Besties for Life: The Diaphragm + The Pelvic Floor

If you’ve ever worked with a physical therapist for back pain, hip issues, or even stress incontinence, you’ve probably heard us talk about your core. But as someone who works at the intersection of orthopedics and pelvic health, I want to zoom in on two (often-overlooked but absolutely vital) players in your core system: the diaphragm and the pelvic floor.

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These two structures live at opposite ends of your torso, but they function as a team. And when that team isn’t in sync, you might feel it everywhere, from your low back to your breathing to your bladder.

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So let’s talk about why.

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The Top and Bottom of Your Core

Think of your torso like a pressurized canister:

The top of the canister is your diaphragm, the dome-shaped muscle that powers your breathing.
The bottom is your pelvic floor, a group of muscles that supports your pelvic organs, helps control continence, and stabilizes your spine and hips.

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When you breathe in, your diaphragm contracts and moves downward. Ideally, your pelvic floor responds by gently lengthening and expanding. When you exhale, both the diaphragm and pelvic floor recoil upward and inward.

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This pressure management system is essential for movement, stability, and function. And when the diaphragm and pelvic floor aren’t communicating well, things can go sideways.

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What Happens When the System Falls Out of Sync?

Whether someone is recovering from surgery, managing chronic pain, or dealing with pelvic floor dysfunction, I often see similar patterns:

Breath-holding during movement, especially when lifting or bracing
Shallow, chest-dominant breathing
Overactive or clenched pelvic floor muscles
Lack of core coordination with everyday tasks

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When the diaphragm isn’t functioning optimally—due to poor posture, stress, injury, or habit—the pelvic floor has to compensate. And over time, that compensation can contribute to:

Low back or hip pain
Pelvic pain or pressure
Leaking with exertion
Core weakness or instability
Difficulty returning to fitness after pregnancy or injury

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Why Orthopedic Rehab Should Include the Pelvic Floor (and vice versa)

As an orthopedic PT, I’ve seen patients make huge gains in pain and mobility once we bring breath and pelvic floor function into the equation. That’s because your pelvic floor doesn’t work in isolation. Rather it’s deeply integrated with your hips, abdominals, spine, and breath.

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Here are some examples:

A runner with recurring hip pain might have a hypertonic (tight) pelvic floor and poor breath mechanics.
A postpartum client with diastasis recti might also struggle with shallow breathing and poor pelvic floor control.
Someone with chronic neck tension may be compensating for poor diaphragmatic function—affecting their entire core system.

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In these cases, we’re not just treating a muscle. We’re retraining coordination, timing, and pressure management from the inside out.

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Where to Start: Simple Awareness, Big Impact

Try this mini check-in:

1. Sit or lie comfortably.

2. Inhale through your nose and feel your ribcage expand outward (not just your belly!).

3. Let your pelvic floor soften or expand downward naturally.

4. Exhale slowly through pursed lips and feel the natural recoil of your abdominals and pelvic floor.

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This breath-driven movement is subtle, but powerful. Over time, restoring this connection can help reduce strain, improve strength, and bring more efficiency to your movement.

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The Takeaway

You don’t have to be postpartum, leaking, or in pain to benefit from this work. Anyone who moves, breathes, or lifts (read: all of us!) relies on the harmony between the pelvic floor and the diaphragm. As a physical therapist who straddles both orthopedic and pelvic health worlds, I believe our most effective rehab happens when we stop treating these systems as separate, and start seeing how beautifully connected they really are.

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If you’re feeling stuck, leaking, bracing, or just off, this connection might be the missing piece.

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Want to learn more or feel this in your own body? I’d love to help. Whether you’re returning to movement, recovering from injury, or just want to breathe better, pelvic floor physical therapy might be the place to start.

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If you live in the Atlanta area, please contact us to schedule a consultation.

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‍Disclaimer: The views expressed in this post are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

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If you’ve ever worked with a physical therapist for back pain, hip issues, or even stress incontinence, you’ve probably heard us talk about your core. But as someone who works at the intersection of orthopedics and pelvic health, I want to zoom in on two (often-overlooked but absolutely vital) players in your core system: the diaphragm and the pelvic floor. These two structures live at opposite ends of your torso, but they function as a team.