The Diaphragm-Myofascial Connection

Aparna Rajagopal, PT, MHS is the lead therapist at Henry Ford Macomb Hospital's pelvic dysfunction program, where she treats pelvic rehab patients and consults with the sports therapy team. Her interest in treating peripartum patients and athletes allowed her to recognize the role that breathing plays in pelvic dysfunction. Aparna and Leeann Taptich DPT, SCS, MTC, CSCS co-authored the course Breathing and Diaphragm which helps clinicians understand breathing mechanics and their relationship to the pelvic floor.

The diaphragm is well established as the primary muscle utilized for breathing and as an important contributor to the control of intra-abdominal pressure.

The diaphragm also establishes a myofascial connection from the neck to the foot linking the pelvic floor to the entire body. The diaphragm links the pelvic floor to the ribs, pelvis, hip, and shoulder through the fascia. While a firm definition of fascia is debatable, fascia is a continuum of collagen containing loose and dense fibrous connective tissue that permeates the whole human body effectively connecting one part of the body to another, literally from the head all the way to the toes (1). Fascial tissue contains proprioceptors and nociceptors and changes in fascial tension can influence the function of the musculature that it connects and in turn influence motor control, length-tension relationships, and overall posture (2).

Starting from the top of the head, the neck fascia connects anteriorly to the rectus abdominis through the pectoralis and obliques as well as the endothoracic fascia (2). The deep neck flexors and sternocleidomastoid muscles attach to the hyoid bone and the clavicle connecting the fascia of the chest and abdominal wall (3). The anterior fascial connections continue from the rectus abdominis and obliques through the pubis and pelvic down to the hip flexors and quadriceps.

Posteriorly, the neck is connected to the sacrum through the thoracolumbar fascia which links the upper trapezius, latissimus dorsi, and gluteal musculature (2). Fascia starting at the suboccipital muscles connects down to the hamstrings, gastrocnemius, and plantar fascia (3). Deeper, and posterior, to the thoracolumbar fascia, the endopelvic fascia has a direct connection with the pelvic floor musculature including the levator ani and ischiococcygeus as well as the obturator internus and piriformis (3).

Proper functioning fascia is necessary to ensure good diaphragm and pelvic floor function. Dysfunctional fascia can create altered breathing mechanics and pelvic floor dysfunction that in turn can affect posture, alter walking mechanics, and affect load transfer from the upper to lower body (2).

In the Breathing and Diaphragm course scheduled for March 9-10, 2024 taught by Aparna and Leeann, you will learn to assess and treat myofascial connections from the upper and lower body. Myofascial assessment and treatment will help the clinician link the whole body holistically to the treatment of incontinence, constipation, pelvic pain, low back pain, and breathing pattern disorders.

References:

1. Adstrum S, Hedley G, Schleip R, Stecco C. Yucesoy CA.  Defining the fascial system.  Journal of Bodywork and Movement Therapies.  2017; 21: 173-177.
2. Tim S, Mazur-Bialy AI.  The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor.  Life.  2021; 11: 1397.  https://doi.org/10.3390/life11121397.
3. Bordoni B.  The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 1.  Cureus. 2020; 12(4): e7794.  https://doi.org/10.7759/cureus.7794.