Issue link: https://www.massageandbodyworkdigital.com/i/434495
F r e e m u s i c d o w n l o a d s f o r C e r t i f i e d m e m b e r s : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 107 Besides its central role in breathing, the diaphragm can contribute to lumbar and low-back pain (Image 5), particularly when there is a tendency toward lumbar lordosis. Teaching your clients to find and use the posterior part of the diaphragm when breathing helps refine interoception and proprioception in an area that is often stiff, immobile, and troublesome. As the largest spinal muscle, the diaphragm attaches to the anterior side of the upper three lumbars through its tendinous crura (or "legs"), and along the shafts of the 12th ribs in the small of the back. We addressed working with this region in last issue's column ("Working with the Lumbars, Part 2: The Iliolumbar Ligament and the 12th Rib," Massage & Bodywork, November/December 2014, page 106). Because the diaphragm acts as an antagonist to the downward pull of the quadratus lumborum on the 12th ribs, the work with the anterior diaphragm described in this column is a perfect complement to the posterior approach described last time. COSTAL ARCH/ DIAPHRAGM TECHNIQUE The respiratory diaphragm's attachments are deep inside the costal arch. Since the diaphragm wraps around the liver, stomach, pancreas, and spleen, its close relationship with these delicate structures makes direct manipulation of the diaphragm inadvisable without specialized in- person training. The liver in particular is vulnerable to bruising or tissue damage; its tissues are so delicate that surgeons removing a lobe of the liver can simply pinch portions off with their fingers. 1 Instead of digging under the ribs for the diaphragm, you can safely use the bony edge of the costal arch to open the umbrella of the diaphragm in a very effective way, without ever endangering the fragile viscera that the diaphragm surrounds. Begin the technique by standing at your supine client's side, at the level of her hips. Palpate the edge of the costal arch on the opposite side of the body (Image 6). Don't attempt to go under the edge of the costal arch where the The diaphragm opens and closes with respiration— flattening and widening on inhalation, raising and narrowing with exhalation, just like an umbrella. The diaphragm can be involved in low-back pain through its direct effects on the lumbars, as well as its role as an antagonist to the quadratus lumborum at the 12th rib. 3 4 5 Watch Til Luchau's technique videos and read his past Myofascial Techniques articles in Massage & Bodywork's digital edition. The link is available at www.massageandbodywork.com, www.abmp.com, and on Advanced-Trainings.com's Facebook page. "Working with the Diaphragm"