The Forgotten Diaphragm Muscle


With anywhere from 656-850 different muscles in the body, depending on who you ask and what exactly constitutes muscle, you would think we as licensed medical professionals would have a solid idea how to strengthen and stretch all of them, right? Wrong! There was actually very little in my Physical Therapy curriculum on advanced strengthening and stretching of the diaphragm. Just ask your PT if he or she knows how to eccentrically contract the diaphragm. You’ll likely to be greeted with a blank stare, followed by some medical jargon of why that isn’t really what the diaphragm does.

For 27 years, I’ve been able to improve some diaphragm function with specific myofascial techniques and those techniques were tremendously helpful, but they are not the whole picture. It was only through my own experience with 3 bouts of severe lower back pain and my continued journey into Yoga Therapy that I really began to understand the vital importance of conditioning the diaphragm. One morning I awoke unable to even shift in the bed. I couldn’t stand, let alone walk. I managed to get myself to the floor to a seated position (as comfortable as I could) and I started to breath deeply, first with the Dirgha breath I had learned, then layering on the Ujaii sound. I felt better so I added a few rounds of Kapalabhati. I then started playing with Agni Sara, a very advanced Yogic breathing exercise to strengthen and stretch the diaphragm. After 4 rounds, I found that I could move more freely and I felt more relaxed. The breath work had brought me to a place where I could begin to move. All I did was to get breath moving in my back!  To really understand the diaphragm and why it’s so important for the health of your lower back as well as blood pressure health, digestive health and healthy venous blood and lymph return from the legs, we must understand the anatomy.


The large dome-shaped muscle inside and under the rib cage is the diaphragm. You can clearly visualize the extensive connections and I’m truly grateful for The Daily Bandha for their incredible 3D images ( The diaphragm separates the heart and lungs from the abdominal organs. In other words, it keeps your Thanksgiving dinner from encroaching on your vital organs. When you inhale, the diaphragm contracts via a central tendon and the belly EXPANDS because it pushes on the abdominal contents. You exhale and it goes back to its nice resting position under the rib cage. That is with a normal breathing pattern. Unfortunately many of us have a REVERSE breathing pattern because we live in a society that values sucking in the gut by tightening the abdominal muscles. When the abdominals are tight the diaphragm cannot contract fully, hence you can only utilize about 40% of your lung volume. Everyone wants to strengthen the abdominals and yet we do nothing for the Diaphragm! Add to this problem, over eating, tight clothing, girdles, and Spanx, which further restrict diaphragm mobility, and my stomach gets tied up in knots just thinking about the restrictions.

The diaphragm can and almost always does have both strength and length imbalances.

The diaphragm arises on each side, between the twelfth rib and the body of L2 from the fascia which overlays two biggest muscular culprits in lower back pain, the quadratus Lumborum and the Psoas Major. They are the most dysfunctional muscles I see in both Physical Therapy and Yoga Therapy.

Three very important structures pass through the diaphragm: the esophagus, the inferior Vena cava (which is resposible for the venous return of all the de-oxygenated blood from the lower half of the body) and the descending aorta. Now your gut must really be tied up in knots! Hiatal hernias, hypertension and venous stasis with poor lymphatic flow all are impacted by a tight diaphragm compressing these structures.


Take a good look at the myofascial connections from your diaphragm to Psoas, Quadratus Lumborum and Iliacus. Having someone work on your psoas without addressing proper diaphragm mobility is like leaving out the chocolate chips in the Chocolate Chip cookie recipe! The results will be…well…rather bland. Ask your Yoga Therapist to show you easy and then progressing to more advanced methods of breathing to strengthen and lengthen the diaphragm muscle. Only a trained Yoga Therapist (RYT500) will be able to educate you on the precautions and contraindications, how to modify for the beginning practitioner as well as how much and how often to perform such breath work. Reverse patterns and old habits are hard to break. A few professional sessions, spaced far apart so you have time to integrate and practice will have you breathing your way to better health quite rapidly.

The benefits of good diaphragm mobility and in particular the practice of Agni Sara are outlined well in this wonderful Yoga International article.

Increasing the physical strength of the diaphragm leads to more vigorous energy, which in turn nourishes a balanced and steady mind. The following medical research outlines the objective findings in diaphragm strength in persons with and without chronic lower back pain. The results showed quite clearly less diaphragm mobility and abnormal shape in the Chronic Low Back pain group.

Here’s to breathing your way to better health!



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About No Boundaries Yoga Therapy

LISA Z. HUGHES, BS, PT, C-IAYT, Certified GYROTONIC Instructor, CPI Lisa Hughes is a licensed Physical Therapist, having received her degree from Northeastern University in Boston, MA. She is an Internationally Certified Yoga Therapist through the International Association Of Yoga Therapists. In 2014, Lisa completed her Yoga Therapy training through the Pranakriya School of Yoga Healing Arts under the direction and tutelage of Yoganand Michael Carroll, E-RYT500, Dean of The Kripalu School of Yoga and Marlysa Sullivan, MPT, E-RYT500, Director of The Center for Integrative Yoga Studies in Atlanta. She is the owner of No Boundaries Yoga Therapy, LLC in Alpharetta, GA., where she sees private clients for Yoga Therapy. In 2015, Lisa founded an Adaptive Yoga class for students with Spinal Cord Injury and other neurological deficits. She has taught "Adapting Yoga for Disability" for Doctoral Physical Therapy students at Emory University and regularly assists Yoga Teachers in opening yoga to all students. Lisa has thirty years of clinical experience as Licensed Physical Therapist, specializing in pain science, sports medicine, and rehabilitation medicine. While working with the head of the American College of Sports Medicine at the Sports Medicine Clinic in Children’s Hospital Boston, Lisa has rehabilitated professional football players from the New England Patriots and Cincinnati Bengals, dancers from the Boston Ballet Company, and many elite level gymnasts, runners and cyclists. She has worked with cancer survivors as well as organ transplant recipients and specializes in adapting Yoga for all disability and for the medically fragile. Lisa treats the whole client, integrating the traditional Physical Therapy modalities of neurophysiological manipulation and myofascial release with the ancient healing tools of Yoga Therapy for clients with chronic medical conditions, the medically fragile and the able-bodied new student. It is her vision to open Yoga to every body, regardless of age or medical condition. Lisa is married and has three children. In her free time, she is dedicated to a zerowaste lifestyle and educating others in living sustainably. She is avid hiker, wilderness adventurist and practices Yoga and Meditation daily. She is a volunteer with the Paralyzed Veterans of America and the Challenged Athletes Foundation (, whose mission it is to provide opportunities and support to people with disabilities so they can pursue active lifestyles through physical fitness and competitive athletics.

2 responses to “The Forgotten Diaphragm Muscle”

  1. Mrs Finkling says :

    awesome – super informative post – thank you!

    • No Boundaries Yoga Therapy says :

      You are so very welcome Mrs. Finkiling! I enjoy helping people understand their bodies. We are so blessed to be able to carry around this body, this container for our emotions and our aliveness in order to walk in this world, We should understand it well.

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