Optimizing Function of the Diaphragm & the Pelvic Floor

Many people are willing to go the extra step to increase their efficiency and function when it comes to their sport: the latest and greatest running shoes, wrist wraps and weight belts to hit a PR or a personal trainer for the extra push.  What if we could improve our function and decrease pain for free?  I think I would have your attention.  
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As we spend hours each week training, two very important muscle groups are ignored:  the diaphragm and the pelvic floor.  It is not for lack of use; every time you take a breath the diaphragm contracts and lowers to help fill your lungs. The pelvic floor works double time; these muscles are firing like crazy to keep you stabilized with each breath and during movements. If they work all day long, they should be strong - right? Not always the case.

The “core”:

Often times the “core” and “abs” are used interchangeably.  The abdominal muscles that you see in a six pack are just the most superficial muscles of the core.  The deep core is comprised of the diaphragm, pelvic floor, transverse abdominis and multifidi.  These four muscles make up the “canister” of the inner core.  As you see in the picture below, the glottis is also included in this as it has direct function with the diaphragm, and thus the pelvic floor.  The transverse abdominis is a deep core muscle that is often referred to as a corset.  It attaches to your pelvis and lower ribs and even has connections to the diaphragm through fascia.  The multifidi are small back muscles that attach your vertebra and also connect to the pelvis at the lower levels.  See how it is all connected? It is important to keep in mind that these are endurance muscles.

The diaphragm is the second largest muscle in the body!  It attaches from the chest bone, to the ribs and down to the upper three lumbar vertebra.  The pelvic floor is a group of smaller muscles that act as a hammock in the bottom on the pelvis.  They attach from the sacrum to the inner ring of the pelvis.  The diaphragm and pelvic floor have an intimate relationship of synergy during breathing.  With inhalation, the diaphragm draws down and the pelvic floor drops simultaneously.  It is essential that they have the endurance to move with each breath, but the pelvic floor must also have the strength to withhold increases in intraabdominal pressure.
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When the diaphragm and pelvic floor are stacked one on top of the other, you are able to more efficiently breathe and manage the pressure in your core. This is best achieved through optimal posture.  When you are unable to manage the pressure, it will push towards the weakest area: often the pelvic floor.  This leads to stress urinary incontinence, or peeing during jumping, running, laughing, sneezing, etc.  This can be exacerbated by poor postures.

Can you imagine how each of these poor postures affects your canister? Both sway back and increased lordosis move the core out of the optimal stacked position. Thoracic kyphosis, rounded upper back, puts your diaphragm in a shortened position, thus making it less efficient. 

Breaking or bending the canister is easily identifiable in poor overhead lifts and poor running form.  The picture below shows that with a poor finish overhead, her diaphragm and pelvis are no longer stacked.  This affects her breathing efficiency, the internal pressure and work of the pelvic floor.  Not to mention, this puts her big movers, specifically the lats, at a disadvantage and can cause back pain.  You have probably also observed runners moving their core out of the optimal position.  Those who run bent over at the waist or those who lean their torso back as if running downhill are essentially bending the canister.

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When you lift something, the deep back and abdominal muscles will contract for stabilization and the pelvic floor should slightly lift to help secure the lower abdominal organs.  However, if you hold your breath and bear down, the pressure pushes the pelvic floor down.  This can make you more susceptible to leaking or pelvic pain.  So I should never hold my breath?  No, you absolutely must hold your breath or brace with certain athletic movements.  Especially lifting heavy weights!

How to Brace:

Bracing or breath-holding is common for many athletes. Learning how to properly brace will ensure success in the movement and the proper distribution of tension throughout the body.  Many times, tension is increased but only in the superior and inferior directions, or up and down.  Remember the picture above: this means that the diaphragm and the pelvic floor are receiving most of the force.  Luckily our diaphragm is big and smart, it knows that in order to live it must work.  Unfortunately, the pelvic floor then becomes the weakest link and may be overtaken by the pressure.  This results in SUI, or leaking during exercise.  Focusing on sending the tension in 360 degrees will be helpful to reduce this downward pressure.  Rather than just bearing down through your thorax, add tension to your hips and shoulder girdle.

But what if you’re a runner?  Obviously you do not want to hold your breath throughout a long run or even periodically.  Then it is important to either down train or strengthen your pelvic floor, depending on your issue.  If you experience problems with bounding or impact such as a box jump, exhaling on the landing will help to decrease the pressure in the thorax and load on the pelvic floor.

Whether you have an underactive, overactive or normal pelvic floor, learning to properly brace with the diaphragm and pelvic floor engagement is important. By spreading the tension throughout your body, you are able to sustain more tension for greater loads. 

Pulling it all together:

As you train, don’t neglect two important muscle groups: the diaphragm and the pelvic floor.  They are often forgotten since you cannot see them in the mirror. But if you optimize their function, then your workouts will improve!  Maintaining optimal posture is a great start; this applies to quiet standing, as well as during workouts.  When you brace, be sure to spread tension throughout your body to avoid pushing it all to the pelvic floor.  

If you continue to experience issues or wish to have someone closely screen your movement with breathing and bracing, come by and see us at Athletes’ Potential.  This is just the tip of the iceberg!

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Thanks for reading,
    
 Dr. Jackie, PT, DPT

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Pictures
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