Pain Free Athlete: Breathe Well to Reduce Back Pain

The Pain Free Athlete
Breathe Well to Reduce Back Pain

Did you know that respiration (breathing) and back pain are intimately linked? A 2006 study found that “the presence of respiratory disease is a stronger predictor for lower back pain than other established risk factors.” And “clinical observation supports the notion that patients with poor breathing muscle co-ordination are more prone to chronic back pain and neck pain.”(Courtney R The functions of breathing and its dysfunctions and their relationship to breathing therapy International Journal of Osteopathic Medicine 12 (2009) 78-85)

Why does poor breathing cause low back pain?

It’s complicated, but I’m going to do my best to explain it simply. First, realize that there are forces acting on the low back from above and below. Above is the diaphragm, and below are the hip flexors, the psoas and iliacus muscles. The fascia, connective tissue around these muscles, connects them in movement. Tom Myers, originator of the Anatomy Trains Myofascial Meridians, refers to this continuous line of tissue as “the cobra.” If you look at the Anatomy Trains image shown to the right, the cobra is the maroon line.

You can see the rounded head of the cobra in the rib cage, which represents the diaphragm in the relaxed position. It attaches to the lumbar spine, as does the psoas, which extends downward from its spinal attachment across the front of the hip and into the top of the leg bone, femur. Therefore, changes in the position of the diaphragm can affect pelvic and leg position, and vice-versa. Myers said it well: the diaphragm is rooted to the lower body through the leg.

The diaphragm is the primary muscle of inspiration, breath. Upon inhale the diaphragm moves down towards the pelvis and flattens. Upon exhalation, breathing out air, the diaphragm moves back up into the rib cage and returns to its domed position. For many people, however, the diaphragm does not fully re-dome and remains in a slightly flattened position upon exhale.

The lengthened diaphragm from an incomplete exhale lifts the rib cage up and away from the spine. This upward pull brings the lumbar vertebrae and discs forward and up with it increasing the arch in your low back.

When this upward-pulling action is combined with the downward pull of tight hip flexors (due to extended sitting or overuse with activities like cycling, walking or running) the arch in the lower back is further exaggerated, creating dangerous compressive forces on the lower spine. This results in disc injuries, spinal degeneration and muscle imbalances. Ouch!

Breathe well to reduce back pain!

Editor’s note: Jessica Kisiel is a local wellness professional specializing in injury recovery and pain management through posture alignment. She is an Advanced Exercise Therapist certified by Egoscue University® and integrates Postural Respiration into her therapy. Direct questions about this column to Kisiel at

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