What is the diaphragm?

The diaphragm is a large, dome-shaped muscle, located below the lungs. 1-2 It is the primary muscle involved in breathing.1-2When the diaphragm contracts, it allows for the expansion of the chest.1 This action allows air to be pumped into the lungs.2 When the diaphragm relaxes, and recoils back, the air the lungs is forced out.1

Image 1: Diaphragm3

What are secondary respiratory muscles?

Secondary respiratory muscles assist breathing by expanding the ribcage.2 The Scalenes and Sternocleidomastoids (SCM) are examples of secondary respiratory muscles that help lift the rib cage.2These muscles attach from your rib cage to your head and neck. When overused these muscles can cause head and neck pain.

Image 2: Secondary respiratory muscles; Sternocleidomastoid (SCM) and Scalenes (middle, anterior and posterior)

What is diaphragmatic breathing?

Diaphragmatic breathing is the contraction of the diaphragm muscle along with expansion of the belly.4 Allowing expansion of the lungs, without using the secondary respiratory muscles.5

What are the benefits of diaphragmatic breathing?

Practicing diaphragmatic breathing has been shown to:4-6

  • Decrease requirement of secondary muscles of breathing, making breathing more efficient
  • Decrease cortisol levels
  • Slow the respiratory rate
  • Reduce anxiety, stress and depressive symptoms

When your Osteopath may prescribe diaphragmatic breathing exercises

  • When the SCM and Scalenes (secondary respiratory muscles) are being overused
  • When patients with recurrent head/neck pain breathe predominantly using their secondary respiratory muscles
  • To help reduce anxiety and stress

How do you perform diaphragmatic breathing?6

  • Lie on your back, with knees bent and head supported
  • Place one hand on your chest and one just below your rib cage
  • Breathe in through your nose so that your belly pushes against your hand, and your chest remains relatively still
  • Breathe out, through pursed lips, and pull your belly button towards your spine (the hand on belly should move down while hand on chest remains still)
  • Continue for 5-10 mins
  • Practice 3 times daily

Image 3: Starting position for diaphragmatic breathing6

Image 4: Inspiration in diaphragmatic breathing6

Image 5: Expiration in diaphragmatic breathing6


  1. Nason L, Walker C, McNeeley M, Burivong W, Fligner C, Godwin J. Imaging of the Diaphragm: Anatomy and Function. RadioGraphics. 2012;32(2):E51-E70.
  2. De Troyer A, Boriek A. Mechanics of the Respiratory Muscles. Comprehensive Physiology. 2011;:1273-1300.
  3. Nguyen P, Debevec-McKenney E, Iradufasha E. Anatomy of the diaphragm [Internet]. Osmosis. [cited 2 October 2021]. Available from: https://www.osmosis.org/learn/Anatomy_of_the_diaphragm
  4. Ma X, Yue Z, Gong Z, Zhang H, Duan N, Shi Y et al. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology. 2017;8.
  5. Hopper S, Murray S, Ferrara L, Singleton J. Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults. JBI Database of Systematic Reviews and Implementation Reports. 2019;17(9):1855-1876.
  6. Diaphragmatic Breathing Exercises & Techniques [Internet]. Cleveland Clinic. 2018 [cited 2 October 2021]. Available from: https://my.clevelandclinic.org/health/articles/9445-diaphragmatic-breathing

Dr Avanthi Wickramasekera (Osteopath)

B.Hsci., B.App.Sc. (Osteo)

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