Clinical Pilates in Practice: Diaphragmatic Breathing for Posture

Written By Calibrate Pilates

By no means a thorough or robust study, we are including this one because of our belief in evidence-informed practice, and this paper does serve as a reminder of the importance of the diaphragm for postural control. (Better references included below.)

Menon, Vivek V., Mudasir R. Baba, Pavankumar, and Sneha Suresh. "Effects of Diaphragmatic Training on Posture and Stability in Asymptomatic Subjects: A Randomized Clinical Trial." Indian Journal of Physiotherapy and Occupational Therapy 14, no. 2 (April-June 2020), 221-225.

Anatomy review: The Diaphragm

  • The thoracic diaphragm separates the thoracic and abdominal cavities.

  • Comprised of central and peripheral parts, that converge at the central tendon.

  • The central tendon fuses with the inferior surface of the pericardium.

  • On either side of the central tendon, the diaphragm ascends to the left and right domes.

The peripheral, muscular portion of the diaphragm is divided into three parts: sternal, costal, and lumbar.

  • Sternal fibres arise from the posterior surface of the xiphoid process.

  • Costal fibres arise from the posterior surface of costal cartilage of ribs 7-10, and directly to the posterior surface of ribs 11-12.

  • Lumbar fibres arise from the anterior surface of L1-L3, via the left and right crura, and the arcuate ligaments.

  • The left crura arises from the bodies and intevertebral discs of L1-L2.

  • The right crura arises from the bodies and intevertebral discs of L1-L3, with some fibres surrounding the oesophageal opening.

  • The crura also blend with the anterior longitudinal ligament of the vertebral column.

  • The medial arcuate ligament is a thickened sheet of fascia that arises from the upper portion of the psoas major, attaching to the lateral aspect of L1 or L2, and the anterior aspect of the transverse process of L1 and/or L2.

  • The lateral arcuate ligament is a thickened sheet of fascia that arises from the anterior surface of quadratus lumborum, extending to the lower margin of the 12th rib and attaching to the anterior aspect of the transverse process of L1, and sometimes L2 and L3.

  • The median arcuate ligament is formed by the medial margins of the left and right crura.

  • Diapragmatic ligaments also attach the diaphragm to the viscera.

www.kenhub.com/en/library/anatomy/diaphragm

Key Points: Diaphragmatic Breathing for Postural Control

  • Diaphragm training has previously been shown to increase the cross-sectional area of the deep spinal stabilisers, such as the transverse abdominals and lumbar multifidus.1

  • Improving diaphragmatic "strength" can improve balance, through deeper core control mechanisms and proprioceptive feedback.

  • Diaphragmatic breath training decreases load through accessory breathing muscles of the neck, thereby supporting cervical posture.

Clinical Pilates in practice

  • Breathing is the most fundamental and foundational work for Pilates (and rehab)!

  • Spend time teaching diaphragmatic breathing techniques, including lateral and posterior diaphragm expansion.

    → Use props to set up for success!

  • When cueing through thoracic extension, diaphragmatic breathing can unload the lumbar spine.

  • Diaphragmatic breath cues can release the scalenes and other accessory breathing muscles to encourage fluid upper body movements.

    → Chest Expansion and other upright arm series on the Reformer.

    → Mermaid using various apparatus.

    → Upstretch on the Reformer.

  • All of the pre-Pilates preparatory mat work will be supported with appropriate diaphragmatic breathing to support a deep abdominal and cylindrical core connections.

References

1. Kocjan, Janusz, Mariusz Adamek, Bożena Gzik-Zroska, Damian Czyżewski, and Mateusz Rydel. "Network of breathing. Multifunctional role of the diaphragm: a review." Advances in Respiratory Medicine 85, no. 4 (2017), 224-232. doi:10.5603/arm.2017.0037.

2. Moore, Keith L., Arthur F. Dalley, and A. M. Agur. Clinically Oriented Anatomy. Philadelphia: Lippincott Williams & Wilkins, 2013.

3. Finta, Regina, Edit Nagy, and Tamás Bender. "The effect of diaphragm training on lumbar stabilizer muscles: a new concept for improving segmental stability in the case of low back pain." Journal of Pain Research Volume 11 (2018), 3031-3045. doi:10.2147/jpr.s181610

4. Gormanc, Niamh. "Diaphragm." Kenhub. Last modified April 15, 2014. https://www.kenhub.com/en/library/anatomy/diaphragm.

Calibrate Pilates
Previous

Clinical Pilates in Practice: Learning Styles Neuromyth
Next

Clinical Pilates in Practice: Joint Impairment & Gait in Juvenile Idiopathic Arthritis