Diaphragm: Pain & Trigger Points

The diaphragm is an important muscle in your body and can trigger a variety of pains and ailments, if it is tense or contains trigger points.

However, it is possible to relieve these tensions and trigger points with a self-massage.

Even if you’ve never heard of it before or if you have doubts, I encourage you to take a closer look.

On this page you will learn

  • what pain and complaints the diaphragm can cause.
  • what you can do about it yourself.
  • why the muscle might have developed problems.
  • and where it is located.

1. Pain Patterns, Symptoms & Differential Diagnoses

1.1 Pain patterns

Trigger points in the diaphragm mainly trigger

  • rib pain
  • chest pain.

These pains arise primarily when breathing, or more precisely when exhaling strongly. Nevertheless, the pain may also occur during inhalation.

1.2 Symptoms and further ailments

In addition to pain, tensions and trigger points in the diaphragm can lead to the following ailments

  • Side stitch
  • Respiratory distress/dyspnea

Side stitches occur mainly in the “lower front” of the ribs.

Dyspnoea or shortness of breath no longer allows for deep inhalation. This shortness of breath caused by trigger points can become so severe that the person concerned fears for his or her life.

This shortness of breath is often triggered by panic attacks or situations preceding such attacks.

This is partly due to the fact that your entire respiratory muscles react strongly to emotional tensions.

Many muscles react sensitively to emotional tension.

1.3 Differential diagnoses

The following diagnoses refer to conditions which can cause similar pains compared to those caused by trigger points in the diaphragm.

Please note that trigger points and the diagnoses below are NOT mutually exclusive. They can coexist!

  • Diaphragm spasm
  • Atypical chest pain
  • Stomach ulcer
  • Gall bladder disease

2. Diaphragm : Attachment Points

The diaphragm is a dome-shaped muscle that “lies” in your thoracic cavity and separates it from your abdominal cavity.


  • Lumbar vertebrae
  • Inside of the 7th – 12th rib
  • Sternum


  • Centrum tendineum

The diaphragm is innervated by the nervus phrenicus.

3. Diaphragm: Function

The diaphragm is your most important respiratory muscle. With every inhalation, it contracts.

By doing that …

  • it gets “smaller”,
  • pushes the organs in the abdomen downward,
  • and enlarges the space in the chest.

This mechanism draws air into the body.

Note: Exhalation is normally a passive process, i.e. it takes place without you doing anything. The diaphragm relaxes and the thorax decreases again, which forces air out of the body.

A very simplified comparison would be the return of a stretched spring to its original state.

4. Diaphragm: Trigger Point Activation

Trigger points in the diaphragm are mainly activated by by active overload.

  • Jogging
  • Fast hiking
  • Mountaineering
  • Cough

These things go hand in hand with increased breathing, especially with increased inhalation.

The strong inhalations can overload the muscle. Remember: The muscle contracts with each inhalation.

Furthermore, tensions and trigger points in the rectus abdominis (one of your abdominal muscles) can activate trigger points in the diaphragm.

In this case one speaks of satellite trigger points. Trigger points in one muscle lead to the activation of trigger points in another muscle.

Therefore, I recommended looking at the rectus abdominis, if you have problems with your diaphragm.

5. Palpation

Since the diaphragm is covered by your ribs, you cannot feel it, at least not as a layperson.

However, this is not a problem because you can still massage it – at least to a certain extent. More about this in the next chapter.

6. Diaphragm: Self-massage

It’s possible to massage the diaphragm yourself at the most inferior part of your ribs. This is where you have access to the deepest fibers of the muscle, for a few centimeters.

For the massage you only need your fingers. For the massage, follow the next steps.

  • Lie down on the floor, bend your legs and put your soles on the ground. This is important to relax your abdominal muscles.
  • Place your fingers under your ribs and lightly press against them.
  • Now start breathing slowly. If you encounter a painful tension, stay in this region for a few breaths.
  • Try to relax while breathing.

Note: You do not have to exert strong pressure during the massage. The diaphragm reacts to slight pressure.

In addition, this area is very sensitive quite often, and strong pressure would be unbearable for many people.

If the tension or pain is very strong, the massage and breathing can cause discomfort and a feeling of anxiety.

So, feel your way slowly towards the massage, listen to the reactions of your body and give yourself time.

Under no circumstances should you attempt to completely eliminate tension in just one massage session – this is usually not possible!


  • Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
  • Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
  • Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Williams & Wilkins, 1999. Print.
  • Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print