Connection Between Diaphragm Dysfunction and Chronic Health Issues
In the course of my research, I found a very important scientific review article which links poor diaphragm mobility to a host of health issues, all of which are common as symptoms or complicating factors in Parkinson’s Disease:
“The text reviews the diaphragm’s functions, anatomy, and neurological links in correlation with the presence of chronic symptoms associated to IBS, like chronic low back pain, chronic pelvic pain, chronic headache, and temporomandibular joint dysfunction, vagus nerve inflammation, and depression and anxiety. The interplay between an individual’s breath dynamic and intestinal behaviour is still an unaddressed point… and the paucity of scientific studies should recommend further research to better understand the importance of breathing in this syndrome.”
This article explains the direct links between diaphragm dysfunction and: issues with the pelvic floor, jaw and tongue; lower back pain; headaches; gastroesophageal reflux (GERD); perceived pain; emotional state and body image; pain and inflammation; the nervous system.
Important nerves both innervate and pass through the diaphragm, including the vagus nerve. The link to Parkinson’s Disease and the vagus nerve has come to the fore in recent years. Indeed, my own perspective is that Idiopathic PD occurs when the Nervous System gets stuck in a “death feigning” or immobilizing response to perceived threats, resulting in inhibition of the ventral (super-diaphragmatic) part of the vagus nerve, and giving control over to dorsal (sub-diaphragmatic) part of the nerve responsible for immobilized defensive states, see
The labelling of the branches of the vagus nerve as “super-” and “sub-diaphragmatic” takes on added meaning here, since the diaphragm not only provides the dividing line between them, but any dysregulation of the diaphragm will have an affect on the proper function of the vagus nerve and the communication between the branches.
Indeed, according to a premise in the above cited review article, if the diaphragm is limited in its movement, it becomes stiff, dry, tight and frozen. Then, instead of gliding past or stroking the various nerves which pass through it, as it contracts and releases, the diaphragm squeezes or elongates or compresses these nerves over its limited range of motion. This then causes dysfunctions in the nerve systems – and some very vital nerves pass through holes in the diaphragm, including the vagus.
“… reduced vagal tone may be induced by mechanical stress caused by a dysfunction of the diaphragm, resulting in a compression of the nerve, which induces abnormal vagal function. There is a close relationship between the vagus nerve and the perception of pain. We know that a compression of the vagus nerve can alter its function and, just like a dysfunction of a peripheral nerve, mimicking an entrapment syndrome. We can assume that abnormal tension of the diaphragm in the region of the oesophagal hiatus could cause a compression of the vagus nerve, reducing its anti-pain and anti-inflammatory activity.”
Another important nerve the article mentions is the phrenic nerve, which also passes through the diaphragm, but which innervates (flexes and senses) the diaphragm itself. I had never heard of this nerve before, so made some based on
“The phrenic nerve originates from the… C3 through C5 nerve roots [in the neck] and consists of motor, sensory, and sympathetic nerve fibers. It provides complete motor innervation to the diaphragm and sensation to the central tendon aspect of the diaphragm.”
“The left phrenic nerve innervates the left diaphragmatic dome, and the right phrenic nerve innervates the right diaphragmatic dome. The motor innervation activation will cause the diaphragm to contract with inspiration, resulting in a flattened diaphragm. During exhalation, the diaphragm relaxes and returns to the dual dome shape.”
“The phrenic nerves provide motor innervation to the diaphragm and work in conjunction with secondary respiratory muscles (trapezius, pectoralis major, pectoralis minor, sternocleidomastoid, and intercostals) to allow respiration.”
“The phrenic nerve supplies sensory innervation to the diaphragm. Pain arising from the diaphragm is often referred to the tip of the shoulder. For example, a patient with a subphrenic abscess or a ruptured spleen may complain of pain in the left shoulder. The hiccup reflex is due to irritation of the phrenic nerve.”
These links between the phrenic nerve and referred pains in the shoulder, and referred pain in the neck and shoulder arising from problems with the diaphragm more generally, is pertinent to PD, in which neck and shoulder pain abound. This is true for myself personally, where my worst pain arises in the right neck and shoulder. Interestingly, two of my most painful spots occur on my right shoulder tip and also beneath my right clavicle, precisely where the anatomy diagrams show the right phrenic nerve passes under.
Many people also have problems in the cervical [neck] vertebrae, especially the C3-C5 region where the phrenic nerves originate, including pain, soreness and a lot of clicking and grinding. It may be worth considering if the origin of these pains is due to diaphragm dysfunction rather than problems with the shoulder itself.
The article also mentions
“… during respiration, the muscles of the abdominal wall and the diaphragm muscle are controlled in an electric combination that allows a perfect synergic contraction during inspiration and expiration. A dysfunction of the diaphragm muscle may alter this functional synergy and cause an alteration in the motor scheme”,
and the anatomy video included below also discusses how a weak or paralysed diaphragm, e.g. due to phrenic nerve damage, can actually move up instead of down on one side when inhaling.
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