Tests for Diaphragm Function
TEST 1: RIB EXPANSION TEST
When you take a deep breath in, your rib cage should expand fully and equally on both sides. To perform this test, stand or sit facing a mirror. Place both hands over the rib cage as shown, with the middle fingers touching over the solar plexus area. Now take several deep breaths in and out and watch your hands move as the rib cage expands and contracts.
Breath Neutral Deep Breath In
(Not Passing - Right)
Passing means your hands should separate equally on both sides, leaving a gap a couple finger widths apart. Not Passing is indicated by one or both hands not separating fully. In the example above, the right side does not expand as fully as the left.
TEST 2: PALPATION OF DIAPHRAGM & STOMACH
To evaluate the Diaphragm manually, sit and lean forward or lie on your back with knees bent to slacken the abdominal muscles. Then, press your fingers up and behind the ribs on both sides (as shown), making sure you are on the underside of the ribs and not pressing down on any organ tissue. As always, feel for taut bands of muscle and tender spots (trigger points).
Then check for Hiatal Hernia by pushing with both hands up on the Underside of the stomach (as shown). The stomach is located just to the left of center beneath the left rib cage. If there is pain upon pushing the stomach up into the Diaphragm, it might indicate that the stomach is pressing up against or slipping slightly through the Hiatus.
3 Step Trigger Point Self-Care for the Diaphragm
You can improve the function of your Diaphragm with simple Trigger Point techniques!
STEP 1: Diaphragm Trigger Point Compression
Assume the same position as you did for palpation - sit leaning forward - or lie on your back with your knees bent to put slack in the abdominal muscles. Press up under the ribs and outward to compress the edges of the Diaphragm and stretch the muscle fibers. Wherever you find a tender spot or taut band, press to tolerance and hold for two full breaths. The breaths help stretch the Diaphragm further.
HICCUP REMEDY: To eliminate an episode of hiccups, feel along the front lower rib cage and press up and under into the Diaphragm muscle. When a hiccup occurs, you will feel a strong contraction in the Diaphragm. Notice the rhythm of the contractions. Anticipate the next hiccup and just as it starts press up firmly enough to inhibit the contraction. Let up pressure when the hiccup contraction begins to dissipate. You many need to repeat several contractions to completely eliminate the episode of hiccups.
STEP 2: STOMACH / ESOPHAGUS STRETCH (good for Hiatal Hernia)
To relieve pressure from the stomach pressing up into the Diaphragm, we are going to stretch the stomach downward away from the rib cage. Start by pressing the fingers up under the ribs on the left center of the rib cage (on top of the stomach) while inhaling. The breath in will flatten the Diaphragm and push the stomach downward so you can reach on top of it more easily.
Then, firmly press downward on top of the stomach and exhale rapidly and fully. This rapid breath out will pull the Diaphragm up into the rib cage as you are holding the stomach downward and away from it. Repeat several times until you feel you have adequately stretched to create some space between the stomach and the Diaphragm.
STEP 3: Sternum Massage (Sternalis Muscle)
The final step is a simple massage and compression of any tender spots on your Sternum. Circular motions with both hands as shown in the picture is effective. Also, slower compression with the fingers or other self-care tool works well. Painful areas over the Sternum have been associated with inhibition of the Diaphragm, perhaps due a relationship between the Sternalis Muscle (along the front and sides of the Sternum) and the Diaphragm. Clinically, we have seen that relieving these tender spots on the Sternum can significantly help restore healthy tone of this important life-giving muscle.
There is one last clinical correlation that is worth noting when we speak of the Diaphragm. Stress and anxiety and close-heartedness are associated with tight shallow breathing, whereas peace, gratitude and open-heartedness are associated with relaxed deep breathing. Perhaps one of the best things you can do to keep your Diaphragm functioning well is to remain accepting and grateful for life and to think of acts of kindness that you would enjoy doing for someone. A good practice of breathing exercises, such as those found in Hatha Yoga, can be very helpful, as well!
You can repeat the above steps within comfort a couple times per day and take note of how your breathing deepens and any symptoms of Hiatal Hernia are relieved. Please make sure to check with your trigger point specialist for any assistance you require. Also, remember to please have any symptoms checked out by the appropriate medical professional.
Pass along this issue of Muculoskeletal Update along to anyone who needs to breath more fully!