Foundational Concepts For Pelvic Wellness: Diaphragmatic Breathing
Updated: May 3
Today I want to talk a little bit about what's called "diaphragmatic breathing." I chose this topic because no matter who I’m working with or what they come into rehab for – pelvic issues, urinary incontinence, postpartum, back, knee, or neck pain, I have them begin working on diaphragmatic breathing right at the start because it is foundational. In this post, I hone in on some of the things that I feel are most important for you to learn and understand to get the most benefit from practicing diaphragmatic breathing.
The "fight or flight."
A couple of things to keep in mind during the practice of diaphragmatic breathing. First, this method of breathing really does create a lot of physical movement in multiple areas of the body. The diaphragm muscle is attached to the ribs, helping to promote good mobility for all of the organs located in the abdominal cavity when expanded and contracted properly - this includes the pelvic floor.
Like many physical and anatomical movements, when you master this technique, it becomes very beneficial for your body's nervous system. Oftentimes we get “stuck” in this “fight or flight” loop where we are in a heightened and alert state. Our systems never truly reach the state of being calm. “Fight or flight” is important for survival and it is important for those moments when we need that extra adrenaline or push to negate bodily responsibilities so that you can focus on the things that are most important at that moment. Although “fight or flight” is critical, we don’t want to get stuck in that state where there is constant tension driving the nervous system.
This is when we bring it back and go into the breathwork we are talking about. If you are doing a lot of shallow breathing, which is what we tend to do when we feel in danger or excited, this tells the brain that there must be some sort of urgency going on. If you are constantly shallow, or upper chest breathing, you are not going to be getting the full expansion and relaxation of the diaphragm, leading to tightness of this structure. The diaphragm is just like any other muscle, we want to move it through its full range of motion. To do this, we must be intentional and work on that.
Let's "rest & digest."
So let’s talk about the things that are most important for you to focus on when you are trying to get diaphragmatic breathing done right. Nine times out of ten, when I have someone lay down at the clinic and say “show me how you breathe,” the first thing I see is that they pull up their chest to make room for their breath, and then as they exhale the chest will come back down. If you are breathing like that, chest rise and chest fall, you are not getting a lot of diaphragm movement. Start with focusing on your ribs. That’s the first cue – keep your chest down and breathe into the largest part of your ribs, where the biggest part of your lungs are living. With this practice, you are going to get the most efficient oxygen exchange right in the big part of your lungs. Focus on getting nice and big inhales, and slow and controlled exhales. Just by practicing this technique, you are going to tell your brain it is time to calm down and revert to “rest and digest,” or the parasympathetic response of your nervous system. You’re going to get better digestion, better sleep, have less inflammation, and so many things are going to improve if you can first take control of your breath. If you'd like to dive deeper into "breathing with a purpose" check out my previous post here to learn more about how breathwork is foundational in supporting our body's delicate systems.
One huge benefit of this "rest and digest" practice of diaphragmatic breathing is pain reduction. I have had people come to me with chronic pain they couldn’t seem to get under control. We work on breath work together at that initial visit and then I send them home to work on breath work for the next week on their own. More often than not, when they come back, they're reporting much less pain - and I didn't even touch them.
Find your position.
I like to have people try this practice of breathwork in different positions to see what is most comfortable for them. I sometimes like to have people work on diaphragmatic breathing in the seated position to start. One of the things I will have them do in this seated position is round their back just a little because it helps them to cue themselves where the top of the lungs are located. This position also helps prevent upper chest breathing because, with the shoulders forward and back a little rounded, the chest is kept down. So picture this: you are seated in a chair, back slightly rounded, shoulders slightly forward and hands relaxed on your thighs. You take a nice deep breath into the largest part of your ribs (raising the outside ribs like "bucket handles"), the biggest part of your lungs, and keeping your chest down. As you exhale, the “bucket handles” (or your side ribs) are going to come back down and that is going to help get the diaphragm involved, fully expanding on inhale and fully relaxing on exhale.
Try this: inhale for about 5-6 seconds and exhale for about 6 seconds. If you can emphasize the exhale to the point where you feel you can’t get any more air out of your lungs, that next inhale is going to be so much better and thus so much better movement for your diaphragm.
Hopefully, you can see that the focus here with diaphragmatic breathing is getting the full expansion of your ribs, lungs, some of the upper back, and a little bit of the tummy. This full expansion and then relaxation gives the abdominal organs a gentle massage and helps to reduce tension in the pelvic floor. Not to mention that diaphragm movement is almost always tied to pelvic floor dysfunction and should be addressed with anyone undergoing pelvic floor rehab. But again, this type of breathwork is foundational for any rehab diagnosis: neck pain, shoulder pain, back pain, knee pain, foot pain, etc.
So start with practicing this type of breathwork for 5 breaths at the start of your day, or 5 breaths right before you go to sleep. Start with small, intentional, achievable habits that will more likely carry over into daily practice. Give it a shot - you'll thank me later :)
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