How Abs of Steel Cause Back Pain
Have you ever had back pain? After it went away, did it come back again? Did that motivate you to do more ab and core work? Did it still come back? The recurrence of back pain despite doing back and core stabilization exercises may indicate there is a missing ingredient to the current model of core exercise programs.
You work out to improve the strength of your back and core. But what if your breathing is counteracting your training? Bad breathing can cause back pain and diminish performance.
Don’t Ignore Your Diaphragm
Studies have found a difference in the breathing patterns of people with and without back pain.1 While the role of abdominal muscles in trunk stability is given a lot of attention, very little attention is given to the role of the diaphragm. The diaphragm plays a role not only in breathing, but also in spinal stability.
Here's the problem with abs of steel: ab-tightening crunches restrict the action of the diaphragm and possibly make back pain worse.
Research finds that people with weak diaphragm muscles are at greater risk for developing back pain2,3,4 and may also develop neck and shoulder pain. Perhaps core training should include deep breathing to improving the power and efficiency of the diaphragm.
Your abs may look impressive, but are they hindering your performance? [Photo courtesy of CrossFit Empirical]
Here is what I've discovered in more than twelve years teaching yoga and yogic breathing: most people don't breathe to their full capacity. We take short, shallow breaths and don’t expand our lungs and torso as fully as we can. As a result, we lose out on the functional core strength that comes from having a strong diaphragm.
By understanding how the diaphragm muscle is integrated with back and core stability, you can use better breathing techniques to improve back and core strength. Better breathing also means you'll improve the strength and endurance of all the muscles in your body.
The Mechanics of Breathing
The diaphragm is a dome-shaped muscle in the center of the torso. The lungs sit above it, and the internal organs rest below it. During normal or functional breathing, there is a coordinated contraction and relaxation of many muscles that assist the diaphragm.
Let's look at some of the things that happen in dysfunctional breathing versus functional breathing.
Functional Breathing (a.k.a. normal or diaphragmatic breathing):
- Breathing is slow, deep, and effortless.
- Inhalation is through the nose.
- The breath reaches down into the lower lobes of the lungs.
- On inhale, the diaphragm contracts and presses downward towards the internal organs. The abdominal region gets pressed outward in all directions.
- On inhale, the lower ribs expand outward horizontally in all directions.
- On exhale, the diaphragm relaxes and moves back upwards towards the lungs.
- This movement of the diaphragm causes intra-abdominal pressure to increase, thus increasing lumbar spine stiffness and spine stability.
- During an inhale, the diaphragm is the dominant muscle, but it receives assistance from transversus abdominis, sternocleidomastoid, upper trapezius, scalenes, and intercostals (rib cage muscles). On exhale, these muscles relax.
- The healthy and complete movement of the diaphragm creates a micro-massaging effect. This helps with the health of the spine and aids with blood flow to the tissues.
The use of the word stiffness above refers to the ability of the spine to hold itself in position without weakening. This is different from tightness or tension in the spine, which is an unhealthy state.
Dysfunctional Breathing (a.k.a., abnormal or chest breathing):
- Breathing is shallow and fast.
- Inhalation is through the mouth.
- Breathing is concentrated in the upper chest and upper lobes of the lungs.
- There is either no movement or there is upward movement of the ribs.
- The chest and the sternum lift up vertically.
- On inhale, the belly pulls inward.
- The movement of the diaphragm is limited - it does not move through its full range of motion.
- The diaphragm loses its strength and becomes weaker over time. This leads to the recruitment of neck, shoulder, and chest muscles to aid in breathing, resulting in overwork and pain in those muscles.
- The intercostals get under worked and become increasingly weaker and less elastic.
- The full movement of the diaphragm may be restricted by tension in the belly or abdominal muscles that are too tight.
During exercise the diaphragm does double duty. As a workout progresses, the diaphragm must meet increased demands for breathing, plus it must continue to stabilize the spine during movement. When your breathing demands increase, the diaphragm's role in spinal stability decreases.5 Because exercise involves respiratory demand, it makes sense to condition respiratory muscles to be able to manage greater demands. Proper movement patterns are only achieved when the diaphragm is free to function fully.
How Soft Is Your Belly?
One of the most obvious signs that your diaphragm is not fully functional is that your ribs do not move outward as you inhale. This might mean that the action of your diaphragm muscle is being limited by tight muscles in the ribs, back, and abdominal region.
Your belly should be able to round out and expand fully without being girdled by abdominal muscles that are too tight. Rectus abdominis is the superficial sheath of muscle running down the front of the stomach that produces the six-pack look. It doesn't contribute much to spinal stabilization. Doing too many crunches can turn rectus abdominis into a muscular version of Spanx - it's holding stuff in, but it's also diminishing your performance.
A fully functioning and strong diaphragm will stabilize and protect the core as well as allow you to relax more deeply. So how do you ensure the diaphragm is strong and able to work at its full capacity?
Start with a test to see if you are breathing functionally:
- Stand in front of a full-length mirror.
- Without making a change to your usual breathing, notice if your shoulders are rising up and down as you breathe.
- Place the palm of your hand on your upper chest. Observe if your chest is rising vertically as you breathe in.
- Place the palm on your hand gently on the front of your belly. Now observe if your belly is hollowing in as you inhale.
- Now place both hands gently on both sides of your lower belly just above your frontal hip bones. Observe if this area is scooping in as you inhale.
- Now repeat the same observations as you take some fuller stronger breaths.
- A dysfunctional breathing pattern is indicated by the following: your shoulders and chest are rising vertically and/or any part of your belly scoops inward as you inhale.
Build Your Diaphragmatic Strength
Once you’ve evaluated your breathing, try this two-part breath exercise to build diaphragmatic strength. Alternate between doing this exercise in a standing position and doing it lying down. Your diaphragm may perform differently in each position. To enhance the workout further, try the breath work while doing squats, arm raises, and other controlled movements.
- Place both hands gently on both sides of your lower belly, just above your frontal hip bones.
- Observe if this area is expanding as you do your usual inhales.
- Now take powerful inhales through your nose. Make the inhales as strong as you can - Superman or Xena Warrior Princess powerful.
- Consciously and deliberately breathe into your lower belly. Get as much expansion of your lower belly as you can with your inhale.
- Exhale with an open mouth for this exercise. The exhale can linger a little so you can let everything come out with your exhale. Don't hold anything back. Let all your muscles relax as you exhale.
- Repeat 8-30 times.
- Now let your breath settle for a moment.
- Next, place the heels of your palms on your outside lower ribs. Let your shoulders and elbows relax down.
- At first without changing your usual breathing, notice if there is lateral/outward movement of your ribs as you inhale.
- Now repeat this with the powerful nasal inhales and the complete open-mouthed exhales. Try to get full expansion of your ribcage in all directions with each inhale.
- A rounding out and expansion of your belly and lower ribs in all directions indicates a functional breathing pattern.
You can experiment with your exhale during this exercise. On some breaths, try making it last longer, then try pushing it all out quickly. See which method allows your body to relax more. During this exercise, aim for becoming fully relaxed on your exhale. Release any muscle tension in the upper chest, shoulders, neck, and lower back.
While you're doing the test and exercise also notice if other muscles are unnecessarily tensing up. Did your neck or shoulder muscles get tense? How about your face and jaw? Try to keep your upper body muscles relaxed while you breathe. Let your diaphragm do its work. Tight upper-body muscles while you breathe can lead to friction, pain, and overuse of those muscles.
Use It or Lose It
Training your diaphragm is like training any other muscle in your body - repetitions and resistance are required. At first just try to get your belly and ribcage to expand in all directions without using extra resistance. As you progress, you can use your hand to apply resistance to your belly or ribs. You can progress more by wrapping an exercise band around your lower ribs and breathing against that resistance.
Consider making deep breathing part of your training regimen. Exercises for the core often involve training with free weights, planking, and crunches. Breathing mechanics play a key role in posture and spinal stabilization. The diaphragm is a muscle, and just like any other muscle in the body, it will atrophy over time if it isn't used.
It all starts with your breath:
Coaches: Are you taking a proactive approach?
1. Anderson, BE, Huxel Bliven, KC, "The use of breathing exercises in the treatment of chronic, non-specific low back pain," Journal of Sport Rehabilitation (2016): doi: 10.1123/jsr.2015-0199
2. Kolar, P., J. Sulc, M. Kyncl, J. Sanda, O. Cakrt, R. Andel, K. Kumagai, and A. Kobesova, "Postural function of the diaphragm in persons with and without chronic low back pain," The Journal of Orthopaedic Sports Physiotherapy 42(2012):352-62. doi: 10.2519/jospt.2012.3830.
3. Smith, M.D., Russell A, Hodges PW, "Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity," Australian Journal of Physiotherapy 52(2006):11-16.
4. Kolar P, Sulc J, Kyncl M, Sanda J, Neuwirth J, Bokarius AV, Kriz J, Kobesova A, "Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment," Journal of Applied Physiology 109(2010):1064-1071. doi: 10.1152/japplphysiol.01216.2009.
5. Hodges, PW, Heijnen, I, Gandevia, SC, "Postural activity of the diaphragm is reduced in humans when respiratory demand increases," The Journal of Physiology 537(2001): 999-1008. doi: 10.1111/j.1469-7793.2001.00999.x