2d • General discussion
How your breathing could be secret to pain and performance
Back pain. Shoulder pain. Neck pain. Rib pain.
What do all of these have in common from a rehab standpoint?
They almost always start with the same exercise:
diaphragmatic breathing (belly breathing).
At first glance that sounds odd. Why would we focus on breathing when the pain is so far away from the lungs?
Because your breathing pattern alters everything you do.
Whether you’re a college athlete or someone who sits at a desk all day, you breathe thousands of times per day. If that breathing pattern is dysfunctional, then every other movement you make is built on compensation.
What is the diaphragm, really?
The diaphragm is a dome-shaped muscle that sits underneath the lungs. It separates the chest cavity (heart and lungs) from the abdominal cavity (digestive organs and more).
It’s unique because it has two critical roles.
First, respiration.
When the diaphragm contracts, it descends and flattens, expanding the lungs and drawing air in.
Second, core stability.
The diaphragm forms the top of what we call the core cylinder:
- Diaphragm on top
- Pelvic floor on the bottom
- Core musculature (obliques, rectus abdominis, multifidus) wrapping around
As the diaphragm descends, it pushes abdominal contents downward. The pelvic floor resists that pressure (a topic that deserves its own post). This interaction creates intra-abdominal pressure (IAP).
IAP acts like an internal weightlifting belt, stiffening and stabilizing the spine against shear and bending forces.
This is the foundation of proper core engagement.
So, what happens when we don’t use it properly?
When the diaphragm doesn’t do its job, people become chest-dominant breathers.
Instead of expanding through the abdomen and ribs, the body recruits muscles around the neck and shoulders to pull air in from above. These muscles were never designed to be primary breathing muscles.
Over time they fatigue, posture deteriorates, the head drifts forward, the shoulders round, and those same muscles can no longer properly support the neck and shoulders.
Pain often follows.
The piece most people miss: the nervous system
So far we’ve only talked about mechanics. But there’s another layer that may be even more powerful.
Diaphragmatic breathing strongly influences the autonomic nervous system, which has two primary states:
- Fight or flight
- Rest and digest
The diaphragm is innervated by the phrenic nerve, which is closely linked to the vagus nerve — a major driver of the parasympathetic (rest and digest) system.
In practice, belly breathing:
- Lowers heart rate
- Reduces blood pressure
- Decreases cortisol levels
This matters enormously for people in pain, but it also benefits high performers. One study showed collegiate athletes who used diaphragmatic breathing had better relaxation and concentration under stress. Other research suggests improved muscle tone and breathing efficiency help deliver oxygen more effectively and reduce lactate buildup during exercise.
Then why do I work on this with every patient
Because this is a skill.
And like any skill, it requires practice.
The better someone gets at using their diaphragm, the more stable their core becomes — and the stronger and more efficient every surrounding muscle can be.
Whether you’re someone who sits all day and feels constant low back tightness, or someone who deadlifts heavy and ends up with back spasms afterward, this foundation matters.
Breathing sets the stage for everything else.
I’ll make another post focused entirely on how to train and integrate diaphragmatic breathing into workouts and daily life. For now, check the Classroom tab where I posted a short video walking through the basics.
Happy Sunday.
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How your breathing could be secret to pain and performance
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