Want to Breathe Better? Work Your Hips!



Not long ago, a regular client came in complaining of shortness of breath as was as her usual pain. With a history of asthma and sinus issues, this wasn't super unusual. But the symptoms were becoming so pronounced, my client was concerned with the possibility of a hospitalizing asthma attack.

Because she remained composed and there were no audible or visual signs of distress, I was unaware of the extent of the situation. (Side note: please, please, please let your therapist know if you are experiencing the beginnings of that you think might be a medical emergency! It serves no one to keep your health professionals in the dark.)

Having had success with opening her sinuses and easing her breathing in prior sessions, I began with her facial bone ligaments. From there I progressed to her sternum and diaphragm. As I worked she noted greater and greater comfort. It was when I began working with her pelvis, however, that the greatest change came.

As I used SMRT to address the ligaments slinging the bladder and uterus between the ischial bones, she explained, “Wow! I can breathe so much better! That makes it easier to breathe!”

How is that possible? By releasing tension in the pelvic floor.


The pelvic floor and the diagram are intricately connected via function and structure. Functionally, these two muscle groups form the bottom and top of the abdominopelvic cavity, working synergistically to maintain intra abdominal pressure; as the diagram pulls down during inflation, the pelvic floor will likewise descend. This is one the reasons why breathwork can be so beneficial in reducing pelvic pain. Take deep, slow breaths with your attention focused on the areas between your sit bones or place your have on your perineum to feel this motion.

Tension in the pelvic floor caused by stress, anxiety, misalignment, or injury can disrupt this parallel movement which leads to intra abdominal pressure increases. Now, pressure increases of this type will happen occasionally over the course of a lifetime. We forget to exhale while lifting, go through drastic periods of change, or sustain an injury that alters or more patterns. Our bodies are made to adjust for these situations and then return to a more neutral state. It is when this tension becomes chronic that the pelvic floor behind to loose it's adaptive capabilities which interferes with it's supportive functions. Higher risk of incontinence and prolapse then results.

Structurally, fascial lines and muscle actions link the pelvic floor to the diaphragm. Fascial connections can be separated into four parts: via the psoas and the quadratus lumborum, via the transverse abdominals (through which the cervical fascia also connects to the pubic bones), via the thoracolumbar fascia into the sacrum, and via the lateral thoracolumbar fascia into the iliac crests. When one of these lines gets kinked, it causes imbalances up and down the chain. This can make it difficult for muscles to function optimally.


Disrupted fascial lines are caused by similar factors to those that cause tension in the body. However, fascial imbalance in the pelvic floor is more likely to lead the complications of misalignment and pain; hip pain, groin pain, thigh pain, low back pain, abdominal pain, even shoulder and neck pain.

So when I slackened the internal ligaments and relaxed the pelvic girdle articulations, I also allowed the pelvic floor to operate more optimally thereby increasing my client's diaphragmatic function. Voila! Better breathing! (No, not really that simple, but that's what it can feel like.)

For more specifics about the connections between the pelvic and respiratory diaphragms, read these! Bordoni, B., & Zanier, E. (2013). Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary Healthcare, 6, 281–291. http://doi.org/10.2147/JMDH.S45443 Park, H., & Han, D. (2015). The effect of the correlation between the contraction of the pelvic floor muscles and diaphragmatic motion during breathing. Journal of Physical Therapy Science, 27(7), 2113–2115. http://doi.org/10.1589/jpts.27.2113

Park, H., Hwang, B., & Kim, Y. (2015). The impact of the pelvic floor muscles on dynamic ventilation maneuvers. Journal of Physical Therapy Science, 27(10), 3155–3157. http://doi.org/10.1589/jpts.27.3155

Think your pelvic floor and/or your diaphragm could use a little attention? Call (856) 857-7535 Questions? Leave a comment below!

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