What I Wish Every Massage Therapist Knew About the Diaphragm
When I was a newer therapist, I used to think of the diaphragm as just “the breathing muscle.” You know, the one that pulls air into the lungs and helps us sigh with relief at the end of a long day. I didn’t even really have a clear picture of what it looks like in my head. It turns out I barely scratched the surface of what the diaphragm really does in the body.
The more I’ve studied and learned from my mentors — and the more I’ve listened with my hands — the more I’ve realized that the diaphragm is the bridge between almost everything: breath and blood flow, stress and calm, upper and lower body, brain and gut, heart and adrenals.
Freeing it to slide and glide relative to all of its neighbors means big changes to the body.
The Diaphragm Isn’t Just for Breathing
Yes, the diaphragm helps us breathe — but it also plays a major role in lymphatic return, venous drainage, digestion, emotion, and nervous system regulation.
It physically divides the thoracic and abdominal cavities. Think of it like a muscular trampoline that all the organs bounce on. If that trampoline is tight or pulled off center, everyone suffers — heart, lungs, liver, intestines, even the brain.
And the diaphragm, when it gets stuck in a pattern, loves to hold on to stress. It’s the silent holder of grudges from long-term trauma, chronic overthinking, old grief, and nervous system exhaustion.
The Diaphragm and the Heart
Let’s talk about the heart for a second. It sits right on top of the diaphragm. Which means if the diaphragm is stuck or restricted, the heart can’t move freely — not just in terms of circulation, but also in the Primary Respiratory Mechanism (PRM).
The pericardium is 95% inelastic, much like the dura mater layer of meninges that cover the brain and spinal cord. It grows out of the diaphragm, and attaches to the back of the sternum. What does that mean for the body? If the diaphragm stays even a little bit chronically contracted, the heart will be pulled down with it, and it will bring with it the pericardium, sternum. lower cervicals, hyoid, and even the head! I wonder if that has something to do with the forward head posture we see so often…
When the Lungs Get Stuck to the Liver (!)
One of the wildest things I’ve learned over the years is how pneumonia or a bad respiratory infection can cause the lungs to stick to the diaphragm. You literally grow connective tissue out of the lungs, through the pleura, through the diaphragm, and piercing into the liver.
What does this do to the body? The liver’s motion starts dragging the lungs with it. You’ll feel it with your hands — a lung that won’t expand well, or that loses its motion altogether as the liver pulls it off axis.
That’s a big deal. It compromises the health of both organs, and the freedom of the diaphragm to do its job — even years after the infection has cleared. Fluids will not be able to fully flow properly into and out of the lungs and liver, and the lack of motion will also affect other organs and systems.
Chronically Tight Diaphragm = Overworked Adrenals
Another overlooked piece? The diaphragm sits right on top of the adrenal glands. So when it’s chronically tight, it’s mechanically and neurologically stimulating the adrenals, asking them to pump out more cortisol and norepinephrine — stress hormones.
Over time, this keeps your client in a sympathetically dominant state. Their body stays wired, alert, and exhausted. They may say, “I just can’t relax,” or “My system is always buzzing.” They’re the ones who come in wound tight, talking loudly, and who seem to refuse to calm down while they are on the table. It’s not their fault! And it’s not yours either, but there is something you can do about it.
We have to address the underlying diaphragm tension that’s fueling the fire.
It Even Pulls the Brain Down
The diaphragm connects all the way to the cranium. You can feel it. A tight diaphragm creates a downward drag on the brain. You can feel this if you lightly place your hands on the head and ask the client to take a deep breath. You will feel the brain move down inside the cranium. What does a chronically held breath do for blood flow to the brain?
Clients with brain fog, headaches, jaw tension, or that heavy, downward-drawn feeling?
Many of them are carrying diaphragm restrictions they don’t even know they have.
Free the diaphragm, and watch what happens to their clarity and breath.
Signs the Diaphragm Might Be Stuck
Shallow breathing
Rib dysfunctions (pain that you might associate with a muscle, but happens to be right where a rib is)
Low back pain (for so many reasons)
Hypervigilance or anxiety
Trouble digesting big meals
A sense that they just “can’t let go” in session
Abdominal pressure
High voice
What Happens When You Free It
Releasing the diaphragm gently and precisely — no digging, no breathing through it — can:
Improve lung expansion
Regulate heart rhythm and PRM
Ease adrenal strain
Support digestion and liver flow
Restore cranial movement
Drop the nervous system into parasympathetic activity
It’s like opening the central valve in a system that’s been stuck in survival mode for too long.
Want to Learn How to Work with It?
If you’re curious about all the things the diaphragm affects — and want to feel these changes for yourself — I teach a Balancing the Diaphragm class for massage therapists and other hands-on professionals. It’s part of my 24-hour CE class series.
You’ll learn how to assess diaphragm motion, treat it without force, and track full-body changes when you release it.
Check my class schedule for upcoming dates — or get on my newsletter to be the first to know when I’m teaching it again.
One More Thing…
Sometimes I think about how many times I worked around the diaphragm early in my career — not even aware of it, really — and how many things could’ve changed for my clients if I had known how to listen to it.
But we all start somewhere. And if you’re reading this, maybe this is your invitation to go deeper.
The diaphragm has so much to say. We just have to be willing to listen.
