The American Lung Association have a slogan – ‘If you can’t breathe, nothing else matters’ and I think that’s true for so many aspects of women’s health – brain, back pain, bladder and bowel function…even hot flashes and heart health!!

Where is the Diaphragm and what does it do?

The diaphragm is a double domed muscle, attached to the sternum, the lower six intercostal margins and the lumbar vertebra, as well as its fascial connections to the psaos, quadratus lumborum, transversus abdominus, rectus abdominus and pelvic floor muscles. As well as its respiratory function it is also a key lumbopelvic stabiliser, as well as a reflector and driver of emotions.

So how does breathing affect back pain? The Diaphragm works in conjunction with the pelvic floor muscles, the deep abdominals and the multifidus muscles of the spine to provide us with dynamic stability and allowing us to move through the world. In a large study in 2014 looking at ‘The relationship between Incontinence, Breathing disorders, Gastrointestinal disorders and Back Pain in Women’, the authors found that ‘ evidence of a relationship between Back Pain, incontinence, respiratory problems, and GI symptoms in which the presence of one symptom is associated with the development of another’ and in fact from an earlier study from the same authors, the research shows that breathing and continence are more linked to back pain than obesity and or level of activity! If we aren’t breathing fully, deeply and widely, our pelvic floor muscles can’t function at optimal levels which may mean that we are more likely to be unable to generate sufficient closure forces around our bladder neck when we cough or sneeze – breathing deeply requires allowing our abdominal muscles to relax and expand with each inhale and similar downward movement should be happening with our pelvic floor muscles: as we breathe in, our diaphragm moves down and widens, our pelvic floor lengthens downwards and our abdominal wall should gently expand to accommodate the movement of our organs. Try placing one hand on your sternum and the other on your abdomen and follow your breath to see where it goes – is one area more dominant? What if you place your hands on your lower ribcage? Can you feel both sides of your ribs opening and expanding equally with each breath? Now tune into your pelvic floor; as you inhale, can you feel the pelvic floor expand, relax and lengthen down towards your chair? As you exhale, can you feel it move ever so slightly back up? This is a great first step towards re-establishing a full functional range of motion and function of the pelvic floor muscles, essential for controlling the opening and closing of your sphincters!

Have you ever tried scarf breathing? Its nothing more complicated than wrapping a scarf around your ribcage, so you can feel where to direct your breath – sometimes we are great at focusing on directing the breath downwards and laterally but we also need to make sure we are expanding 360′ – all the way around the ribcage! This can be a great tool to focus your brain to direct the breath down and out, and perhaps to practice a few rounds of 4,7,8 breathing; inhale for 4, hold for 7, and slow down your exhale, through pursed lips, to make it last for a count of 8! Try this sitting and allow your breath to return to normal before you stand up (**if you have any medical/ health issues, do consult with your healthcare provider first!)

In another study from 2012, the authors showed that deep, slow breathing can change pain perception, mood and autonomic functioning.Our digestive health is dependent on good autonomic functioning – when we are stressed, we go into sympathetic drive, our ‘fight or flight’ mode but when we are calm and relaxed, we are in more of a parasympathetic state, where we can ‘rest and digest’ – we’ve probably all noticed that our digestive systems are very responsive to our emotional wellbeing – do you become constipated when you are stressed? Or perhaps a bit more prone to diarrhoea? We can’t change the fact that as long as we are alive, we will be exposed to stress, but what if we could improve our stress management by practicing a few simple breathing techniques? Alternate nostril breathing has been shown to alter cardiac output (in a good way!) – just five minutes a day of this simple exercise could benefit your heart! The North American Menopause Society recommends ‘..breathing exercises such as paced respiration (slow, deep, abdominal breaths in through the nose and out through the mouth).

Have a look here for some more breathing strategies:

Remember, if you can’t breathe, nothing else matters! For optimal pelvic floor and core function – you have to start with the Diaphragm!!


If you’d like to learn more about working with Peri-Menopausal Women, check out the 3rdAge Online Global Certification, co-created by myself, Jenny Burrell and Jessica Drummond 

Or if you are just starting your journey into Pelvic Health, I’d love to recommend the Pelvic Floor and Core Foundations course, co-created by Myself and Jenny Burrell; this covers all the basics of pelvic health and is fast becoming a best seller with glowing recommendations!

Until next time

Onwards & Upwards!