Diaphragm pain may not be as common as some other health conditions but, in most cases, it can be very unpleasant and long-lasting. Looking at the most popular health forums, you can come across numerous cases of people complaining about pain in the thoracic diaphragm region lasting for months, sometimes even years!

It is our desire to help these people (and you) understand your body better, learn more about the diaphragm and the best way to deal with pain in this region.

Diaphragm Anatomy

To avoid any confusion, I must point out that today we will be talking about thoracic diaphragm exclusively; there are other “diaphragms” in the human body (such as urogenital or pelvic) but we won`t be covering them in this article.

Thoracic diaphragm is a dome-shaped sheet of muscles which separates the the thoracic from the abdominal cavity 1. The thoracic cavity, or chest cavity, is a chamber  enclosed by the ribs, sternum and spine, which contains major respiratory and circulatory organs (lungs and heart) 2; and the abdominal cavity is the space between abdominal muscles and the spine, containing a number of vital internal organs (stomach, liver, pancreas, intestines etc.) 3.

Its name comes from Greek diaphragma meaning partition or a barrier, so it literally means the muscle that divides thorax from the abdomen 4.

We already said that this is a sheet of muscles, and it is divided into three groups (based on the muscle fiber origins):

  • Sternal – originates at the back of the xiphoid process
  • Costal – from the inner surfaces of lower six ribs and their cartilages and
  • Lumbar – from the lumbar vertebrae by two pillars called crura.
Diaphragm Anatomy

Diaphragm Openings

Since the diaphragm is strategically positioned between thoracic and abdominal cavity, it is pierced in a number of places to allow various structures to pass from one to the other cavity. We won`t be going through all of them, but we must mention the larger ones:

  • Aortic hiatus (hiatus – Latin meaning opening/gap 5) – located at the back of the diaphragm (you can see it on the image above), through which passes the aorta (main artery of the human body), azygos vein and the thoracic duct (largest vessel of the lymphatic system)
  • Esophageal hiatus – situated in front of the aortic hiatus through which esophagus (foodpipe) passes
  • Vena caval foramen (foramen – Latin meaning opening as well ) – for caval vein (one of the largest veins in the human body)


Diaphragm is the main respiratory muscle. When we inhale, it drops down and increases the volume of thoracic cavity, which creates suction that draws the air into our lungs. When we exhale, the diaphragm relaxes and recoils back to its original position, and the air is forced out.

Diaphragm Pain Causes

You have to be aware that diagnosing the exact cause of chest or upper abdomen pain yourself, is not something I would recommend. Usually, my first recommendation is to visit your doctor and see what is going on, but it is my duty and pleasure to help you educate yourself when it comes to your own body.

Painful Inhalation and Exhalation

There is some confusion when it comes to diaphragm pain and breathing. If you experience pain on a full inhale, it is more likely caused by problems with transversus abdominis muscle (muscles on the side of the abdominal wall); and if you feel pain on a full exhale, it is likely related to the diaphragm 6.

Pain can also be felt when coughing or sneezing. Shortness of breath may also indicate problems with diaphragm.

Diaphragmatic Spasm

Patients with diaphragm spasm usually complain about pain in the area below the sternum and just below the ribs on either side of the abdomen 7. They may also complain of chest pain, shortness of breath and inability to get a full breath.

Pain release requires diaphragm stretching which occurs at the end of a forced exhalation. Forced exhalation may be accomplished by using the power of the abdominal muscles, hand pressure on the abdomen or bending the body forward as you exhale. Most corrective measures involve changes in posture and breathing exercises.

It is important to note that there were cases where the diaphragm went into spasm due to an intense emotional stress. Once the stress was gone, so was the spasm.

Pain During Exercise

Intense, vigorous exercise without warm-up can cause pain on the side of the thorax, around the lower border of the rib cage. This pain is usually relieved when person is resting and it intensifies by continuing exercising.

And the best way to prevent this type of pain is to do a proper warm-up and stretching prior to exercise.

Hiatal Hernia

Hiatal hernia is a condition where the upper portion of the stomach protrudes upwards, into the thoracic cavity, through the opening on the diaphragm called esophageal hiatus (we mentioned it above). It is relatively common in older population (of people over 60 years of age), but can present itself in younger adults due to:

  • Obesity
  • Poor posture
  • Frequent heavy lifting
  • Smoking etc.

Most common symptoms are chest pain, difficulty swallowing, coughing or frequent hiccups.

Home treatment usually involves changes in the lifestyle: losing weight, improving posture, exercising or changing your diet. Surgery is rarely needed but it will bring relief in case of an emergency.

Pain During Pregnancy

Shortness of breath is normal in pregnancy and should not be a cause for concern. As the baby grows and the uterus expands, diaphragm may rise up to 1 1/2 inches and decrease your lung capacity 8. When this happens (better yet, before it happens), you should consult your doctor and ask for some exercises for improving your breathing and posture.

However, if you start experiencing pain in this area, consult a medical professional.

Diaphragmatic Rupture

This is a more severe injury and it is usually associated with blunt trauma (in motor-vehicle accidents) where there is a tear . Not all accidents will cause thin injury though, frequency varies from 0.8-8% 9, and it may sometimes be overlooked.

The injury will not heal on its own so the surgery is needed.