The Role of the Diaphragm in Chronic Low Back Pain: Insights from Dynamic MRI

Procedure Information

May’s Five Minute Manager

The Core’ De-mystified part 2

Postural Function of the Diaphragm in Persons with and without Chronic Low back pain



18 patients with greater than 6 months Low Back Pain and 29 healthy subjects



Dynamic MRI measuring absolute Diaphragmatic excursion and local regions during 

  1. Tidal breathing
  2. Upper limb resisted movement- (Isometric shoulder flexion in supine)
  3. Lower Limb resisted movement- (Isometric hip/knee flexion from supine)



Tidal breathing: No difference

During UL + LL: in chronic pain patients: smaller diaphragm excursion, higher diaphragm position.



Patients with chronic low back pain appear to have both abnormal position and a steeper slope of the diaphragm, which may contribute to the etiology of the disorder. Whilst correlation does not constitute causality Intra-abdominal pressure is generated by the diaphragm’s descent. 

An appropriate progression of strengthening exercises may help correct unhelpful movement patterns seen in patients with chronic pain.

Following abdominal or pelvic surgeries other muscles involved in generating Intra-abdominal pressure are compromised, strengthening six weeks later would help decrease the risk of Lumbar pain or injury.


Hope this helps! Looking forward to seeing you soon!


Michael Rafla
Australian Sports Physiotherapy
Ivanhoe, Heidelberg, Coburg, Northcote, Carlton North
0431 271 714


Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):352-62. doi: 10.2519/jospt.2012.3830. Epub 2011 Dec 21. PMID: 22236541.

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