Anatomic connections of the diaphragm: influence of respiration on the body system – J Multidiscip Healthc. 2013 – free full-text PMC article
The article explains the scientific reasons for the diaphragm muscle being an important crossroads for information involving the entire body. The diaphragm muscle extends from the trigeminal system to the pelvic floor, passing from the thoracic diaphragm to the floor of the mouth.
To assess and treat this muscle effectively, it is necessary to be aware of its anatomic, fascial, and neurologic complexity in the control of breathing.
The patient is never a symptom localized, but a system that adapts to a corporeal dysfunction.
Like many structures in the human body, the diaphragm muscle has more than one function, and has links throughout the body, and provides the network necessary for breathing.
Anatomy and anatomic connections
The diaphragm is a dome-shaped musculotendinous structure that is
- very thin (2–4 mm) and
- concave on its lower side and
- separates the chest from the abdomen
With regard to anatomic attachments, a costal, a lumbar, and a sternal portion can be identified.
The sternal portion, which is made up of two tiny muscle bundles, derives from the back of the xiphoid process near the apex and delimits an irregular opening located in the medial area, ie, Larrey’s fissure, through which the prepericardial connective tissue contacts the preperitoneal connective tissue.
The costal (lateral) section originates on the internal surface and the superior margin of the last six inferior ribs, via six digitations that intersect those of the transversus abdominis muscle
The lumbar section derives from the medial, intermedial, and lateral diaphragmatic pillars, and it is important to emphasize the fact that the main pillars, ie, the medial and lateral pillars, make contact with the retropericardial and the perinephric tract, and their related fat.
This is important for two reasons:
- first, it is a further demonstration of the continuous connection existing between the various body structures, and
- second, the visceral fat is a source of proprioceptive information from the diaphragm itself, and establishes once more the role played by this organ in affecting structures that are distant from each other.
The area above the diaphragm: the dotted line for the support of heart 3: inferior vena cava; 10: esophagus; 9: aorta; 8: tendinous center; 5: lumbar area.
This brief description demonstrates how the diaphragm is both an important exchange point of information, originating in different areas of the body, and a source of information in itself.
The sub-diaphragmatic area: 2: tendinous center or phrenic; 16: inferior vena cava; 3: esophagus; 5: aortic orifice; 15: medial pillar; 14: intermediate pillar; 13: pillar lateral; 6: pillar arcuate medial; 7: lateral arcuate ligament; 10: quadratus lumborum muscle; 11: psoas major muscle.
The suboccipital muscles can be the cause of problems at the base of the neck,
Moreover, these muscle regions have proprioceptive properties that are greater than those traced in larger muscles, such as gluteus maximus.
The cervico-cranial area: 1: lesser occipital nerve or C2; 19: cranial nerve XII; 4: cranial nerve X; 5: cranial nerve XI; 17: geniohyoid muscle; 10: phrenic nerve.
AA VV, Anatomia dell’uomo, 4 ed, Edi.ermes, [Several authors, Human Anatomy, Fourth Edition, edition EdiErmes], Milano. www.eenet.it.
Vascular and lymphatic connections
Respiration is a constant and powerful modulator of cardiovascular control.
It reduces negative intrathoracic pressure through inhalation (specifically, there is a suction with subsequent reduction of pressure on the right atrium) and, by means of a muscular contraction of the limbs, the venous drainage is enhanced.
During inhalation, the inferior vena cava diameter decreases,104 and the efficiency of this process reaches its climax in slow and deep respiration
Research has shown that correct physiologic activity of the diaphragm will prevent any problem related to venous drainage
Finally, it is important to consider the fascial and connective links between the diaphragm and the pelvic floor, and the rest of the body. First, the abdominal muscles are related to the costal, lumbar, and pubic iliac regions of the body, ie, rectus abdominis, the internal and external oblique muscles, pyramidalis, cremaster, transversus abdominis, great psoas, quadratus lumborum, sacrospinalis, and transversus spinalis (where the multifidus spinae is distinguishable).
A physiologic alteration in any part of the body will affect everything that is covered by this connective sheet: the symptom will arise in the area concerned with the alteration or in a distal area, when this is not capable of adapting to the new stressor.
Another important fascial system is the fascia transversalis, which is firmly connected to the transversus abdominis muscle and deserves our attention. This is a continuation of the endothoracic fascia and is related to the pleura, pericardium, and the diaphragm
These fascias are extremely important because they improve performance of the muscles.
Indeed, the contractile forces are transmitted to all directions via the connective tissue, improving its tonus and, at the same time, sending information and moving all the body regions
If handling of these forces is restrained, postural and visceral equilibrium will become dysfunctional
The diaphragm muscle not only plays a role in respiration but also has many roles affecting the health of the body
- It is important for posture, for proper organ function, and for the pelvis and floor of the mouth.
- It is important for the cervical spine and trigeminal system, as well as for the thoracic outlet.
- It is also of vital importance in the vascular and lymphatic systems.
The diaphragm muscle should not be seen as a segment but as part of a body system
In presenting this review, we hope to have made a small contribution towards perceiving the patient as a whole and to have spurred new thinking.