Written by Tom Christ PT, DPT

The start of this decade has been a challenge for everyone.  The Covid-19 pandemic has been unpredictable and has changed the way all of us approach each day.  With the overall uncertainty of when our lives can get back to normal, these past few months have been some of the most stressful times our world has endured.  Now more than ever, it is important to find strategies to manage stress and anxiety in a productive healthy manner.  Now more than ever, it is important to remember to take a break from your daily stressors and just breathe.  

While that sounds simple there is quite a bit of science behind the importance of proper breathing as it relates to management of stress, anxiety, depression, and even concentration.  Diaphragmatic breathing is a popular exercise often incorporated into yoga, medication, tai chi and other mindfulness based practices.  Multiple studies have shown it is a useful non-pharmacological way to improve feelings of anxiety, depression, and has even shown to improve concentration.  But what even is the diaphragm and what is diaphragmatic breathing?

The diaphragm, which is located on the underside of our ribs and attaches to our lumbar spine is designed to be our primary respiratory muscle.  When we are infants this muscle works properly and you can observe a babies belly expand when they inhale, and contract when they exhale.  This expansion during the inhalation indicates that the diaphragm is working properly.  Commonly adults lose this natural breathing pattern and adopt a breathing pattern primarily using our “accessory breathing muscles” which are some of our neck, shoulder, and chest muscles.  Re-training diaphragmatic breathing is common in physical therapy practice, and can be performed by following these steps.


Diaphragmatic Breathing Steps

  1. Assess your breathing pattern: To start, lay flat on your back with one hand on your stomach, and the other hand on your chest.  Take some deep breaths, and try to notice what moves more as you inhale; does your stomach rise more? Does your chest rise more? With proper diaphragmatic breathing the chest should not rise much during the inhale, instead the stomach should rise and expand (think baby example from above)
  2. Assess the arch in your back: In order for the diaphragm to work properly, your ribs and pelvis must be aligned properly.  An easy way to assess this is by the arch in your back.  It is normal to have some arch in the low back, but you should not be able to fit your entire hand underneath your low back.  If this is the case, consider using some type of wedge or rolled up towel underneath your pelvis to roll your hips backwards, this will help align your back better.
  3. Take deep breathes into your belly: Place your hands gently on your belly as a reminder that you want your belly to expand as you are inhaling.  Take a deep slow breath in through your nose and imagine breathing down into your pelvis. As you breathe in your stomach should inflate.  This sounds strange but with practice will make more sense.  As you exhale, purse your lips together and somewhat forcefully without straining exhale out of your mouth. 
  4. Frequency and duration: Studies have shown benefits on stress, anxiety, and concentration by performing diaphragmatic breathing for as little as 5 minutes at a time.  A good time to practice diaphragmatic breathing may be during breaks if you are working from home, and is also beneficial before going to sleep. 


In simplest form diaphragmatic breathing helps us relax and reset our heart rate and respiratory rate. As we continue to shelter in place and socially distance ourselves from our friends, family, and other social outlets it is important to take time to focus internally and manage our stress levels.  Consider taking some time to practice diaphragmatic breathing, for as little as 5 minutes a day to help reduce stress and anxiety, improve concentration, and maintain a healthy mindset during this difficult situation.