We all know the respiratory diaphragm is the main muscle of respiration, but it is a coordinated event with other structures in the body, in particular the pelvic diaphragm.
Anybody who has attended my workshops knows that I like to think of the respiratory diaphragm like a jellyfish contracting and relaxing with fluidity within the body. However, the respiratory diaphragm and pelvic diaphragm are like a pair of jellyfish synchronised and moving in harmony with every breath. If there is a lack of coordination with one, it will affect the other. These two diaphragms have a fascial and functional connection. The pelvic diaphragm is fascially linked to the respiratory diaphragm by the transversus abdominis, obliques and thoracolumbar fascia.
The respiratory diaphragm separates the thoracic and abdominal cavities. The thoracic cavity is closed by the respiratory diaphragm at the bottom and the vocal folds superiorly, containing intrathoracic pressure. The glottis modulates intrathoracic pressure and is in turn connected with the pelvic diaphragm, a study showed an improvement in singing technique with increased strength in the pelvic diaphragm, but I am going to hold that thought for another article. The abdominal cavity has the respiratory diaphragm superior and the pelvic diaphragm inferior and maintains intra-abdominal pressure.
On inhalation the respiratory diaphragm contracts and moves downward drawing air into the lungs, at the same time the abdominal wall distends slightly to make room for the displaced abdominal viscera and the pelvic floor relaxes/ eccentrically loads. On exhalation the pelvic diaphragm and abdominals contract as the respiratory diaphragm relaxes to transfer intra- abdominal pressure from the abdomen to thorax.
Research shows that diaphragmatic motion was assisted by and more effective with strong pelvic diaphragm contractions in breathing. Think of your clients in clinic with weakness in their pelvic diaphragm and then think of their breathing pattern and that lack of support they seem to have. However, we have the opposite side to the coin. Contraction of the pelvic diaphragm can hinder diaphragmatic movement, so if someone has a hypertonic pelvic diaphragm this will restrict movement of the respiratory diaphragm. Again, think of your client who is holding on so tightly in the pelvic diaphragm/ glutes and diaphragm, they seem to have no diaphragmatic movement but maybe lots of shoulder movement when they take a breath.
Respiratory function requires the support of the pelvic diaphragm and pelvic diaphragm function requires respiratory diaphragm movement. In clinical practice this means taking a step back and viewing the dysfunction more globally. Your client with the pelvic diaphragm dysfunction may need assessed above and below. Your client with breathing dysfunction, shallow breathing, over breathing definitely needs to be assessed above and below the respiratory diaphragm.
In ‘Balancing the Diaphragms’, we look at the connections and communication between these diaphragms and use manual and movement therapy to help with the clients body awareness and diaphragm coordination.
Find out more about this workshop June 3rd and 4th in Amsterdam, The Netherlands.
References
Emerich Gordon, K., & Reed, O. (2020). The role of the pelvic floor in respiration: A multidisciplinary literature review. Journal of Voice, 34(2), 243–249. https://doi.org/10.1016/j.jvoice.2018.09.024
Park, H., & Han, D. (2015). The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. Journal of Physical Therapy Science, 27(7), 2113–2115. https://doi.org/10.1589/jpts.27.2113
Siracusa, C., & Gray, A. (2020). Pelvic Floor Considerations in COVID-19. Journal of Women’s Health Physical Therapy, 44(4), 144–151. https://doi.org/10.1097/JWH.0000000000000180
Tim, S., & Mazur-Bialy, A. I. (2021). The most common functional disorders and factors affecting female pelvic floor. Life (Basel, Switzerland), 11(12), 1397–. https://doi.org/10.3390/life11121397