Why we assess Diaphragmatic Breathing

Diaphragmatic Breathing Matters More Than Most People Think

Breathing is the one movement you do more than any other, up to 20,000x a day.

It happens while you sleep, while you train, while you work, and while you recover. Because it is constant, small inefficiencies add up fast. Over time, a suboptimal breathing strategy can influence how your ribcage moves, how your spine is supported, how your neck and shoulders behave, and how your nervous system responds to stress.

Diaphragmatic breathing is not a trendy wellness concept. It is a foundational human pattern that supports both respiration and mechanics. Research shows the diaphragm does more than move air. It also participates in trunk control and spinal stability demands, and that role can shift when breathing becomes more effortful. (PubMed)

What “Diaphragmatic Breathing” Actually Means

The diaphragm is a dome shaped muscle that separates the thorax from the abdomen. During an efficient inhale, the diaphragm contracts and descends. This helps expand the ribcage and encourages a gentle, three dimensional expansion through the lower ribs and abdomen and stabilizes our posture through intra-abdominal pressure.

During an efficient exhale, the diaphragm returns upward as air leaves the lungs.

In real life, good diaphragmatic breathing does not mean your belly dramatically rises and falls, and it does not mean you force a huge inhale. It means the diaphragm is doing its share of the work without the body relying excessively on accessory muscles like the scalenes, sternocleidomastoid, or upper chest strategies.

Why Breathing Patterns Affect Pain, Posture, and Movement

The diaphragm is also a postural muscle

The diaphragm is active not only for breathing but also during tasks that challenge trunk stability. When respiratory demand increases, its postural contribution can change, which helps explain why people often feel less stable and more “tight” when they are breathing harder or breathing inefficiently. (PubMed)

In people with chronic low back pain, research has found altered diaphragm function during postural tasks compared with controls. (JOSPT) That does not mean the diaphragm is the only issue, but it supports a practical clinical point: breathing and trunk control are linked, and ignoring one can limit progress on the other.

Breathing influences intra abdominal pressure and trunk coordination

A well coordinated inhale and exhale interacts with the abdominal wall, pelvic floor, and spinal stabilizers to manage pressure and movement. When a breathing pattern becomes shallow, upper chest dominant, breath held, or chronically over ventilated, people often compensate elsewhere. Common places include the neck, upper traps, ribs, low back, and hip flexors.

Posture and breathing affect each other

Forward head posture and thoracic positioning can alter breathing mechanics and measurable respiratory function, and breathing focused interventions are being studied in posture related complaints. (PMC) This matters clinically because posture is not “fixed” by forcing someone to sit up straighter. It is often influenced by how they stack their ribcage over their pelvis, how they manage pressure, and how they breathe under load.

Why We Assess Breathing Patterns in a Movement or Bodywork Setting

A breathing assessment is not about judging how you breathe. It is about identifying the strategy your nervous system defaults to, especially under stress, fatigue, pain, or effort.

Breathing is one of the fastest windows into autonomic state. Diaphragmatic and slow breathing strategies have been shown to influence stress related outcomes in controlled research settings, including changes in affect and cortisol responses. (Frontiers) Breathing patterns can also influence heart rate variability measures, which are often used as a proxy marker of autonomic flexibility. (PMC)

If someone is doing “all the right exercises” but they are breath holding, chest breathing, or bracing all day, the system may keep choosing protective strategies. That can show up as recurring tightness, poor tolerance to training volume, persistent neck and shoulder tension, or a low back that never quite feels stable.

What a Breathing Pattern Assessment Looks Like

In clinic - specifically our Neurokinetic therapy session - our breathing assessment is typically simple and observational first, then we slowly direct and teach the clients how to connect, expand and breath into the lower ribs, back and pelvic floor. This can be challenging at first for many clients. A clinical framework for integrating breathing pattern assessment into a musculoskeletal exam has been described in the rehabilitation literature. (PMC)

We might look at:

1. Breathing rate at rest

2. Where motion is occurring, more upper chest, more lower ribcage, more abdominal expansion, or very little motion

3. Rib flare and “stack,” meaning how the ribcage sits over the pelvis

4. Accessory muscle dominance, especially visible neck activity at rest

5. Breath holding, sighing, or irregular rhythm

6. Nasal versus mouth breathing habits, particularly at rest

7. How breathing changes with simple movements like reaching, squatting, or lunging

8. How the pattern changes when load, fatigue, or complexity is added

Why Breathing Retraining Can Improve Outcomes

Breathing retraining is not a substitute for strength, mobility, or skilled hands on care. It is a foundation that can make those inputs stick and last longer.

Research in chronic low back pain suggests that adding diaphragmatic breathing exercises to core focused programs may improve outcomes compared with core exercise alone in certain measures. (PubMed) The practical takeaway is not that breathing “fixes” back pain. The takeaway is that when breathing mechanics and pressure control improve, people may be able to access better trunk coordination and move with less protective tension.

The Most Important Part: Transfer Into Real Life

Breathing drills only matter if they change what happens during your day.

If you do five minutes of breathing practice but spend the next ten hours bracing your abs, living in shallow chest breathing, or holding your breath every time you stand up, your nervous system will keep rehearsing the pattern it thinks is safest. Real progress happens when the new strategy shows up during work stress, in the car, during training, during parenting, and during sleep.

That is why we assess breathing patterns, and that is why we revisit them constantly.

We are not chasing perfection. We are building a more adaptable system.

Peer Reviewed Studies and Clinical Papers

Ma X, Yue Z, Gong Z, et al. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology.
https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2017.00874/full

Hodges PW, Gandevia SC. (2001). Postural activity of the diaphragm is reduced in humans when respiratory demand increases. The Journal of Physiology.
https://pubmed.ncbi.nlm.nih.gov/11744772/
https://physoc.onlinelibrary.wiley.com/doi/abs/10.1111/j.1469-7793.2001.00999.x

Kolář P, et al. (2012). Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy.
https://www.jospt.org/doi/10.2519/jospt.2012.3830

Chapman EB, et al. (2016). A Clinical Guide to the Assessment and Treatment of Breathing Pattern Disorders in the Physically Active. International Journal of Sports Physical Therapy.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5046973/

Bradley H, et al. (2014). Breathing Pattern Disorders and Functional Movement. International Journal of Sports Physical Therapy.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3924606/

Russell MEB, et al. (2017). Inclusion of a rest period in diaphragmatic breathing increases high frequency heart rate variability. Psychophysiology.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5319881/

Adams J, et al. (2009). A Randomized Controlled Trial of a Controlled Breathing Intervention on Heart Rate Variability after Myocardial Infarction. Annals of Behavioral Medicine.
https://pubmed.ncbi.nlm.nih.gov/19506003/

van Dixhoorn J, Duivenvoorden HJ. (1985). Efficacy of Nijmegen questionnaire in recognition of the hyperventilation syndrome. Journal of Psychosomatic Research.
https://www.sciencedirect.com/science/article/pii/002239998590042X

Grammatopoulou EP, et al. (2014). Hyperventilation in asthma: a validation study of the Nijmegen Questionnaire. Journal of Asthma.
https://pubmed.ncbi.nlm.nih.gov/24823322/

Han J, et al. (2016). Effects of forward head posture on forced vital capacity and deep breathing. Journal of Physical Therapy Science.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4755989/

Masroor S, et al. (2023). Effect of Adding Diaphragmatic Breathing Exercises to Core Stabilization Exercises in Patients With Chronic Low Back Pain. Journal of Chiropractic Medicine.
https://pubmed.ncbi.nlm.nih.gov/38205226/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10774616/