Diaphragmatic Function and Musculoskeletal Pain Management

The diaphragm is central to respiration but also contributes to spinal stability, posture and pain modulation. Its coordinated contraction increases intra-abdominal pressure, supporting the lumbar spine during movement and reducing load on paraspinal structures. In conditions such as chronic low back pain and neck pain, diaphragm dysfunction manifests as reduced thickness, impaired excursion and altered breathing patterns. Restoration of diaphragmatic function through targeted exercises, manual therapy and biofeedback has been shown to improve core stability, diminish central sensitisation and enhance both static and dynamic balance. Interventions range from hypopressive abdominal gymnastics and inspiratory muscle training to stretching techniques and electrical stimulation, all aiming to normalise respiratory mechanics, re-educate deep stabilising muscles and alleviate musculoskeletal pain. This integrated approach emphasises the diaphragm’s dual respiratory and postural roles, offering global significance for athletic rehabilitation, postoperative recovery and management of chronic spinal disorders.

Research from Nature Portfolio

Recent studies have explored how variations in breathing patterns and posture influence abdominal muscle activation and intra-abdominal pressure. A cross-sectional comparison of tasks such as forced expiration and exertional inspiration in plank and supine postures revealed significant interactions between breathing phase, posture and activation of the transverse abdominis-internal oblique and external oblique muscles. Forced expiration in supine and exertional inspiration in plank positions produced the highest muscle activation, while intra-abdominal pressure peaked during maximal expiratory efforts. These findings elucidate the biomechanical underpinnings of diaphragm-centric stabilisation, informing exercise prescription for both healthy individuals and those with core dysfunction.

Diaphragmatic Function and Musculoskeletal Pain Management publication trend

The graph below shows the total number of articles in diaphragmatic function and musculoskeletal pain management across all publications each year (not limited to Nature Index journals).

Technical terms

Diaphragmatic excursion: The amplitude of diaphragm movement during respiration.

Intra-abdominal pressure (IAP): The pressure within the abdominal cavity generated by muscle contraction.

Inspiratory muscle training (IMT): A regimen of resisted breathing exercises to strengthen the muscles of inhalation.

Static stability: The ability to maintain equilibrium and control of the spine without movement.

Dynamic balance: The capacity to maintain postural control during movement or changing conditions.

References

1. The Main Role of Diaphragm Muscle as a Mechanism of Hypopressive Abdominal Gymnastics to Improve Non-Specific Chronic Low Back Pain: A Randomized Controlled Trial. Journal of Clinical Medicine (2021).
2. Effects of diaphragm stretching on posterior chain muscle kinematics and rib cage and abdominal excursion: a randomized controlled trial. Brazilian Journal of Physical Therapy (2016).
3. Interaction of breathing pattern and posture on abdominal muscle activation and intra-abdominal pressure in healthy individuals: a comparative cross-sectional study. Scientific Reports (2023).
4. Effects of combining diaphragm training with electrical stimulation on pain, function, and balance in athletes with chronic low back pain: a randomized clinical trial. BMC Sports Science, Medicine and Rehabilitation (2021).
5. Effectiveness of Ultrasonography Visual Biofeedback of the Diaphragm in Conjunction with Inspiratory Muscle Training on Muscle Thickness, Respiratory Pressures, Pain, Disability, Quality of Life and Pulmonary Function in Athletes with Non-Specific Low Back Pain: A Randomized Clinical Trial. Journal of Clinical Medicine (2022).