Diaphragm Details That Unlock Thoracic Mobility
In this week’s episode of the Unreal Results Podcast, I talk about the often-overlooked role of the diaphragm. I bring this topic up because I see it often in my NFL athletes around this point in their season and how diaphragm stiffness starts to affect their performance. In the episode, you’ll hear me talk about diaphragm anatomy and function, how stiffness of the diaphragm can lead to limited thoracic mobility and pain, and give you practical exercises that I use with my athletes to improve their diaphragm mobility. Regardless if you work with athletes or not, this episode can give you a lot of insight on understanding and treating the diaphragm if you think it’s contributing to your client’s thoracic spine or T6 costovertebral joint pain.
Resources Mentioned In This Episode
Episode 48: Small Intestine and Mesenteric Roots
Video: Prone Breathing w/ Coregeous Ball
Video: Diaphragmatic Breathing / Vacuum
Video: DaVinci Rolling
Video: Segmental Bridge
Learn the LTAP™ In-Person in one of my upcoming courses
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello, hello, welcome back to another episode of the unreal results podcast. I Am alive still I mean you heard from me last week a couple times, but if you're watching on YouTube My eyes should look very different I Still am NOT 100 percent But I am fully over the old adenovirus conjunctivitis. So that's great.
I no longer have any pink in my eyes, on my eyes, in my eyes, around my eyes. I'm still a little swollen, still a little painful, still very dry eye, so I still don't have my vision back. But, improvement. So much improvement. So every day there's a little bit more improvement and I will take that because for a long time during the Pink Eye Chronicles it really felt like I was never going to get better.
So it's day, uh, I don't even know, 26, I believe, of the Pink Eye Chronicles. So, um, Yeah. And though, yes, I guess technically says I don't have it anymore. I guess I can stop counting, but also like I'm still in recovery mode from the symptoms. So I'm still not a hundred percent. Oh, excuse me. But I'll get there.
Um, there is proverbial light at the end of the tunnel. Um, it will be a good day when I can drive. Right. Still not driving because my vision and it will be a good day when I can wear makeup. So still no makeup because my eyes just are not ready for it. Um, so those are my like two big steps is good vision, vision, good enough to drive vision back to normal.
Eye movements back to normal. They're still very uncomfortable, medial lateral. Movement and then being able to put eye makeup on again. So anyways, um, thank you all for your support and your messages and just your general Good vibes. I really appreciate it and Yeah, especially too because I was kind of lonely like somebody asked how I was doing and I was like honestly like it's kind of lonely Being in quarantine from everyone.
So I did get to go home for Thanksgiving I did get to go to University of Oregon for the Oregon Um, Washington football game with my athlete Devon. He was the honorary captain for the game. That was really what I had circled on the calendar of like, I really didn't want to miss that. It was just like a special occasion and I didn't want to miss the opportunity to have fun.
So I'm very grateful that I was able to do that. Um, and had, and had a great time. A great time. I, I actually, I hadn't been home To, well, that's not home, but I hadn't been to a home game, a University of Oregon home game, for 10 years. Which is a little mind blowing because Oregon football is very high on my priority list.
I do make it to a game Almost every year, but most of them are away games. So when they come down to Southern California or when they're in Arizona, I often go to a bowl game if they're in the bowl game. So, um, that's why it doesn't feel like it's been that long since I was at a home game, but I was like looking back through pictures and like wracking my brain and I'm like, I told Devon, I was like, Um, I actually think the last home game I was at, he was playing, he had an epic game.
It was like September, maybe October, September, October, 2014. They played Michigan state. He had two touchdowns. It was, he, he did awesome that game. I like distinctly remember how well he did that game and that was before I knew him. Um, and, um. So I just think it's so ironic that the first home game back was him being the honorary captain and me going with him as his friend because, like I said, I didn't know him back then.
So, crazy. And, um, that also gave me some nostalgia because that last home game I went to in 2014 was the first Oregon game that I went to, home game that I went to after my mom passed away. And that was significant because prior to my mom getting lung cancer, I actually had season tickets for Oregon football and I would go up for a lot of games.
And that was like my thing. And um, when my, when my mom got diagnosed with cancer and when she was going through that, Literally anytime I left, I was living in Phoenix at the time, anytime I left Phoenix, all I wanted to do was go to see her. Like, I had no interest in going on vacations, I had no interest in going and hanging out with friends, I was basically like, if I was going to leave Phoenix, it was only to go be with my mom.
And so during that time I had, um, sold my season tickets and then just not renewed. And so going to that 2014 game, It was really significant because it was my first time back and then also because that was also around the time that I felt like I was starting to feel like myself again, which was, um, uh, about a year after she passed away.
And so it was also a big, it's a big game that sticks out in my head, not just because Devon went. Not just because Devon had a great game, and we won, um, but because it was a return of like fun Anna, and that just meant a lot to me, like reclaiming joy after my mom passed away was like a big deal. And actually, now that I say this out loud, I watched on the flight home yesterday, I watched In N Out 2.
Not In N Out? In N Out. That's the burger place. Inside Out 2. And, um, I hadn't seen it yet. And, ugh. It was, I mean, of course. Inside Out number one makes, made you cry. Inside Out 2 definitely is a crier too. You know, because anxiety comes on board and, um, All these other emotions that are like, not so fun and um, steal the joy, right?
And it was a realization from Joy, the emotion of Joy, that Joy used to lead everything, like lead the life of young Riley. And like, you know, everything she did was like, Joy did everything to like, make sure she was just always happy all the time. And um, Um, as Riley got older and had these new emotions, Joy had this realization that as, as you get older, like, um, it's harder to find the joy.
It's harder to always have joy driving what you do and, um, but also realizing like all the emotions need to work together to, like, fully. Be who you are. And, uh, It was just, yes, it was like, ugh, that scene When she has this realization that Joy can't be like there all the time Was like, ugh, I've felt this at a very deep level.
And I'd say still, it's still However, how many years has my mom been gone for? I don't even know, um, 11 years now. It's still hard for me to find joy in a lot of things, which I know that sounds really sad and depressing because there are, like, work brings me a lot of joy. I love what I do. I, I do. But then it's like, just that playful joy, um, still have to, like, work for it.
And I don't think that's unique to me and because of grief. I think that's growing up. I think that is the You know, that's the reason why I quit my job and like started my own business is because I realized that as you get older, it's really easy just to put all the responsibilities first and like stop having joy in a lot of things.
And so, you know, really my path of my career starting Movement Rev was like to reclaim that to take care of myself, which includes. arranging my life in a way that brought more joy. So anyways, very big sidetracked, but kind of like full circle moment when I was back at the game. And it just, you know, going back to your college town, like I hope it feels like this for you, but going back to my college town feels like coming home.
Um, always feels like coming home and, um, that's nice. And it's really nice to be able to share that with a good friend like Devon and an athlete like, you know, one of my athlete clients, because he feels that too. And so it's nice for us to have that connection, even though we were there at different times, it makes us both feel very at home and I love that.
I love that for us. I love that for him. I love that for me. Um, to be able to have that is really, really cool. So, anyways. Very good weekend. Very fun. Now. I haven't, I, I promised you last week when I was talking about the Pink Eye Chronicles that I would have an actual episode for you this week, and I do! I was like waiting for some inspiration, and one of my football players called me with a question over Thanksgiving, and I was like, this, this is what I'm going to talk about because I think it is, uh, I think it is like a very profound theory or idea.
And, uh, I want to talk about it actually. And it's funny cause it's like, Oh, this topic I've been actually wanting to talk about for a while because I'm always sort of talking about it without talking about it. But this way this gives me an even more important reason to talk about it. So when, uh,
wow, I'm like, what is with the yawning? It's because it's like, The, the sun is going down, the sun is going down these days, these short days. And so, even though I have no business being tired, it's four, like 440, um, this, the light is changing and so my body's like, Oh, it's time for bed. Anyways. So this episode what I want to talk about is the diaphragm and how it came up with him is because he's having some pain around like the area of rib 6 7 and um, it got me thinking Just that zone around the thorax, T6 through T8.
And how so often when I'm assessing people, it is like the spot of dysfunction. And when I think about it too, like it is the most common spot to have like a rib out, you know? And one of the reasons I've always talked about or thought about why is because when we look at. When we look at the path, the path or the pattern of kinetic linking or how energy ground reaction forces like move through our body, you know, it comes up through our feet, crosses at the SI joint, goes up the spine, and then crosses around T6 as it goes to the opposite side of the head or the opposite arm, right, it can dissipate in either or both.
That is sort of the Opposition line. Right. And one of the things that I, I look to even that is an SI joint test or that is a test I like to do, like an assessment test I like to do is like, have a force hit up someone's leg on the table. And I like to see how it travels. Um, but so often we see. You know quote unquote problems around that level of t6 to t8 and so, you know Part of the reason is it's a transition zone But also what what is important to remember is it's also the top even though we think of the end of the thorax as being A transition zone, which it is too, right?
The thoracolumbar junction is a transition zone. When we're actually looking at the cavities of the body, T12 is not the bottom of the thoracic cavity. The bottom of the thoracic cavity is around the level of T8. Um, Between T6 and T8, basically. And So, this is actually then the true transition zone between the thoracic cavity and the abdominal cavity.
And whenever we have transition zones in the spine, those levels have a tendency to have excessive motion driven through them because they're pivot points. And so, um, So, of course, it would make sense for T6, 7, and 8 to have some sort of extra issues. Same reason we have issues a lot at L5 S1, it's a transition spot.
Same thing at C6 T1, or C7 T1, C6, 6, C7 T1, transition zone, cervical thoracic junction. Even at the top, the occipital cervical area. transition zone. A lot of movement needs to happen there. So, um, it can, there, they can be problematic spots. So, it's, one of the things is just, again, knowing the anatomy better, that, yes, the transition from the thoracic spine to the lumbar spine is another transition zone because the, the, the facet joints change.
in their orientation, and then there's no more ribs. That means the function and the ability for movement changes. We go from a, we go from a Part of the spine that cannot side bend very well because ribs are there, to a part of the spine that now can side bend very well because there's no ribs and the, the facet joints are set up in an orientation where they allow for a lot of side bending, flexion, and extension, but no rotation of, you know, the level just above in the thorax.
They are in a different position, right? They go from being sagittal to more coronal and they allow for more ranges of motion, but the spinous processes don't allow for extension. So this is a transition zone too, but it's not as big of a transition zone as the top of the abdominal cavity. So, when we look, when we really look at the thoracolumbar junction being a zone of rotation, which it is, that is because the lumbar spine below it doesn't rotate, but it is rotating.
But the diaphragm, top of the diaphragm is that more T8 spot. The level of T8 in the front is rib 6. So that is why it's rib 6, 7, it's not rib. The level of T6, 7, and 8 is then affected at that zone of movement or that transition zone. So, a lot of rotation is driven there as well. Further understanding the anatomy of the diaphragm helps you to understand this all because then we add in that muscular component of, so we already know the facets and all of the thoracic spine are set up for rotation, but not side bending, flexion.
Not so great for extension, but when you add the musculature and the tendons of the diaphragm, now this changes the available mobility as well because it adds a relative stiffness to the system. It adds more stiffness to resisting motion at the levels between T12 and T8. Alright, so even though we know rotation and flexion can occur there, well, it doesn't as easily as it does above because of the stiffness.
And that means too, as the diaphragm stiffness increases, Right, as relative stiffness increases, it's going to drive hypermobility even more through those paths of least resistance at T8, T7, and T6, which sets us up for more pain and dysfunction in those areas, right? It's, it's too much movement and that usually creates pain.
And then this goes to talk about, this is why I want to talk about the diaphragm because I want to talk about all the ways that the diaphragm, like the diaphragm can be stiff. And on the flip side, how, what are interventions that we can do to decrease diaphragm stiffness? And, and this is, you know, how I said, like, this episode was inspired by one of my athletes is because he's having pain in this area of the ribs where it's at this transition zone.
And I was just asking him questions on like the timing, like what's going on and what's happening. And, and I'm also like, I have a feeling your diaphragm has gotten really, really stiff. And I know it's gotten really stiff because of what he, what he told me he's been doing for exercise as well as what week it is in the NFL because he's an NFL player.
And over my career, especially in the last 10 or 11 years that I've been traveling during the season with my athletes, specifically NFL athletes, I've noticed that around week 13, the thoracic spine. Um, not even, I don't even say the thoracic spine, the thorax and all associated structures get really, really stiff.
I believe it's a reflexive stiffness or a neurological stiffness. A lot of it is driven from that because of her protective mechanism from the 13 weeks of load of hypersympathetic state of competition of and of getting hit right and doing a lot of dynamic starting and stopping and then people starting and stopping them with their bodies so I see a lot of increased stiffness of everyone's ribs spine diaphragm mediastinal ligaments during around the same time in the league.
And so I also know that he's been lifting more and doing more speed work, which those are two things that are going to increase stiffness of the diaphragm. And I'll talk about that more in a second. And though he takes good care of himself, he does a lot of like, Self massage. He does a lot of stretching.
He does a lot of, um, he eats really well. He gets massages twice a week. Like, he takes good care of himself. But I do know that he's not doing anything that specifically stretches the diaphragm because not just anything mobilizes and stretches the diaphragm. You have to be very intentional. To be getting this muscle because this muscle is oriented in a different plane than every other muscle in our body or not every other, most other muscles in our body.
And so we, it doesn't have, it doesn't get stretched out with like the typical mobility exercises. And so we have to be a little bit more intentional of understanding all the parts of the diaphragm and how to open them up. So that's what I want to talk about a little bit more too. Um, the diaphragm is one of the largest muscles of the body and it has a,
what's, it has a like, um, timeline that it goes through. When we're born, the diaphragm actually only has one function and it's in a different place, relatively. That sounds like a, that's a misleading thing to say. It's in the same spot. It is, it is the muscle between the thoracic cavity and the abdominal cavity.
Okay, so, that was maybe a little misleading, it's in the, it's in, it's where it's supposed to be. It's between the thoracic cavity and the abdominal cavity, but when you're born it's way higher up and the diaphragm at that point only has one function, it is only a respiratory muscle. It is not fully It has not fully grown into, for life, a pun, it has not fully grown into its three functions.
The diaphragm has two parts and three functions. So as the baby develops and starts to gain control of its head. And starts to gain control of its limbs, the diaphragm gets stronger and starts to drop down in the chest. And that's when it starts to improve upon its other two functions and play a role in postural stability and visceral, um, control.
So those are the three parts of the diaphragm. Respiratory? postural and visceral. Those three parts of the diaphragm all work together
to, all work together because it's one muscle. It has two parts though. So it has a costal part, the part of the diaphragm that connects to the ribs, hence the name costal. Then it has a crural part, crural. Are the long, more tendinous, well they're muscle too, but tendon and muscle, um, legs of the diaphragm that connect to the vertebrae.
They're like the anchor point. Then there's the costal connection. And the costal part and the crural part come together at the central tendon. Now the central tendon is not considered a different part of the diaphragm, like the crura or the costal part, but that is where everything comes together. The central tendon is also where the visceral function Or the visceral connections live.
The crura also play a role in the visceral pieces. So the crura and the central tendon are considered the visceral part of the diaphragm, whereas the costal part of the diaphragm is more of the respiratory and the postural connection. But, really, all Parts, both parts, both, all three units, I guess if you could call it, are the same muscle and therefore all participate in respiratory, postural, and visceral, right?
So the, and they all, like they all work together. They have to all work together since they're all one muscle. Seems like basic, but like true. And just like everything else in anatomy, we piece it apart to better understand it, but then we have to learn how to put it all back together and realize how it works together.
Now when you have a muscle that has multiple different parts and multiple different functions, also means you usually have multiple different nerves that control or communicate. from it. And that's true here too. You have two nerves that can control the motor function of the diaphragm. And then you have nine nerves that participate in the sensory experience from the diaphragm.
The motor nerves are the phrenic nerve and the vagus nerve. And then the sensory nerve. sensory nerves are the phrenic nerve and the vagus nerve, and then the spinal nerves from the level of T5 all the way to T12. So, there is a lot of opportunity then for us to influence the diaphragm function and mobility from various spinal levels.
including C3, C4, C5, including the occipital area of the, um, cervical spine because of the vagus nerve, the thoracic inlet, and then T5 through T12. So super interesting. And the, the reason they all work together like that and why there's multiple parts is because we need to be able to. Um, do those three functions at the same time.
And so that's why it's important then for the muscle to have different parts is because we need to be able to be breathing and stabilizing. Um, we need to be able to be breathing, but then also throw up, right? And so, um, these nerves and these muscle parts all communicate with each other to create all these different functions.
So the, the visceral function of the diaphragm is, there's multiple, there's multiple parts of this visceral function. The main visceral function of the diaphragm is the role of the diaphragm as a sphincter muscle for the esophagus. So the esophagus is one of the holes that is like penetrates the diaphragm.
And the curl part of the diaphragm wraps itself around the diaphragm. Um, esophagus right there at the gastroesophageal sphincter forms the gastroesophageal sphincter and that crua and that sphincter also is continuous with the ligament called the ligament of trites, which Joe can link it in the show notes.
I talk a lot about in the episode about the small intestines and the mesenteric root because the ligament of trites is part of that mesenteric root at the duodenal jejunum. Junction, but also loops in and interdigitates with the cura of the diaphragm and the sphincter around the esophagus, right? So this is a direct visceral connection to the diaphragm.
In visceral role that the diaphragm plays in stabilizing the small intestines, the posterior abdominal wall, anchoring the diaphragm, as well as anchoring the sphincter muscle. The other visceral part of the diaphragm is the hiatus for the, the, um, inferior vena cava that goes through the central tendon.
The inferior vena cava and the right phrenic nerve go through that opening, as well as lymphatic vessels. And the, um, central tendon also is connected to the peritoneum in the abdominal cavity and the, uh, pleura and the mediastinal fascia. pericardium in the thoracic cavity. So there is a direct connection to the lungs and the heart as well as the liver, the stomach, the spleen, all those visceral organs right under the diaphragm as well.
And the small intestine, which I just told you, right? So the central tendon and the crua are big visceral parts of the diaphragm. The aorta It looks like there's a hole for the aorta to go through in the diaphragm, but it's not actually a, a hole like the hole for the vena cava and a hole for the esophagus.
The aorta actually is, um, the diaphragm sort of wraps around because it, the diaphragm sort of wraps around it just like it does the spine and the aorta is right in front of the spine. And so. The oreaorta actually passes behind the diaphragm, but because of the relationship of the domes or the leafs of the diaphragm and the crura, it also sort of looks and, um, presents itself like a hiatus.
And anywhere we look at Spots like how hiatus is like that, it's a possible entrapment site for those organs too. The other thing that passes at that aorta hiatus it's called is the vagus nerve. Um, the vagus nerve also has parts, has branches all along the esophagus, so passes through the esophageal hiatus as well.
So two spots for the vagus nerve. Um, also some lymphatic vessels, um, pass through there and there's a couple other little, um, orifices in the diaphragm for, um, nerves and lymphatic vessels and small, um, vascular vessels as well. So um, interesting, right? I don't know if I said it already, but the crural part when we talk about the, the um, anchor to the vertebrae also connects to the anterior longitudinal ligament of the spine and that is continuous from the base of the skull all the way to the pelvic floor.
I'll say that again. The crua of the diaphragm, the crural part of the diaphragm. It connects to the front of the vertebrae, the intervertebral discs, and the anterior longitudinal ligament. The anterior longitudinal ligament connects from the base of the skull to the pelvic floor.
Interesting, right? So, um, the other fun thing about the crua that I might have not said already, um, Latin, crus, crus, C R U S, is Latin for legs. So that's why it's those long legs of the diaphragm, the anchor of the diaphragm. Um, in order for the diaphragm to Contract. It needs the ribs to move. The ribs, the rib 11 and 12, the floating ribs, move in a caliper motion, opens up like this.
This is a caliper, right? Like a skin caliper for like body fat, it opens up this way. It would also look like this. external rotation. So that's what the caliper motion is, is external rotation and internal rotation at the costovertebral joint. The ribs above it, ribs 8 through 7, 8 and 7, 8, 9, 10, 8, 9 and 10.
7, 8, 9, and 10, 8, 9, and 10. Those ribs do a pump handle motion and have to open like this, it's as if my elbows are opening up. So you have these ribs opening this way, the bottom ribs opening this way, that allows for the costal part of the diaphragm to expand and the central tendon to contract, which pulls the diaphragm up but helps flattening everything out.
It's confusing because contraction of the diaphragm often seems like it gets opened up, which most of the time opening something up, getting bigger, wider, makes you think that it is lengthening. But in this case, one part is and one part's not. Because then on the exhalation, or the relaxation, the ribs come back in, caliper and bucket handle, so the bucket handle drops down, the ribs come back in, everything squeezes, the domes lift up, the crural gets pulled, and everything shortens.
It's a very backwards feeling. But yet, that's what's happening. Um, but you have to think on that exhalation, that exhale position of the diaphragm, it gets very domed up and it lifts up. It has to, those domes have to lift up into the chest. And they go up anterior to the level of rib 6 on the right.
That's really high up in the chest. Remember, rib 6 on the right is about the level of T8 on the back. Right? Depending on the person's dynamic posture, but that's like normal. Where the front of the rib is lower than the back of the rib. So rib 6 is actually at the level of T8. Um. A lot of movement of the ribs have to happen both on the contraction and the relaxation.
And actually this is why I don't call it contraction and relaxation a lot because it's confusing in my brain. I'm just like the ribs have to move into inhalation and an exhalation. In fact, there's some studies that show that the motion available at those segments from a three dimensional circumference measurement would be two and a half inches into inhalation and two and a half inches into exhalation from the midpoint.
That's a five inch change from inhalation to exhalation, five inches. That's a lot of mobility. Most people don't have that kind of mobility, which that means if you're not using that kind of mobility, your diaphragm is never going through its full range of motion, which means it's getting stiffer. It's just like when I put my elbow in a cast and stuck, stuck it, stick it in flexion, if it's never going through the full range of motion, when I take the cast off, it's going to be a really stiff muscle that can't extend.
So same thing in our diaphragm. If we haven't been breathing in that big three dimensional breath on an inhale and an exhale, then the diaphragm itself has gotten stiff. So, the other things that cause some stiffness in the diaphragm, both the crural part as well as the costal part, is
Stabilizing your spine. Postural stabilization, right? That was one of the functions of the diaphragm. So if you're doing activities that demand a lot of trunk stiffness, postural stability and control, then your diaphragm is getting stiffer. It's a muscle. It grows. It lays down new muscle cells in parallel and becomes stiffer.
So when you're lifting really heavy loads, axial heavy loads, heavy weight training, your diaphragm's getting stiffer. When you're moving your limbs very fast, your diaphragm's getting stiffer. It is a postural stabilizer for those things. This is a good thing. This is a good thing. But also, what happens when something gets stiffer?
It's a game of relative stiffness. If my diaphragm gets really stiff, but then my abdominal muscles or my paraspinal muscles or my intercostals are less stiff, then we're just going to move through those segments instead of the diaphragm itself, because it's a game of relative stiffness, right? The path of least resistance is always going to be the thing that moves first.
Which is why it's so important to know stretches, to know exercises that actually target the diaphragm from a mobility standpoint over the other things. And it's not just breathing exercises. Though breathing exercises is one of the things, it's not just breathing exercises. And it's not just breathing, it's intentional breathing for mobility of the diaphragm.
Different than breathing for relaxation. Different than breathing for, um, mental focus. Different than breathing for, like, stress response, okay?
So, you know, bringing it back to my athlete who was asking me this question, he was lifting really heavy. He does a lot of sprint work. He's at that point in the season where things are just stiff and then he's starting to get pain at that transition zone. So I'm like, Oh, you know what? You need to add in some diaphragm stretches.
So let's add in some specific diaphragm stretches and see if we can move the needle a little bit on your pain. See if we can. mess around with the game of relative stiffness a little bit. Okay? The, um,
The other thing I wanted to say in that is
Oh, the last thing that can create stiffness is more of a neurological stiffness. So we talk about a lot on the podcast when the body is protecting something important like a visceral organ, the musculoskeletal system organizes itself around it and sort of splints the organ. to prevent movement. So the diaphragm does this.
The diaphragm is a muscle at the end of the day. So it is a bodyguard of these organs, especially the organs that live below it and above it. And so oftentimes when, when one of those organs can, is not moving well or is not functioning well, the diaphragm neurologically splints itself, neurologically limits mobility around that organ to protect it.
And so then you get a stiffness of the diagram and then driving, again, driving mobility through those more hypermobility segments. So the first step with anything, right, when somebody presents with pain or a dysfunction or something that's happening in their body that they need help with, they're not liking, right?
Like a function, subpar performance, like lack of mobility, pain, whatever it may be, we need to do an assessment to first be like, Are you protecting a visceral organ? Because I can do all the stretches in the world. I can do the best diaphragm stretch in the world, but if the diaphragm is splinting an organ, neurologically creating stiffness to protect something more important.
I'm not going to have very much success in decreasing the stiffness of the diaphragm. Only when I direct my focus and attention on the organ that it's protecting and do treatment or movement or manual therapy there first, then the diaphragm, you know, quote unquote lets go and decreases its stiffness.
And then you might find that you don't need a diaphragm stretch. But also probably everyone needs a diaphragm stretch because nobody, I don't want to say nobody, not a lot of people are doing specific diaphragm stretches in their practice on a daily basis. Or at least on a weekly basis. So, um, that's important too, but that's also why it's like all of this, right?
Like anytime I talk about any injury or complaint of pain on the podcast, it doesn't live in a vacuum. We still have to start where we always start, which is with LTAP, the locator test assessment protocol, to figure out where the body is protecting, if it's protecting something. So we know, is this musculoskeletal issue, this, in this case, this diaphragm stiffness, is it because of a protective pattern, or is it Because of lifting heavy or running fast or whatever it may be, right?
We have to figure out why. The better we have a why, the easier it's going to be to treat and to maintain our results from it. So, okay, without further ado, what are the diaphragm stretches, Anna? Like, you keep talking about how important they are, like, what the fuck? What are they? So, my top ones, right, we talked about two, like, Because the diaphragm has different parts, it's one muscle, but it has these different parts and functions.
That means our diaphragm mobility exercises also look different. Number one, you have to include something to, to address the mobility into a bucket handle motion at the lower ribs and a caliper motion at the floating ribs. Okay. Number one. What is my favorite things for that? You guessed it. Coregeous ball, sideline, breathing.
Directed, you could direct it at the liver on the right side. You could direct it on the left side. You could do both sides. You could do kind of towards the front, towards the back. You know, I like to avoid the area of the pancreas and I can probably do front on the left side, but front on the right side would be okay.
Um, But, you know what else I'm going to do? Prone breathing on the Coregeous ball, or prone breathing over something to restore the thoracic curve, especially at T5, T5, T6, T7, T8. I care about those ones a lot. One because it's that transition zone, but all the way at T5, remember when I talked about the nerves that innervate, the sensory nerves that innervate the diaphragm?
That's, that's the one. That's what we got to target. So T5 and down. I want to improve the mobility around that. Especially into spine flexion. Especially into flexion. Then, so I got prone breathing, we got lateral breathing for mobility. You can just do, like, hands on the side or a band on the side, posterior lateral or lateral breathing.
But then there's two other really good ones. Number one, DaVinci breathing. I talk about it all the time. The wonderful thing about DaVinci breathing is it takes the diaphragm and it rotates it and then expands it. And when you add a twist to a, to a muscle, That's lengthening, oh baby. The stretch is so much bigger.
Even hamstrings, if you're stretching your hamstrings like in a bent over position, forward fold position, if you bend one knee, straighten the other one and add rotation to that side of the straight leg, man, that stretches your hamstring out more because you're creating a spiral on it. Whenever we can create spirals on these big muscles, we get a lot more mobility out of them.
So the DaVinci roll really is emphasizing that. Plus you're still emphasizing the lateral breathing component of it, and the dropping down of the diaphragm component of it. That's huge. The other stretch I love in that same sense is this,
you can integrate them together. Or you can do them separately. We'll go separately first. So using this posterior lateral or just lateral breathing component. Really emphasizing the bucket handle motion. And then adding in hip internal rotation. As we go into hip extension. Really lengthening out the psoas.
That's a great one because the psoas interdigitates with the crua of the diaphragm. So it starts to stretch out that anchor point really well. If we could do that with a little rotation in the trunk too, ooh, then we get that anger point and some of the central tendon and the leafs of the diaphragm. And get this, once you do it on an inhale breath, and open up laterally and lengthen out the psoas, Hold that length in the psoas and do a big, huge exhalation.
Bring those ribs in and imagine the dome reaching away from your feet. Feel the opposition of the dome and your feet. Ooh, that is a really good feeling because again, we want to stretch it out both on the inhaled position and on the exhale position. You're going to get different parts of the diaphragm.
So, then, the last thing is a diaphragm vacuum. A diaphragm vacuum is sort of taken from the yoga world, but it's great at, again, that opposition and widening together with the respiratory function. So, you exhale completely all the way. You really dome the diaphragm up on that exhale, like really get your ribs as close together as possible.
And then you hold your breath, but then you consciously open your ribs back up. And you go into the position of an inhalation on the diaphragm, but you don't let your breath change. It creates a vacuum and you really get to feel the costal part of the stretch and the crural part of the stretch at the same time.
Then you can supercharge that whole thing by adding in the interrotation and the hip extension, the psoas piece. Oh, and then you can go even crazier and add in a rotational piece and do it all together. And that is a great way to stretch the diaphragm. And the last way to do it, which again, you can add in all of these layers to if you wanted, was an exhalation segmental bridge.
The, but the part of the segmental bridge where you're rolling back down one bone at a time, you roll up segmentally if you want, or you can just lift up in like a glute bridge, but then you're going to do a big exhale breath. And as you're exhaling, you're going to be dropping one bone down at a time into thoracic flexion.
And that's really going to take that curl part and lengthen it out and stretch it out. Oh, it feels very nice, but again. You can switch it up. You can change the intention. You can do an inhale breath with it and get the costal part and the crural part at the same time as you roll down. And then as you lengthen down, then do a big exhalation and pull the dome back up.
Boy, that feels really good too. And what I hope you see from all these descriptions is the better you understand the relationship of the anatomy of the diaphragm. And what's going on on the inhale and the exhale and how it connects to the psoas, how it connects to the posterior abdominal wall, the role in torsion or a spiral in the stretch.
Now you start to see that you can change a lot of the things that you're doing and just change the intention on where you're directing your focus of the exercise and make it more of a diaphragm stretch. You could even do it in a general like 90 90 stretch. It doesn't even have to be da Vinci, right? It can be something simple, but when you're focused on the, on the area where the diaphragm is at, you're going to have a way bigger influence.
And then playing around with the cueing on the inhale and the exhale and the doming and really emphasizing those. And it can be really helpful. So, there's a lot of exercises that I do that I can cue for a diaphragm and make it more efficient. But, to keep it simple, like what I gave my athlete, because I'm not with him, I need to keep it simple.
He's doing the sideline breathing with a quarters ball, the prone breathing with a quarters ball, and then he's doing the, um, Segmental spine roll down with the exhale breath. And then he's doing the diaphragm vacuum with the legs. And that's it. And I just asked him to do it like at least once a day. You can do it more if he wants, but at least once a day.
And give it, you know, I told him give it like three days to a week. And let's see if it changes his pain. If it doesn't change his pain for three days to a week, then we're on the wrong path. Path, or we're missing a protective stiffness pattern, so, but hopefully that's helpful. I'll have Joe link in the show notes, the related episode, um, as well as any videos I have of any of these interventions, so you can try them too, um, and, uh.
Looking forward to how, hearing how you liked it. Thanks for being here.