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Diaphragm Pain

The diaphragm is the main muscle responsible for breathing, being the part of the body that separates two of the most important cavities of the body, the abdomen and the thorax. When we breathe air in, the diaphragm acts by decreasing the amount of pressure in the lungs and helping the rib cage to expand. Diaphragm pain can be a symptom for a wide range of medical problems and it often appears in patients who had have heart surgery. In many cases, the etiology of the disease that also causes diaphragm pain to appear is unknown. It has been stipulated that even an inefficient breathing pattern can cause diaphragm pain.

Causes of Diaphragm Pain

Diaphragm pain can appear as a symptom in any of the following medical conditions:

Anatomic defects

  • Congenital – these appear at birth and, most of the time, their cause is unknown
  • Acquired – these can appear after different types of injuries, traumas and as post-operative complications but they also have idiopathic etiologies in many cases

Innervation defects

  • Stroke – in many cases, hemiparesis appears as a direct result of the stroke, causing one side of the diaphragm muscle to be paralyzed as well. The muscle part on the healthy side will have to work more and thus pain will be unavoidable.
  • Disorders of the spinal cord – traumas, ALS, motor neuron disease they can all lead to diaphragmatic pain.
  • Neuropathy of the phrenic nerve – the phrenic nerve is responsible for the innervation of the diaphragm. It can lead to severe diaphragmatic pain, especially if there is a tumor involved. Also, it might be important to add that the phrenic nerve can also be injured during different types of surgeries in the area.
  • Myasthenia gravis – this is a medical condition in which the breathing capacity is severely impaired and diaphragm pain is an additional symptom.

Other Causes

  • Muscular disorders
    • Muscular dystrophy
  • Diseases of the connective tissues
    • Rheumatoid arthritis
  • Neurologic disorders
    • Multiple sclerosis
    • ALS (amyotrophic lateral sclerosis)
    • Poliomyelitis
  • Thyroid disorders
    • Hyperthyroidism
    • Hypothyroidism
  • Malnutrition
  • Radiation therapy
  • Infection
  • Trauma – the diaphragmatic rupture is extremely painful and it can be accompanied by respiratory distress and even cardiac dysfunction, representing a serious medical emergency.
  • Hiatal hernia
  • Inefficient breathing pattern
  • Chiropractic manipulation


In order to solve the diaphragmatic pain, one must solve the underlying condition that has led to the symptom in the first place. These are the most common courses of treatment undertaken for different pathologies involving diaphragmatic pain:

  • Surgery for congenital and acquired anatomical defects
  • Neurologic medication and physical therapy for stroke
    • The neurologic medication is meant to guarantee the faster healing of the area where the stroke took place and one can also recommend medication for coronary artery disease, as this is sometimes the main cause behind strokes
    • Physical therapy will improve the range of mobility and will help the patient to learn new moving patterns, including when it comes to getting out of bed and, for later stages, walking
  • Neurologic medication and physical therapy can also help disorders to the spinal cord. Occupational therapy is also recommended in order to teach people how to handle daily living activities
  • Phrenic nerve pacing is recommended for phrenic nerve neuropathy. This is also known as supportive management and it involve the placement of a pacemaker in the diaphragm, in order to guide respiration and eliminate upsetting symptoms, such as diaphragm pain. The process is similar to the cardiac pacemaker
  • Oxygen therapy and specific medication for myasthenia gravis
  • Physical therapy, occupational therapy, orthotics and muscle relaxers are the best way to handle muscular dystrophy. In more severe cases, oxygen therapy might be required
  • Anti-inflammatory medication for rheumatoid arthritis
  • Specific medication, physical therapy and occupational therapy are recommended for neurologic disorders
  • Hormone therapy is indicated for thyroid disorders
  • Slow food intake and vitamin supplements are recommended for malnutrition
  • Surgery for trauma
  • Repair surgery for hiatal hernia
  • Improved breathing with respiratory physical therapy

There are symptomatic treatments available for diaphragm pain as well:

  • Anti-inflammatory medication
  • Corticosteroids for more severe cases
  • Morphine in case of severe diaphragm rupture

Diaphragm pain during pregnancy

In the late stages of pregnancy, you will most likely experience diaphragm pain, accompanied by a feeling of not having enough air to breathe. What happens is that your uterus expands to accompany the growing baby and thus it pushes the diaphragm out of its rightful place. As the diaphragm is the main muscle responsible for breathing, you can understand that by rising with 4 cm from its usual position, shortness of breath and pain will appear. The shortness of breath is caused by the rise of the diaphragmatic muscle, that also decreases lung capacity. Choosing comfortable positions and learning breathing techniques can help you deal with such matters.

Diaphragm pain due to coughing

There are many respiratory conditions in which coughing is a main symptom. In cases of chronic coughing, the diaphragm is under a lot of pressure, as it constricts with every coughing fit. A patient diagnosed with tuberculosis for example is bound to suffer from diaphragm pain, as the constant coughing keeps this breathing muscle into a continuous stress. Learning more effective breathing techniques from an experienced physical therapist can help reduce the frequency of coughing and also the pain experienced at the level of the diaphragm.

Diaphragm pain after eating

This often appears in cases of hiatal hernia. In such situations, what happens is that the stomach bulges up into the chest, causing diaphragm pain among other upsetting symptoms. Overweight people present an increased risk for such problems and this is why losing weight can be a good way to prevent diaphragmatic pain from appearing. However, the most common course of therapy recommended is surgery, through a minimal invasive laparoscopic procedure.

Diaphragm pain after running

Running is the kind of physical activity that requires not only a lot of effort but also a certain breathing capacity. If you are not properly trained and you do not perform a short warm up before the actual running, then you stand a very high chance to suffer from diaphragm pain. This happens because the diaphragm is also a muscle and it is also the one responsible for breathing. If you are not trained, the diaphragm will contract and contract trying to keep up with the rest of the body and all that stress will lead to pain. Warming before running and taking things slow will help. Also, you might want to learn effective breathing techniques during running as this will help to prevent diaphragm pain as well.

As you have seen for yourself, diaphragm pain can appear in a wide range of conditions and situations. Do not wait before it is too late and make sure to contact your doctor, in order to receive the proper treatment. And, if the diaphragm pain is associated with running or eating, make sure that you take a step in making a change. Sometimes, the smallest changes provide the biggest results.

Diaphragm Pain
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