DIAPHRAGMATIC BREATHING & CORE

Question 1

What is the structure of the diaphragm?

Answer 1

The diaphragm is a dome-shaped muscle located in the thorax, separating the thorax (chest) from the abdomen.

Question 2

Why is the diaphragm asymmetric, with the left side slightly more inferior than the right?

Answer 2

The diaphragm is asymmetric due to the liver on the right side, and possibly the heart on the left pushing it slightly downward.

Question 3

How many large openings does the diaphragm have, and what is their function?

Answer 3

The diaphragm has three large openings that allow structures to pass between the chest and the abdomen.

Question 4

What structures pass through the esophageal opening of the diaphragm?

Answer 4

The esophagus and the vagus nerve, which controls much of the digestive system, pass through the esophageal opening.

Question 5

What structures pass through the aortic opening of the diaphragm?

Answer 5

The aorta, the main artery transporting blood from the heart, and the thoracic duct, a main vessel of the lymphatic system, pass through the aortic opening.

Question 6

What structure passes through the caval opening of the diaphragm?

Answer 6

The inferior vena cava, a large vein that transports blood to the heart, passes through the caval opening.

Question 7

Where does the sternal part of the diaphragm originate?

Answer 7

It originates as two fleshy slips from the back of the xiphoid process.

Question 8

Where does the costal part of the diaphragm originate?

Answer 8

It originates from the inner surfaces of the cartilages and adjacent parts of the lower sixth ribs on each side, interdigitating with the transversus abdominis.

Question 9

Describe the origin of the medial lumbocostal arch of the diaphragm.

Answer 9

It is a tendinous arch in fascia covering the psoas major. Medially, it attaches to the side of the body of L1, and laterally, it connects to the front of the L1 transverse process (TVP).

Question 10

Describe the origin of the lateral lumbocostal arch of the diaphragm.

Answer 10

It is a tendinous arch in fascia covering the upper part of the quadratus lumborum. Medially, it attaches to the front of the L1 TVP, and laterally, it connects to the lower border of the 12th rib.

Question 11

Where does the diaphragm insert?

Answer 11

The diaphragm inserts into a central tendon.

Question 12

How do the muscle fibers from the right crus contribute to the diaphragm’s function?

Answer 12

The fibers from the right crus traverse up on the left side, encircling the esophageal orifice in a sling-like loop, acting as a valve to help prevent regurgitation of stomach contents into the esophagus.

Question 13

What are the primary muscles of respiration?

Answer 13

The primary muscles of respiration are the diaphragm and the external intercostals.

Question 14

Name the accessory muscles of respiration.

Answer 14

The accessory muscles of respiration include the sternocleidomastoid (SCM), scalenes, pectoralis minor, serratus anterior, latissimus dorsi, and serratus posterior superior.

Question 15

What is the primary role of the diaphragm in respiration?

Answer 15

The diaphragm is a muscle of inspiration and exhalation. During inhalation, it contracts and flattens, expanding the chest cavity. During exhalation, it relaxes and elevates, helping push air out of the lungs.

Question 16

How do the diaphragm and external intercostal muscles work together during inhalation?

Answer 16

During inhalation, the diaphragm contracts and moves downward, while the external intercostals raise the anterior chest wall like bucket handles, making the chest cavity larger and allowing air to enter.

Question 17

What happens to the rib cage and diaphragm during exhalation?

Answer 17

During exhalation, the rib cage and chest wall sag and return to their original position, while the diaphragm relaxes and elevates, pushing air out of the lungs.

Question 18

How does the diaphragm assist in urination and bowel movements?

Answer 18

The diaphragm aids in urination and bowel movements by contracting and increasing intra-abdominal pressure, which works with the anterior abdominal muscles to assist in processes like defecation, urination, and vomiting.

Question 19

Explain the diaphragm’s role in the thoracoabdominal pump and lymph flow.

Answer 19

When the diaphragm descends during inhalation, it decreases intrathoracic pressure and increases intra-abdominal pressure, which compresses the inferior vena cava (IVC) and aids in blood flow to the heart. This action also compresses abdominal lymph vessels, aiding lymph flow through the thoracic duct, which is further assisted by negative intrathoracic pressure and valves preventing backflow.

Question 20

What is the primary goal of diaphragmatic breathing?

Answer 20

Diaphragmatic breathing helps the patient learn to consciously use their diaphragm during breathing.

Question 21

What are the breathing effects of diaphragmatic breathing?

Answer 21

Diaphragmatic breathing strengthens the diaphragm, decreases ventilation rate, reduces oxygen demand, and increases the efficiency of gas exchange.

Question 22

What are the non-respiratory effects of diaphragmatic breathing?

Answer 22

It increases lymphatic flow, improves perceived relaxation, helps break the pain cycle, aids in pain management, and assists with excretory functions like bowel movements, urination, and vomiting.

Question 23

Why is assessing for dysfunctional breathing patterns important?

Answer 23

Dysfunctional breathing can indicate that secondary muscles are being used instead of the diaphragm, affecting respiratory efficiency and suggesting issues like paradoxical or apical breathing.

Question 24

Describe paradoxical and apical breathing patterns.

Answer 24

Paradoxical breathing is when the abdomen does not rise during inhalation, indicating no diaphragm involvement. Apical breathing involves only slight diaphragm movement and reliance on secondary muscles.

Question 25

What are the first steps in the diaphragmatic breathing technique while lying down?

Answer 25

1) Lie on your back with knees bent, head supported, and hands placed on your chest and below the rib cage. 2) Breathe in slowly through your nose, moving your stomach out against your hand while keeping the chest still.
3) Exhale through pursed lips, tightening the stomach muscles.

Question 26

What are the stages of breathing in the diaphragmatic breathing technique?

Answer 26

1. Breathe into the abdomen.
2. Breathe into the ribcage, expanding laterally.
3. Breathe into the chest, combining all three stages for full breath efficiency.

Question 27

How can diaphragmatic breathing be practiced while sitting?

Answer 27

Sit comfortably with knees bent, relaxed shoulders, head, and neck. Place one hand on your chest and the other below the rib cage, breathing in so the stomach moves outward, then exhaling through pursed lips.

Question 28

What is the recommended frequency for practicing diaphragmatic breathing?

Answer 28

Begin with 5-10 minutes, 3-4 times per day. Gradually increase both duration and intensity, using a book on the abdomen for added resistance as you progress.

Question 29

What is the primary aim of core stabilization?

Answer 29

Core stabilization aims to effectively recruit trunk muscles and control the lumbar spine position during dynamic movements, promoting “proximal stability for distal mobility.”

Question 30

Why is the lumbar spine considered “inherently unstable”?

Answer 30

The lumbar spine relies on muscle stability to support the area, along with sensory input to provide the CNS with feedback for movement refinement.

Question 31

How do core structures work together to maintain stability?

Answer 31

They distribute forces and generate maximum force with minimal compression, translation, or shearing forces along the kinetic chain.

Question 32

Define “stabilization” in terms of core stabilization.

Answer 32

Stabilization involves maintaining the spine in a neutral, pain-free, stable position through continuous fine muscle tension adjustments in response to fluctuating loads.

Question 33

Describe the “muscular box” of the core.

Answer 33

The core is a box formed by the abdominals (front), glutes and paraspinals (back), diaphragm (roof), and pelvic floor and hip girdle muscles (bottom), with 29 pairs of muscles aiding spine, pelvic girdle, and kinetic chain stability.

Question 34

List the global muscles involved in lumbar spine stabilization.

Answer 34

1) Rectus Abdominis, 2) QL Lateral Fibers, 3) Internal/External Obliques, 4) Erectors, 5) Iliopsoas.

Question 35

List the deep segmental muscles that control the lumbar spine.

Answer 35

1) Transversus Abdominis (TrA), 2) Multifidus, 3) QL Deep Fibers, 4) Deep Lateral Rotators.

Question 36

Why can’t global muscles stabilize individual spinal segments?

Answer 36

Global muscles lack direct attachment to the vertebrae and can only apply compressive forces, potentially stressing inert tissue if segments are unstable.

Question 37

What is the importance of co-contracting the TrA and multifidus in core stability training?

Answer 37

Co-contraction increases thoracolumbar fascia tension, boosting intra-abdominal pressure and creating stabilizing forces on the lumbar spine.

Question 38

Explain the term “Setting the Core.”

Answer 38

“Setting the Core” is the co-contraction of the TrA and pelvic floor, followed by multifidus activation before any limb movement, stabilizing the lumbar spine.

Question 39

How are deep trunk muscles trained for core stability?

Answer 39

Deep trunk muscles are trained using abdominal bracing with low-force, endurance-based isometric contractions for segmental stability.

Question 40

Why is trunk musculature recruitment and timing crucial in core stabilization?

Answer 40

Proper recruitment and timing ensure that stabilizing muscles like TrA, pelvic floor, and multifidus activate sequentially, preventing instability during dynamic movements.

Question 41

What should you avoid when engaging the TrA to prevent incorrect muscle recruitment?

Answer 41

Avoid tensing the whole stomach or letting the upper abdominals bulge, as this indicates the rectus abdominis is being recruited instead of the TrA.

Question 42

How much contraction of the TrA is required during core stabilizing exercises?

Answer 42

Only a gentle contraction is needed; focus on endurance rather than strength.

Question 43

Why is it important to maintain a neutral pelvis position during core exercises?

Answer 43

Tilting the pelvis or flattening the back indicates a loss of neutral position, which you need to stabilize effectively.

Question 44

What is an important breathing guideline to follow during core stabilizing exercises?

Answer 44

Do not hold your breath; breathe normally while maintaining co-contraction of the TrA and multifidus.

Question 45

How can you use biofeedback during core stabilization exercises?

Answer 45

Use your fingers on either side of your lower abdomen to monitor and feel the gentle contraction of the TrA.

Question 46

What is the initial position for the Abdominal Hollowing Technique (Drawing-in Maneuver)?

Answer 46

The initial position is hooklying (lying on the back with knees bent).

Question 47

Describe the first action in the Abdominal Hollowing Technique.

Answer 47

Contraction of the pelvic floor, similar to “holding back pee” or performing a Kegel exercise.

Question 48

How is the Transversus Abdominis contracted during the Abdominal Hollowing Technique?

Answer 48

Place fingers on the medial side of ASIS and try to draw the two ASIS together, or draw the navel inward and upward towards the shoulder blades.

Question 49

What is the role of biofeedback in the Abdominal Hollowing Technique?

Answer 49

Clients should use their own fingers just medial to the ASIS for biofeedback to ensure proper contraction.

Question 50

Describe the repetition protocol for the initial phase of the Abdominal Hollowing Technique.

Answer 50

Perform 10 x 2-second repetitions for 2 sets without losing the contraction before progressing.

Question 51

What is the progression for the Abdominal Hollowing Technique?

Answer 51

Progress to 5 x 10-second contractions, and then to 5 x 10-second contractions with diaphragmatic breathing.

Question 52

What is “Setting the Core” in core stabilization?

Answer 52

It is the co-contraction of the Transversus Abdominis, pelvic floor, and multifidi.

Question 53

In what position is Multifidi Strengthening first performed, and how is it checked?

Answer 53

Position: Prone. Check by having the client set the core and challenge the spinous process of a lumbar vertebra by asking them to “resist your pressure.”

Question 54

How is Multifidi Strengthening performed in sidelying?

Answer 54

With a belt around the pelvis/gluteus maximus, set the core, palpate the laminar groove, and gently pull on the belt, asking the client to resist. You should feel the multifidi contract.

Question 55

What core strengthening exercise is done in hooklying position?

Answer 55

Slide one heel forward and then back to neutral, performing 10 repetitions x 2 sets per leg without losing core contraction.

Question 56

Describe the progression of core strengthening exercises from hooklying to quadruped.

Answer 56

Start with heel slides, progress to lifting one bent leg off the floor, then in quadruped (bird-dog), extend one leg while palpating medial to ASIS. Continue with alternating arms and legs, aiming for 5-second holds.

Question 57

How can the quadruped (bird-dog) exercise be further progressed?

Answer 57

Raise one arm above the head and hold for 5 seconds, working up to 10 reps x 5 sets. Progress by performing it in prone.

Question 58

What is the position and movement for the abdominal self-stretch (Cobra pose)?

Answer 58

Position: Prone. Movement: Slowly push up with hands in front, keeping hips on the ground and focusing on arching the back rather than extending.

Question 59

What modification can be made for Cobra pose if the hip flexors are tight?

Answer 59

Place towel bolsters under the hips to reduce strain.