The document outlines diaphragmatic breathing exercises, emphasizing that these techniques involve the movement of the abdominal wall and lower ribs. It details the appropriate patient positioning for effective practice and presents two approaches to teaching diaphragmatic breathing. Emphasis is placed on gentle breathing, relaxing the upper chest, and avoiding forced expiration to prevent airway obstruction.

1. DIAPHRAGMATIC
BREATHING EXERCISE
DR. T SUNIL KUMAR
DEPT. OF PHYSIOTHERAPY

2. INTRODUCTION
• ONE METHOD OF ‘DIAPHRAGMATIC’ BREATHING
CONCENTRATES ON FORWARD MOVEMENT OF THE
WHOLE ABDOMINAL WALL.
• ANOTHER TECHNIQUE COMBINES FORWARD
MOVEMENT OF THE UPPER ABDOMINAL WALL
WITH SOME LATERAL MOVEMENT OF THE LOWER
RIBS.
• THE DIAPHRAGM IS THE MAIN MUSCLE OF
RESPIRATION, BUT IT MUST BE REMEMBERED THAT
THE DIAPHRAGM ALSO PLAYS AN IMPORTANT PART
IN LOWER COSTAL BREATHING EXERCISES.
• THE TERM ‘DIAPHRAGMATIC BREATHING’ IS
THEREFORE MISLEADING.

3. POSITION OF THE PATIENT
• ‘DIAPHRAGMATIC’ BREATHING IS USUALLY TAUGHT IN A
RELAXED HALF-LYING OR SITTING POSITION.
• THE PATIENT SHOULD BE SITTING STRAIGHT AND
UPRIGHT WITH THE HEAD AND BACK FULLY
SUPPORTED, AND THE ABDOMINAL WALL RELAXED.
• IF HE IS IN BED RELAXATION OF THE ABDOMINAL WALL
IS HELPED BY SLIGHTLY FLEXING THE KNEES (PROVIDED
IT IS REMOVED AFTER TREATMENT, A SMALL PILLOW
MAY BE USED).
• WHEN TEACHING BREATHING EXERCISES OUT OF BED,
A HIGH-BACKED CHAIR WITHOUT ARMS IS PREFERABLE.

4. • THERE ARE TWO SCHOOLS OF THOUGHT CONCERNING
THE TEACHING OF DIAPHRAGMATIC BREATHING:
THE FIRST CONCENTRATES ON-EPIGASTRIC AND
LOWER RIB MOVEMENT (GASKELL AND WEBBER, 1980).
THE SECOND CONCENTRATES ON ALLOWING THE
WHOLE ABDOMEN TO SWELL AS THE DIAPHRAGM
DESCENDS (INNOCENTI, 1966).
TECHNIQUE
1. THE PHYSIOTHERAPIST PLACES HER HANDS ON THE
ANTERIOR COSTAL MARGINS AND UPPER ABDOMEN
TO FEEL THE MOVEMENT OCCURRING; AT A LATER
STAGE THE PATIENT CAN FEEL THIS MOVEMENT
HIMSELF.

5. • HE STARTS BY GENTLY BREATHING OUT, WHILE
RELAXING THE SHOULDERS AND UPPER CHEST,
AND FEELING THE LOWER RIBS SINK DOWN AND
IN TOWARDS THE MID-LINE.
• WHEN THE PATIENT IS READY TO BREATHE IN, HE
IS TOLD TO BREATHE IN GENTLY AND TO ‘FEEL
THE AIR COMING IN AROUND THE WAIST’.
• IF DONE CORRECTLY, THE UPPER ABDOMEN WILL
BULGE FORWARD SLIGHTLY AND THE ANTERIOR
COSTAL MARGINS WILL MOVE UP AND OUT.

7. 2.THE PHYSIOTHERAPIST PLACES BOTH HANDS
OVER THE ABDOMEN. THE PATIENT STARTS BY
GENTLY BREATHING IN AND CONCENTRATING ON
ALLOWING THE ABDOMINAL WALL TO SWELL,
GENTLY NOT FORCIBLY, UNDER THE SLIGHT
PRESSURE OF THE PHYSIOTHERAPIST’S HANDS.
• ON BREATHING OUT HE FEELS HIS ABDOMEN
SLOWLY SINKING BACK TO REST.
• THE PATIENT CAN PRACTICE BY RESTING BOTH
HANDS OVER THE ABDOMEN TO FEEL THE GENTLE
MOVEMENT WHICH OCCURS AS A RESULT OF
DIAPHRAGMATIC MOVEMENT NOT ABDOMINAL
MUSCLE CONTRACTION

9. • THE UPPER CHEST AND SHOULDERS SHOULD
REMAIN RELAXED THROUGHOUT.
• THE EMPHASIS SHOULD BE ON GENTLE
BREATHING WITH THE MINIMUM OF EFFORT.
• IF THE PATIENT TAKES TOO DEEP A BREATH HE
WILL EXPAND THE APICAL AREA IS OF HIS CHEST.
• THE PATIENT SHOULD BREATHE AT HIS OWN RATE
AND NO ATTEMPT SHOULD BE MADE TO SLOW
THIS UNTIL A MORE CONTROLLED PATTERN OF
BREATHING IS ACHIEVED.

10. • IT IS VITAL TO REMEMBER THAT THE EXPIRATORY
PHASE IS COMPLETELY PASSIVE; ANY FORCED OR
PROLONGED EXPIRATION MAY INCREASE AIRWAYS
OBSTRUCTION.
• IN NORMAL EXPIRATION THE AIRWAYS SHORTEN
AND BECOME NARROWER, SO IF THE AIRWAYS ARE
ALREADY PARTLY OBSTRUCTED AND THE PATIENT
FORCES EXPIRATION THE FLOW OF AIR WILL BE
FURTHER REDUCED.

11. • FORCED EXPIRATION (HUFFING) MUST NOT BE
USED WHEN TEACHING BREATHING CONTROL.
• AFTER CAREFUL INSTRUCTION EMPHASIS NEEDS
TO BE PLACED ON THE IMPORTANCE OF REGULAR
PRACTICE.

12. THANK YOU