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  • Writer's pictureAndray Voronov

The Importance of Diaphragmatic Control in Lower Back Pain Rehabilitation

When it comes to lower back pain, there's a lot of focus on exercises, stretches, and techniques to improve strength and flexibility. But what about the breath? Believe it or not, the way we breathe can have a big impact on lower back pain and rehabilitation. And that's where diaphragmatic control comes in, according to the research of Robert McKenzie and Stuart McGill.

First, let's talk about the diaphragm. It's a muscle located at the base of the ribcage that plays a key role in breathing. When we breathe in, the diaphragm contracts and moves down, creating space for the lungs to expand and fill with air. When we breathe out, the diaphragm relaxes and moves up, pushing the air out of the lungs. Simple enough, right? But here's the thing: most of us have a tendency to breathe shallowly and use the muscles in our chest and shoulders instead of the diaphragm. This is called "chest breathing" and it can contribute to lower back pain(McKenzie & May, 2003).

Here's where things get interesting, according to McKenzie and McGill's research, chest breathing can lead to a lack of support to the spine, leading to increased stress on the lower back. This is like, imagining a building with a weak foundation. The building will collapse and fall. Similarly, when the diaphragm is not working properly, the spine doesn't have the support it needs, leading to pain and injury. That's why diaphragmatic control is important in lower back pain rehabilitation(McGill, 2007). By learning to breathe deeply and engage the diaphragm, we can improve support to the spine, reduce stress on the lower back, and ultimately, alleviate pain.

The good news is that you can learn to control your diaphragm and get better at it with practice. One simple exercise involves laying on your back. Place one hand on your stomach, and concentrate on deep breathing into the hand. As you take a breath in, the hand should go up. This shows that your diaphragm is contracting and moving down. As you let your breath out, the hand should drop, showing that your diaphragm is relaxing and moving up. If you have trouble with this, you can also try placing a small weighted object (such as a dumbbell) on your stomach. This provides some added mechanical feedback that may help bring your awareness to the area.

It's important to note that diaphragmatic control is not a standalone solution for lower back pain. It works best in conjunction with other techniques, such as McKenzie's progression of exercises and McGill's "big three" core exercises(McGill, 2007), which are bird dog, curl-up, and side plank. By working on diaphragmatic control and incorporating it into a comprehensive rehabilitation program, we can breathe easy and reduce pain and injury.

In conclusion, diaphragmatic control is a crucial component of lower back pain rehabilitation. By learning to breathe deeply and engage the diaphragm, we can improve support to the spine, reduce stress on the lower back, and ultimately, alleviate pain. So, take a deep breath and give it a try.


McKenzie, R. A., & May, S. (2003). The lumbar spine: mechanical diagnosis and therapy (2nd ed.). Waikanae, New Zealand: Spinal Publications.

McGill, S. (2007). Ultimate Back Fitness and Performance (4th ed.). Wabuno Publishers.

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