I recently had a new patient who was coming in for chronic back pain. I was quite surprised when I evaluated her and noticed that she had really good posture: her shoulders and hips were level, her head was not jutting forward, there was no evidence of any weakness and she was pretty well balanced overall. She has a job that requires that she sits 8-12 hours per day. She sits with a back support. Yet she has daily lower back pain. I looked at her muscle lengths and she did indeed have tight back muscles. Still – why? There was no history of trauma or any other evidence of an inflammatory condition or problems with the kidneys. Then I asked her to take a deep breath. Her belly tightened, her shoulders rode up toward her ears and her ribcage only expanded to about 1 inch (1.5-2 inches is optimal). Now I saw her problem – her diaphragm.
Everyone knows that the diaphragm is a “breathing muscle”, but many do not know that the diaphragm is a postural muscle as well. In fact, the diaphragm actually attaches into the spine right where the low back begins. The “bellows” action of the diaphragm not only allows air to enter the lungs, it also massages the abdominal organs and aids with blood flow. It also helps with keeping the proper “tension” in the abdominal cavity. And importantly, the diaphragm is part of the body’s “core” which protects the lower back.
When I mention the “core” muscles, my patients automatically think they need to do more crunches. Crunches only train the outer abdominal muscles (and hip flexors if you do them wrong). If the outer abdominal muscles are too tight, it inhibits the deeper core muscles, so doing lots of crunches is actually counterproductive in core training. Really tight abdominal muscles will also restrict breathing weakening the diaphragm muscle which IS a core muscle.
When you breath, the belly and the lower ribcage should expand, the shoulders should be relaxed and the upper chest only move at the end of a deep inspiration. My patient had what I call a “stress breathing pattern” which places a lot of stress on the shoulders, neck and upper ribs. Also, with this type of breathing pattern, less oxygen is taken in and body becomes more acidic as carbon dioxide builds up. When the body is more acidic it becomes more inflamed and muscles become irritated. The most important thing I could do for my patient is to teach her how to breath properly.
Do yourself a favor and make sure that improper breathing is not causing extra tension and pain in the back. Put your hand on your breastbone and one just below your belly button. Take a deep breath. The lower hand should move first and the upper hand should barely move. The upper shoulders should not move at all. If you find you are using your shoulders to breath, then you are susceptible to neck, shoulder and back pain.
To correct this, think of your belly as a balloon you need to fill up and concentrate on not moving your chest or shoulders as you breathe. Do deep breathing exercises regularly.