1) Sit in a comfortable chair with your back supported and your shoulders and neck relaxed

2) Place one hand on your upper chest and the other on your stomach (just below your ribcage)

3) Slowly breathe in through your nose so that your stomach moves out against your hand

4) Gently tighten your stomach muscles as you exhale

5) Aim to complete 6-10 breaths per minute with your expiration lasting longer than your inspiration

By: Ryan Dewar

Resident Physiotherapist

If you have any questions on how to engage your diaphragm or incorporate diaphragmatic breathing into your daily routine, schedule an appointment with one of our physiotherapists by calling In-home Therapeutics at (343) 370-7393


1. B. & Zanier, E. 2013. Anatomic connections of the diaphragm: Influence of respiration on the body system. Journal of Multidisciplinary Healthcare 6 281-291. DOI: 10.2147.JMDH.S45443

2. Russo, M.A., Santarelli, D.M. & O’Rourke, D. 2017. The physiological effects of slow breathing in the healthy human. Breathe 13 (4). 298-309. DOI: 10.1183/20734735.009817.

3. Szczygiel., E., Blaut, J., Zielonka-Pycka, K., Tomaszewski, K., Golec, J., Czechowska, D., Maslon, A. & Golec, E. 2018. The impact of deep muscle training on the quality of posture and breathing. Journal of Motor Behavior 50 (2). 219-227. DOI: 10.1080/00222895.2017.1327413

4. Kolar, P., Sulc, J., Kyncl, M., Sanda, J., Cakrt, O., Andel, R., Kumagai, K., & Kobesova, A. 2012. Postural function of the diaphragm in persons with and without chronic low back pain. Journal of Orthopedic and Sports Physical Therapy 42 (4) 352-362. DOI: 10.2519/jospt.2012.3830

5. Vostatek, P., Novak, D., Rychnovsky, T. & Rychnovska, S. 2013. Diaphragm postural function analysis using magnetic resonance imaging. PLoS ONE 8 (3) e56724. DOI: 10.1371/journal.pone.0056724

6. Janssen, L., Brumagne, S., McConnell, A.K., Hermans, G., Troosters, T. & Gayan-Ramirez, G. 2013. Greater diaphragm fatigability in individuals with recurrent low back pain. Respiratory Physiology & Neurobiology 188. 119-123. DOI: 10.1016/j.resp.2013.05.028

7. Cavaggioni, L., Ongaro, L., Zannin, E., Iaia, F.M. & Alberti, G. 2015. Effects of different core exercises or respiratory parameters and abdominal strength. Journal of Physical Therapy Science 27 (10), 3249-3253. DOI: 10.1589/jpts.27.3249

8. Busch, V., Magerl, W., Kern, U., Haas, J., Hajak, G. & Eichhammer, P. 2012. The effect of deep and slow breathing on perception, autonomic activity and mood processing – An experimental study. Pain Medicine 13 215-228. DOI: 10.1111/j.1526-4637.2011.01243.x

9. Schmidt, J.E., Joyner, M.J., Carlson, C.R. & Hooten, W.M. 2013. Cardiac autonomic function associated with treatment adherence after a brief intervention in patients with chronic pain. Applied Psychophysiology and Biofeedback 38 193-201. DOI: 10.1007/s10484-013-9222-9

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