The Role of the Diaphragm in Trunk Stability: Difference between revisions

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== Introduction ==
== Introduction ==
In this course, we look the at role of the diaphragm in trunk stability. This is important to remember in our rehabilitation post mechanical ventilation, lower back pain, gait and many situations which include the diaphragm, that we might have forgotten about in our rehabilitation plan. Below is a brief overview of the muscles of respiration, an overview of concepts that are relevant to our knowledge when re-educating the diaphragm and information on Core stability and the diaphragm.  
In this page, we look the at role of the diaphragm in trunk stability. This muscle should not be forgotten when working with patients post-mechanical ventilation, or in individuals who have lower back pain, gait or balance dysfunction. This page includes a brief overview of the muscles of respiration, and discusses concepts that are relevant when working to re-educate the diaphragm and enhance core stability.


=== 1. Overview on Muscle systems ===
=== 1. Overview on Muscle systems ===

Revision as of 22:23, 25 February 2022

Original Editor - Carin Hunter based on the course by Rina Pandya
Top Contributors - Carin Hunter, Ewa Jaraczewska, Jess Bell, Kim Jackson and Merinda Rodseth

Introduction[edit | edit source]

In this page, we look the at role of the diaphragm in trunk stability. This muscle should not be forgotten when working with patients post-mechanical ventilation, or in individuals who have lower back pain, gait or balance dysfunction. This page includes a brief overview of the muscles of respiration, and discusses concepts that are relevant when working to re-educate the diaphragm and enhance core stability.

1. Overview on Muscle systems[edit | edit source]

The local muscle system is comprised of a deep layer of slow-twitch muscles that control intersegmental movements. These muscles respond to changes in posture and extrinsic loads.

Key local muscles include:

The global muscle system involves fast-twitch, long muscles that possess a large lever arm to produce torque and gross movements.

Key global muscles include:

For more information please see the Physiopedia Page on the Muscles of Respiration.

2. Important Concepts in Relation to Diaphragm Rehabilitation[edit | edit source]

  1. Thoracoabdominal Pump
    • The diaphragm plays an important role in the venous return the the body. When we breathe in, The diaphragm descends into the thoracic cavity. The movement of the diaphragm increases the pressure in the abdominal cavity and decreases the pressure in the intrathoracic cavity. The increase in the abdominal cavity causes a compression of the Inferior Vena Cava (IVC) which move the blood, against gravity, into the right atrium of the heart.[1] [2]
    • This concept is also applies to the abdominal lymph vessels. The negative intrathoracic pressure, caused by the decent of the diaphragm, and the compression of the abdominal lymph vessels, results in an upward movement of the lymph. the valves in the thoracic duct the lymph flowing back down.
  1. Valsalva Maneuver
    • The valsalva maneuver is classified as forced expiration against a closed glottis. It is associated with an increase in the intrathoracic and intra-abdominal pressure. It is simple but associated with complex cardiovascular changes, controlling the arterial blood pressure was one of the first aims as it is affected by signals of the baroreceptor.[3]
    • For more on this, please see Valsalva Test.
    • Detecting heart murmurs
      • The Valsalva maneuver can also be used clinically to augment heart murmurs and classify them as clinically right-sided or left-sided.[4][5][6]

Diaphragm: Balance, Gait and Trunk Stability[edit | edit source]

  • The diaphragms primary role is a muscle of respiration and controls how we breathe.
  • The diaphragm has an important role in stabilising the trunk to enhance balance and walking[7] in conjunction with the abdominal muscles and paraspinal muscles.[8]
  • The diaphragm also plays a role in trunk stability by controlling intra-abdominal pressure and reducing stress on the spine through cooperative action with the abdominal and pelvic floor muscles.[9]

The Diaphragm as a Core Stabiliser[edit | edit source]

Diaphragm cylinder.png

The diaphragm, multifidus, transversus abdominis, and the pelvic floor muscles, act as one unit at the centre of various functional kinetic chains. It has been noted that the co-contraction of the abdominal muscles and the diaphragm increases intra-abdominal pressure, fixes the trunk, and reduces stress on the spine, especially in the lumbar region.[10]

  • Muscle of Abdominal Straining and Weight Lifting

The contraction of the diaphragm will assist in the contraction of the muscles of the anterior abdominal wall in raising the intra-abdominal pressure during normal processes like micturition, defecation, vomiting and parturition (childbirth).[11]

Trunk stability[edit | edit source]

There are two types of spinal instability:[11]

  1. Gross Instability: obvious radiographic displacement of the vertebra associated with neurologic deficit and deformity.
  2. Functional/Clinical Instability: "Clinical instability as the loss of the spine's ability to maintain its patterns of displacement under physiologic loads so there is no initial or additional neurologic deficit, no major deformity, and no incapacitating pain“[12]
  • Core strength provides proximal trunk stability for distal mobility. Hence most of our exercises will focus on the mobility of extremities along with core/ lumbar stabilisation with deep breathing techniques.[13]
  • Training of the core involves the coordination of both sensory and motor inputs, comprising of:
    • Neuromuscular control
    • Passive structural components (osseous and ligamentous elements)
    • Active mobile components (29 pairs of muscular elements)[14]

Please see the following Physiopedia pages for more information on Strengthening[edit | edit source]

References[edit | edit source]

  1. ↑ McCool FD, Manzoor K, Minami T. Disorders of the diaphragm. Clinics in chest medicine. 2018 Jun 1;39(2):345-60.
  2. ↑ Bains KN, Kashyap S, Lappin SL. Anatomy, Thorax, Diaphragm. StatPearls [Internet]. 2021 Jul 26.
  3. ↑ Pstras L, Thomaseth K, Waniewski J, Balzani I, Bellavere F. The Valsalva manoeuvre: physiology and clinical examples. Acta physiologica. 2016 Jun;217(2):103-19.
  4. ↑ Bains KN, Kashyap S, Lappin SL. Anatomy, Thorax, Diaphragm. StatPearls [Internet]. 2021 Jul 26.
  5. ↑ Roy JK, Roy TS, Mukhopadhyay SC. Heart sound: Detection and analytical approach towards diseases. InModern Sensing Technologies 2019 (pp. 103-145). Springer, Cham.
  6. ↑ Wirth K, Hartmann H, Mickel C, Szilvas E, Keiner M, Sander A. Core stability in athletes: a critical analysis of current guidelines. Sports medicine. 2017 Mar;47(3):401-14.
  7. ↑ Kocjan J, Gzik-Zroska B, Nowakowska K, Burkacki M, Suchoń S, Michnik R, Czyżewski D, Adamek M. Impact of diaphragm function parameters on balance maintenance. Plos one. 2018 Dec 28;13(12):e0208697.
  8. ↑ Wilhelm M. The Effect of Low Back Pain History on Multifidus Co-contraction During Common Lumbosacral Voluntary Stabilizing Contractions (Doctoral dissertation).
  9. ↑ Hodges PW, Gurfinkel VS, Brumagne S, Smith TC, Cordo PC. Coexistence of stability and mobility in postural control: evidence from postural compensation for respiration. Experimental brain research. 2002 Jun;144(3):293-302.
  10. ↑ Michael S, Erik S, Udo S, Edward L. Atlas of Anatomy: General Anatomy and the Musculoskeletal System.
  11. ↑ 11.0 11.1 Pandya R. The Role of the Diaphragm in Trunk Stability Course. Physioplus, 2022.
  12. ↑ Panjabi MM. Clinical spinal instability and low back pain. Journal of electromyography and kinesiology. 2003 Aug 1;13(4):371-9.
  13. ↑ Kim E, Lee H. The effects of deep abdominal muscle strengthening exercises on respiratory function and lumbar stability. Journal of physical therapy science. 2013 Jun 25;25(6):663-5.
  14. ↑ Walters S, GradCert B. Investigation into intra-abdominal pressure and neuromuscular activation to increase force production in traditional martial arts practitioners (Doctoral dissertation, University of Southern Queensland).
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