The Diaphragm is a vital organ which must be taken into consideration to develop an effective and holistic therapeutic approach.  Because of its anatomical and physiological connections, the diaphragm is often a site of dysfunction in lower back pain, hip conditions, poor posture, respiratory pathologies and cervical pain.  These are the key anatomical points that we need to take into account when considering the diaphragm:

  • Anatomical attachments: costal, lumbar, sternal
  • Connection between the chest and the abdomen is an anatomic continuum, where the diaphragm plays a vital role in managing the information related to both cavities.
  • The costal portion originates from the inner surface of ribs seven through twelve
  • The Lumbar section has both medial (closer to the midline) and lateral (further from the midline) aspects. The medial aspects of the diaphragm arise from the front of the first three lumbar vertebrae (L1-L3). The lateral aspects arise from three tendinous arches. The first tendinous arch is associated with the abdominal aorta, and the second and third with the psoas major and quadratus lumborum muscles respectively
  • Functionally, two sections can be recognised: the crural region, responsible for correct breathing, and the costal region, which prevents gastroesophageal reflux
  • Pelvic diaphragm: supporting pelvic organs and resisting increased pressure, but also affects respiratory functions
  • The phrenic nerve innervates the diaphragm, and runs from the root of c3-5


  • The Fascia involving the diaphragm posteriorly is separated in 4 parts.  It joins the aortic system, , inferior vena cava, liver, psoas, quadrates lumborum, cardiac area, phrenic oesophageal ligaments and the kidneys.    This is also know as the inter-fascial plane.
  • Fascia transversalis links the diaphragm to the tranversus abdominis.
  • It plays an important role in the stabilisation of the sacroiliac joint.
  • Thoracolumbar fascia is essential for muscles that involve the column.  Diaphragmatic dysfunction will negatively affect these tissues, leading to central and peripheral symptoms.
  • Cervical pain can have diaphragmatic causes, and has repercussions for the neck through the thoracolumbar fascia.  This is a bidirectional process.  This link might explain six pain with dysfunction of the diaphragm and pelvic floor.

At Marcophysio, we often treat diaphragmatic dysfunctions to address mechanical dysfunctions affecting posture and sports performance.