Back Pain, Core Muscles and Breathing…

Breathing and the core muscles are connected!

Weird isn’t it? On the surface it’s hard to believe a few breathing exercises can actually make any difference to your back pain! Well believe it or not it CAN :-)

The hardest part is describing it on paper…

I will start with the muscles that make up our spinal support system – these muscles are the local stabilisers commonly referred to as core muscles

They are:

Multifidus, Transverse Abdominis, the Internal Obliques, the Diaphragm and the Pelvic Floor muscles

Core musclesBreathing is something we all do and it happens without us even thinking about it but let’s look at how this happens

As we breathe in the diaphragm (the main muscle of inspiration (breathing in)) contracts, flattens and lowers (descends) drawing air into your lungs. To make space for the diaphragm as it lowers the pelvic floor muscles also descend and the abdominal wall will expand.

This action increases the intra-abdominal pressure (IAP) – I will come back to this in a moment!







As we breathe out the diaphragm returns to it’s resting domed position as the abdominal wall softens and the pelvic floor rises.

It is this underlying gradual change in pressure with the well-timed co-ordination of all of these muscles that provides the trunk and spine stability.

So exactly how does this work?

Any demand on the body beyond sitting and standing will require a varying degree of increase in trunk stiffness. In other words an increase in the intra-abdominal pressure (IAP). This reduces the forces or load on the spine.

The main muscle which influences the IAP is the diaphragm.

Although you can learn to increase your IAP via bracing of the abdominal muscles it isn’t as effective. It creates a really stiff trunk, which restricts your movement and can cause more back pain! Changes in IAP happen anyway, in anticipation of any kind of limb movement, lifting, pushing, pulling or when the trunk is challenged in anyway.

The relationship between your ‘core’ muscles and breathing is something of a challenge to get your head around but think about the last time you had a bad cough or cold… I am sure you felt the effects on your stomach muscles :-)

Research has shown that just before you move your arm the diaphragm contracts (tightens) 20 milliseconds before! With the abdominal muscles contracting at the same time. This is called the feed-forward response in other words your nervous system is always just a step ahead of you! Anticipating how much muscle tone is needed and where to make sure there is minimal stress on the spine – clever eh?!

There is also evidence that shows the diaphragm will switch from being the main muscle for deep breathing to the main muscle creating postural stability (increasing IAP) – in other words it works to hold your trunk steady! There is no need to worry about breathing though… this always takes priority over spinal stability ;-)

So how does back pain affect this?

Ok so we know that the diaphragm is the main muscle contributing to an increase in IAP and that the muscle needs to lower and flatten to do this. We also know the abdominal muscles (transverse abdominis, internal obliques) contract at the same time.

So researchers have looked at the difference in the performance of these muscles in people who have chronic low back pain and found that the diaphragm doesn’t expand (spread) as well when they asked subjects to lift and arm and hold it for 20 seconds. Instead the arm lift resulted in a bracing / stiffening effect of the abdomen, which as we now know does not increase the IAP and therefore, does not create effective spinal stability.

They also noted a change in the way the diaphragm worked when the subjects took a breath in, suggesting an increase in force/pressure on the lumbar spine (lower back).

Finally, another study has shown that individuals with recurrent low back pain create a stiff posture to maintain balance regardless of whether they were out of breath or not.

So in summary…

The diaphragm (the main muscle of breathing) works with the local ‘core’ muscles to create an increase in intra-abdominal pressure (IAP). The increased IAP helps spread the forces along the spine evenly by creating a slightly stiffer spine. BUT still allows your spine to move and flex whilst you are moving your arms, legs, push, pull and lift! This is not the same as bracing.

Back pain reduces the effectiveness of the diaphragm and therefore, the IAP. This leads to a less supported and much stiffer spine (which doesn’t bend and flex as well) and the forces / load on the spine are not spread evenly when you move your arms, legs, lift, push or pull. This may increase your risk of feeling pain. This is commonly referred to as bracing.

And the answer is?

Yep that’s right some breathing exercises :-)!! Try them first and last thing









  • Lie on your back with your knees bent and feet on the floor or bed
  • Head supported if you need on a small pillow or towel
  • Place one hand on your chest – just under your throat
  • Place one hand on your stomach – low down below your belly button
  • Allow your back to settle nicely into the bed / floor


  • Start by just being aware of how you breathe – so you get more chest movement or more belly movement?
  • Then practise taking 3 or 4 breaths in and out and only allowing your belly to move up and down (or in and out!) – keeping your chest and top hand completely still
  • If you feel like you are getting a bit breathless don’t worry this is perfectly normal just allow yourself to go back to your normal rhythm
  • Do these 4 or or 5 times more

Step 2!


  • Spread your finger and thumbs apart and place your hands either side of your lower ribs – so your hands are now around the side of your trunk
  • Practise taking 3 or 4 breaths and concentrate on allowing your ribs to expand sideways out into your hands – so you are filling the bottom of your lungs and your ribs move up and outwards
  • Do these 4 or 5 times more


Step 3


  • Hands are now on the on the top of your chest – palms down




  • Practise breathing up into your upper chest – feeling your hands lift up and out.
  • Practise 3 or 4 breathe
  • Do these 4 or 5 more times


Final Step!



  • Put your hands either on your belly, ribs or chest – Depending on which you fon=und the most difficult



  • Take a really deep breathe in – as much air as you can! Fill all of your lungs, the bottom, sides and the top visualise the air spreading around your lungs
  • Then slowly breathe out – completely emptying your lungs until there is no more air to squeeze out!
  • Repeat 3 times!
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