This muscle gives you the breath for life

What is the diaphragm?

The diaphragm (Diaphragma) is a dome‑shaped muscle 2 to 5 mm thick. It is a musculo‑tendinous plate that forms the boundary between the chest and abdominal cavities. This flat, broad muscle connects the sternum to the lower ribs and the thoracic and lumbar spine. Above lie the heart and lungs; below are the abdominal organs such as the stomach, liver and intestines. The shape of the diaphragm resembles an inverted “U" and it can unfold and contract like an umbrella.

It has several openings for the passage of important structures such as the main artery (aorta), the inferior vena cava and the oesophagus. These openings are structural weak points where diaphragmatic hernias can occur.

The diaphragm's muscle consists of a central tendinous portion, the so‑called central tendon, and several muscular portions that radiate outward from this centre. These muscular parts enable the contractile movement of the diaphragm. On inhalation the diaphragm contracts; on exhalation it relaxes. It is therefore essential for the expansion of the ribcage and abdomen to create space for air in the lungs. The diaphragm is thus the most important respiratory muscle. Without its function, breathing — and hence life — would not be possible.

What is the function of the diaphragm?

The diaphragm fulfils many important tasks in our body. As the primary respiratory muscle, its function is essential for breathing and is as important as the pumping capacity of the heart. It plays a central role in respiratory movement: on inhalation it contracts and moves down, increasing the volume of the thoracic cavity. This creates negative pressure which draws air into the lungs. On exhalation the diaphragm relaxes, rises and reduces the volume of the chest cavity, pushing air out of the lungs. Abdominal breathing is also controlled by the diaphragm.

In addition, the diaphragm helps, through its up‑and‑down movements, to mobilise body fluids, including the blood circulation and the lymphatic fluid. This constant movement supports all organs in the abdominal cavity and aids good digestion. The diaphragm also helps to stabilise the spine and makes lifting and carrying loads easier.

Because the diaphragm directs airflow along the vocal cords, it is also an important modulator of the voice. Diaphragm flexibility is important for speech accentuation. It also helps keep stomach contents in place, which can prevent heartburn.

An optimal balance of tension in the diaphragm is crucial for health: breathing and stretching exercises can relax the diaphragm, resulting in greater mobility, improved posture, stimulated digestion and supported circulation.

How do diaphragm problems present?

When the diaphragm is tense, problems can present in various ways. The most common symptoms include pain in the diaphragm area itself, neck tension, back pain and restricted movement in the chest and back. Affected individuals may feel chest tightness and general breathing difficulties, for example a sensation that the breathing “jerks". Additionally, fatigue, concentration problems and a general feeling of bodily imbalance may occur.

A poorly functioning or overly tense diaphragm can lead to a variety of problems, including back pain, pelvic twisting, blocked thoracic vertebrae and ribs, stomach issues such as reflux and heartburn, chest tightness and functional breathing problems, digestive disorders, functional heart issues such as arrhythmias or blood pressure problems, tension in the shoulder girdle and neck pain, headaches and postural problems, as well as emotional imbalance.

Furthermore, diaphragm problems can be related to voice training and speaking, such as shortness of breath, disruption of airflow, lack of vocal projection, difficulties with intonation and emphasis of words, reduced speaking endurance and lack of depth due to insufficient diaphragmatic support when speaking and singing.

What is a diaphragmatic hernia?

When part of the stomach or other abdominal organs move through a weakness or opening in the diaphragm into the chest cavity, this is called a diaphragmatic hernia or a hiatus hernia. This can cause a wide range of symptoms from mild to severe.

There are different types of diaphragmatic hernias which affect the nature and severity of symptoms. In an axial hiatus hernia (sliding hernia), a small part of the stomach slides through the diaphragm into the chest cavity. In a para‑oesophageal hernia, the stomach remains in its usual position, but part of it protrudes through the opening in the diaphragm beside the oesophagus. There is also a mixed form that combines the two aforementioned types. If sudden trauma or injury damages the diaphragm and abdominal organs enter the chest cavity, this is called a traumatic hernia.

A diaphragmatic hernia can be congenital or acquired later in life through injury, ageing or other factors. Symptoms can range from upper abdominal pain, heartburn and difficulty swallowing to breathing problems and serious complications. Possible complications include incarceration of organs, breathing difficulties, acid reflux and, in severe cases, strangulation of a bowel segment — a medical emergency.

Although not all diaphragmatic hernias require immediate medical intervention, some can pose serious health risks. Fortunately many hiatal hernias can be successfully treated, whether through lifestyle changes, medication or, in more severe cases, surgery.

How can the diaphragm be examined? 

Various methods are available to examine the diaphragm. A common method is spirometry, which measures lung function to determine whether the diaphragm is functioning properly. In addition, an ultrasound of the diaphragm can be performed to provide information about its movement and condition. If a diaphragmatic hernia is suspected, additional standing and supine X‑rays can be taken to identify possible displacement of internal organs. Combining these diagnostic approaches allows for an accurate diagnosis that forms the basis for selecting an appropriate treatment strategy and preventing possible complications.

How to train the diaphragm: best tips and tricks

• Incorporate yoga and Pilates into your training routine to promote diaphragm mobility. Some yoga and Pilates exercises can be beneficial. For example, poses such as the “Katzenbuckel" or the “Kind" in yoga help stretch and relax the area around the diaphragm.
• Practice conscious diaphragmatic breathing by inhaling deeply through the nose and letting the abdomen rise. Hold for a few moments, then exhale slowly through the mouth. Repeat this exercise several times daily.
• Try balloon breathing by attempting to inflate a balloon through the mouth to strengthen the diaphragm.
• Use singing or humming as an unconventional but effective method to train the diaphragm through the vibrations produced.
• Try a mobility breathing exercise by resting your upper body on a table and breathing deeply in and out. Repeat the exercise for five to ten minutes. This helps release tension throughout the trunk.
• Avoid spicy foods, caffeinated drinks, hard‑to‑digest foods, alcohol and carbonated beverages to reduce discomfort.
• Split your meals into smaller portions throughout the day to relieve the stomach and reduce the risk of heartburn.
• After eating, avoid lying down immediately. This gives the body time to digest food properly. Elevating the upper body while sleeping can also help prevent acid reflux. 
• Avoid heavy lifting, smoking and wearing tight clothing to prevent worsening of a diaphragmatic hernia.
• Regularly practise relaxation techniques such as meditation to reduce stress and relieve the diaphragm.
• Drink enough water to keep the body hydrated and optimise diaphragm function.
• Seek medical advice promptly if symptoms persist or if you suspect diaphragm problems to obtain the best possible treatment.

The diaphragm is the unsung hero of our breathing — often overlooked but undeniably vital. It influences many aspects of our wellbeing, from mobility to vocal power. Caring for and strengthening this muscle can not only improve breathing but support the health of the entire body.