Trauma & The Respiratory Diaphragm, A Personal Story

Written by Justin Krull, Registered Physiotherapist, Myofascial Release Therapist

In…2…3…and out…2…3…and in…2…3…and out…2…3… For the rest of your life on earth, every waking and sleeping moment will be meticulously governed by this simple rhythmic pattern.   There is an old adage called the Rule of Threes: You can survive 3 weeks without food, 3 days without drinkable water, 3 hours in harsh environments, and 3 minutes without breathable air.  This is why so much importance is placed on the ABCs of First Aid and CPR in this order: Airway, Breathing, and Circulation.  Thankfully our reptilian brain contains all the programming it needs to help automatically regulate the breathing process and will continue to signal you to breathe between 12 and 16 times per minute as long as the brainstem is healthy and the spinal cord isn’t damaged between C2 and C4 (where the nerves that innervate the diaphragm originate).  But what happens when the breathing process becomes a little less automatic?  When illness or irritants restrict airflow in the lungs; pain limits our ability to take a nice deep breath and rest in a comfortable position for breathing; or stress makes us feel like every breath in is a struggle, and every breath out a groaning and frustrated sigh.

I was in grade 2 when I was tackled from behind by a kid I didn’t know for being friends with a kid that they didn’t like; and while pinned down, had an arm across my throat pulling upwards to choke me.  A choke with all of the hate and malice of a troubled child who was attempting to kill me.  I can look back on the situation now and stay centered in my experience of it, not let the rationalization of the emotions cloud the very real expression of my body.  In that moment I was dying.  What I didn’t realize until much later while doing (ironically) a mindful breathing practice with a group during a course, was that since that day a small part of me, somewhere deep in the recesses of my body, was still dying.  More on that later…

The respiratory diaphragm is the primary driver for the breath cycle.  When we take a breath in, the diaphragm contracts pushing down on the abdominal contents, facilitating the rib cage to expand as the intercostal muscles pull an elevate the ribs laterally and the sternum anteriorly.  The change in volume creates the negative pressure that pulls external air into the lungs and facilitates gas exchange. Once the oxygen is delivered from the lungs to our systemic circulation, the delivery of it to our tissues is largely the responsibility of the cardiovascular system.  Assuming that there are no serious circulatory issues then, it is the way in which the air is brought into our bodies that is the most important.  Does the air flow easily?  Are the ribcage and diaphragm creating enough of a pressure gradient for air to flow well and gas exchange to occur?  What muscles are being recruited to get the job done?  Is the breath shallow or deep?  From the nose or the mouth?  If the ultimate goal of getting oxygenated blood to the tissues is accomplished, does it matter?  ABSOLUTELY!

Myofascial restrictions of the respiratory diaphragm, ribcage and surrounding areas can develop from trauma (big or small), previous surgeries (OF ALL TYPES) or injuries in and surrounding the tissues or simply by the adoption of unhelpful postures and movement strategies overtime.  Mobility is the key to wellness in the breathing and circulatory systems and for the act of breathing itself we rely heavily on the mobility of the diaphragm muscle, and of the rib cage.  Overall these restrictions can be the cause of or result of the misalignment of anatomical structures within and surrounding the thoracic and abdominal cavity.  The inadequate function of the diaphragm or rib cage mobility can manifest itself in many ways. Individuals may feel shortness of breath, chronic fatigue and weakness, mood changes, headaches, light headedness and even gastrointestinal symptoms such as acid reflux and urine or fecal incontinence. In some patients, restrictions of the tissue in and surrounding the ribcage and diaphragm can lead them to feel as if they are choking or have tightening in the chest, or being unable to catch a full breath.  When the diaphragm is unable to contract and relax or the rib cage is unable to expand and relax optimally, it has a spiraling effect on how well our lungs are able to bring in oxygen and expire unwanted gases such as carbon dioxide. Moreover, it can impact many bodily systems as our breathing is closely connected with our regulation of stress through the nervous system, our mood and our overall sense of well-being.

Additionally, the feeling of choking or being unable to catch a full breath can lead to upregulation of the sympathetic nervous system or our “fight or flight” response because the body interprets the sensation as being under attack. This hypervigilance of the sympathetic nervous system has its own consequences. When this occurs, the sympathetic nervous system increases our heart rate and blood pressure, slows down our digestion and prepares big prime mover muscles to contract and prepare for action. It also encourages the use of the neck muscles to facilitate deeper breathing (imagine the way you put your hands on your thighs and breathe after just having run the 100m dash at your top speed) in a way that mimics the fight/flight response further exacerbating the sympathetic nervous system drive.  Alongside the physiological affects we feel, the sympathetic nervous system also initiates the release of stress hormones. Ultimately potentially giving you a sense of panic, fear or anxiety. In this state of hypervigilance, we alter the way our body responds to the environment and change the postures by which we hold our body in space. This overtime can lead to more restrictions in movement, more mechanical misalignments and chronic pain.

Taking back control of your breath and of the sympathetic nervous system response to chest restriction requires one thing above all else: A sense of safety.  Many clients have entered our office with minds racing, a sense of agitation, shallow breathing, chest or mid-back tightness, chronic shoulder and neck tension and a myriad other symptoms which all shout the same innate subconscious message:  I can’t breathe.  Whether the reason is stress, feeling oppressed by responsibilities and roles placed upon us by family, friends, or coworkers/employers, fear of failure, fear of success, constant postural strain, injury, trauma or otherwise; Myofascial Release as a mindful therapeutic practice, and the act of Myofascial self-care in the form of rebounding and unwinding creates a safe environment to re-establish a healthy connection between your mind and your body, a sense of safety and whole-ness.

…Continued from above…I stood there in the hotel banquet hall surrounded in very close proximity all around by my peers and yet utterly alone.  I was choking unable to speak.  They didn’t matter.  Nothing else mattered.  As I stood there in the flow of deep tribal drums and the instructor’s voice beckoning us to breathe in and out deeper, and deeper, and finally at the apex start vocalizing the strongest yell from the deepest depths of my body I could muster, I began to scream.  I screamed for eternity.  I screamed until there was nothing left.  I screamed as I threw that kid off of me with the strength of a savage beast.  I screamed until there was no more room for the fear in this memory to live in my body any longer.  And then finally I wept; I shook; I convulsed; I was leaking from my face.  All I could do was just rock back and forth gently and hold myself.  It was about 30 minutes of this until the experience was over and I started to feel like myself again…only lighter.  The key to healing is feeling.

Need to release your respiratory diaphragm or let go of trauma? Join our Fascial Freedom group on Facebook to check out recordings of live guided self-treatment sessions or book a session with us.