PHYSICAL THERAPY THE RESPIRATORY DIAPHRAGM: EAST MEETS WEST By Stuart Robertson, physiotherapist

The purpose of this article is to stimulate and challenge our therapeutic viewpoint in much broader terms than in the con- text of the respiratory diaphragm, but the diaphragm can act as a useful example of the shortfall we may face in terms of our education as manual therapists. In essence, this article charts my journey as a therapist from being a very focused sci- entifically orientated physiotherapist to a place I would have thought to be totally intangible to common scientific sense, using the diaphragm as the central theme.

As a massage therapist, physiotherapist, or bodyworker of any description, how important do you feel the respiratory diaphragm is to your clinical practice? If you have a background in Tai Chi, Yoga, Meditation, Qi-gong, etc, then an awareness and focus on breath may well play an important part in your life and in the work you do with clients.

But, as was the case with me, I did not have an eastern per- spective or a more holistic viewpoint, and it therefore seemed relatively insignificant. Simply because I was not taught ways of treating it, I disregarded it. So where did that piece of logic come from?

BELIEFS In short ‘my map of the world’ was very much limited by my beliefs. We hadn’t been taught how to treat the diaphragm at college, therefore I didn’t

believe it to be important. I had pushed, stretched, prodded every muscle and joint in the body accessible to man but I hadn’t looked at the diaphragm, as I couldn’t palpate it. The diaphragm is a skeletal muscle like any other, so doesn’t it get ‘tight’? The average person breathes approximately 20,000 times per day. It doesn’t even rest while you are asleep and while the other mus- cles get a bit of a break. So on the face of things it looks as if it participates pretty fully in our existence!

I have since discovered that there are ways of treating the diaphragm, and as a result of this and of the sometimes profound changes they have bought about, my map of the world has changed significantly. What follows is a brief review of just one perspective of how you may choose to add the diaphragm to your clinical reasoning. There are of course many other perspectives on breath and the diaphragm.

THE DIAPHRAGM’S ROLE IN RAISING INTRA-ABDOMINAL PRESSURE AND ENHANCING LUMBAR SPINE STABILITY Core stability has been a buzz word used by many ther- apists for some time now, indeed I am even getting patients quoting chapter and verse on core stability, with the increasing popularity of pilates. One of the

proposed mechanisms through which core stability is achieved is the production of fascial tension via the tho- racolumbar fascia (TLF) and the raising of intra- abdominal pressure (IAP) (1). With regard to raising intra abdominal

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