Diaphragm Trigger Points

Introduction

The diaphragm is the primary muscle of respiration, playing a vital role in breathing, posture, and core stability. When trigger points develop in this muscle, they can cause chest tightness, shortness of breath, rib pain, and even symptoms mimicking anxiety or heart problems.

Name and Area

  • Name: Diaphragm

  • Area: A dome-shaped muscle separating the thoracic and abdominal cavities, attaching to the lower ribs, sternum, and lumbar spine.

Indications

Diaphragm trigger points may contribute to:

  • Shortness of Breath or a Feeling of Restricted Breathing

  • Tightness or Pain in the Chest or Lower Ribs (Can Mimic Heart or Lung Issues)

  • Pain in the Lower Ribs and Upper Abdomen (Resembling GERD or Digestive Issues)

  • Frequent Sighing or Shallow Breathing (Especially During Stress or Anxiety)

  • Referred Pain to the Neck and Shoulder (Particularly the Left Shoulder, Mimicking Cardiac Pain)

  • Side Stitches or Rib Pain During Exercise (Common in Runners and Athletes)

Pain from this muscle is often mistaken for heart problems, anxiety attacks, or acid reflux.

Muscle Action

  • Primary Muscle of Breathing: Contracts to draw air into the lungs.

  • Stabilizes the Core: Works with the abdominal and pelvic muscles for posture control.

  • Affects Digestive and Circulatory Functions: Helps regulate pressure in the thoracic and abdominal cavities.

The diaphragm is critical for respiration, posture, and overall body function.

Signs and Symptoms

Individuals with diaphragm trigger points often report:

  • Tightness in the Chest or Lower Ribs (Worse With Deep Breathing or Exertion)

  • Frequent Shallow Breathing or Difficulty Taking Deep Breaths

  • Pain That Radiates to the Neck, Shoulders, or Upper Back

  • Frequent Yawning or Feeling Like They Can't Get Enough Air

  • Increased Symptoms During Anxiety, Stress, or Hyperventilation

  • Rib or Side Pain When Running or Exercising (Often Called a "Side Stitch")

Pain worsens with emotional stress, exercise, or prolonged poor posture.

Perpetuating Factors

Common causes of diaphragm trigger points include:

  • Chronic Stress or Anxiety (Leading to Habitual Shallow Breathing)

  • Poor Posture (Slumped Shoulders or "Chest Breathing" Instead of Diaphragmatic Breathing)

  • High-Intensity Exercise Without Proper Breathing Control (E.g., Running, Sprinting, Weightlifting)

  • Respiratory Issues (Asthma, COPD, or a History of Smoking)

  • Digestive Issues (GERD, Hiatal Hernia, or Abdominal Bloating, Increasing Pressure on the Diaphragm)

Trigger Point Referral Pattern

Trigger points in the diaphragm refer pain to:

  • The lower ribs and chest (Can Feel Like Heart or Lung Pain)

  • The neck and shoulders (Particularly the Left Shoulder, Mimicking Cardiac Pain)

  • The upper back and thoracic spine

Pain from this muscle is often confused with heart attacks, lung problems, or digestive issues.

Differential Diagnosis

Diaphragm trigger points may be mistaken for:

  • Heart Problems (Angina, Heart Attack, or Pericarditis – Due to Chest Pain and Left Shoulder Referral)

  • GERD or Hiatal Hernia (Acid Reflux and Abdominal Discomfort)

  • Panic Attacks (Shortness of Breath, Chest Tightness, Feeling of Air Hunger)

  • Asthma or COPD (Breathing Difficulties and Chest Pressure)

  • Rib or Intercostal Muscle Strain (Pain in the Lower Ribcage, Especially With Movement or Breathing)

A thorough respiratory, cardiovascular, and musculoskeletal examination is necessary for correct diagnosis.

Associated Trigger Points

Diaphragm trigger points often co-exist with:

  • Scalene Muscles (Neck Pain, Upper Rib Dysfunction, and Breathing Restrictions)

  • Pectoralis Major (Chest Tightness and Shoulder Pain)

  • Rectus Abdominis (Abdominal and Rib Pain, Often Mistaken for Digestive Issues)

  • Quadratus Lumborum (Lower Back and Side Pain Related to Breathing Dysfunction)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Diaphragm Lower ribs, xiphoid process, lumbar vertebrae Central tendon of the diaphragm Phrenic nerve (C3–C5)

The phrenic nerve is crucial for breathing and originates from the cervical spine (C3–C5), which is why neck issues can affect breathing.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender spots along the lower ribs, sternum, and diaphragm area.

  • Breathing Pattern Assessment: Observe if the patient breathes using their chest instead of the diaphragm.

  • Rib Mobility Testing: Assess for tightness or restriction in rib movement during inhalation and exhalation.

  • Phrenic Nerve Function Testing: Evaluate neck mobility and any referred pain from the cervical spine.

Corrective Actions

Manual Therapy

  • Trigger Point Release: Apply gentle sustained pressure along the lower ribs and sternum.

  • Myofascial Release: Stretch and mobilize the diaphragm and surrounding muscles.

Stretching

  • Diaphragmatic Breathing Exercise: Place one hand on the chest and one on the abdomen; inhale deeply into the belly while keeping the chest still.

  • Side Stretch: Reach over to one side while taking a deep breath to mobilize the diaphragm and intercostal muscles.

Strengthening Exercises

  • Core Stability Drills: Strengthening deep abdominal muscles improves breathing mechanics.

  • Controlled Exhalation Training: Exhaling slowly through pursed lips strengthens diaphragm endurance.

Postural and Behavioral Adjustments

  • Practice Relaxed, Diaphragmatic Breathing (Avoid Habitual Shallow Chest Breathing)

  • Avoid Slumping in a Seated Position (Maintains Proper Rib Cage Expansion)

  • Use Proper Breathing Techniques During Exercise (Inhale Through the Nose, Exhale Through the Mouth)

Summary Table: Diaphragm Trigger Points

Field Details
Name & Area Diaphragm; Located between the thoracic and abdominal cavities
Indications Chest tightness, shortness of breath, rib pain, side stitches, anxiety-related breathing issues
Muscle Action Primary muscle of respiration, stabilizes the core, regulates thoracic and abdominal pressure
Signs & Symptoms Difficulty taking deep breaths, referred pain to the shoulders, frequent sighing, tension in the lower ribs
Perpetuating Factors Chronic stress, shallow breathing, poor posture, respiratory issues, digestive problems
Trigger Point Referral Chest, lower ribs, left shoulder, upper back
Differential Diagnosis Heart conditions, GERD, panic attacks, asthma, rib dysfunction
Associated Trigger Points Scalenes, pectoralis major, rectus abdominis, quadratus lumborum
Anatomy & Innervation Phrenic nerve (C3–C5)
Corrective Actions Manual therapy, diaphragmatic breathing, core stability exercises, postural correction

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.