Core pressure and breathing
Why a stronger core isn’t always the answer
What do I mean by core pressure?
Intra-abdominal pressure is the pressure inside your abdomen. It changes when you breathe, cough, or lift. Your diaphragm, the main muscle you use to breathe, works alongside your abdominal muscles and pelvic floor, the muscles at the bottom of your pelvis. Together they help you adjust to what you’re doing. [1, 2, 3]
Why I look at how you use your strength
A heavy lift may call for more bracing. Getting out of a chair may call for much less. If both feel like they take the same effort, I want to see what happens when you change how you breathe, how you start the movement, or where your feet are. The goal is to find something you can actually use in the movement that bothers you.
What an assessment can show
Say standing up feels stiff. I might watch you do it as you normally would, then ask you to try a small change, like breathing out as you stand. We compare the same movement and talk about what you notice. An easier stand tells me we have something worth exploring. It can’t tell me exactly which muscle was responsible.
What the research tells us
Lab studies show that pressure inside the abdomen can contribute to how the lower back resists movement. Exercise that helps you coordinate your trunk muscles is one option for ongoing low back pain, and a Cochrane review found similar results with other forms of exercise. I use the assessment to decide whether breathing and coordination deserve a place in your plan. [4, 5, 6]
Watch the pressure system explanation
Frequently asked questions
I can hold a plank. Why do I still brace before picking up the laundry basket?
Show me how you lift it and what you do just before it leaves the floor. We can compare a comfortable lift with a change in setup, then notice whether it takes less effort while you keep breathing comfortably.
How do I know I’m using less effort when I’m thinking about something else?
Pick a familiar task that comes up naturally, like standing from your desk. Notice whether you still have to prepare for it. That gives us a way to see whether a cue from the clinic was useful in your day.
Why can I breathe normally lying down but hold my breath on the stairs?
I’d compare the tasks at a level you can manage. Tell me where on the stairs you start to hold your breath. We can see whether a change in support or pace helps and decide what deserves more practice.
What if a breathing cue helps once but I have to think about it every time?
That tells me it helped under those conditions. I’d compare a simpler version of the task with less cueing, then use what happens during your regular routine to decide how to build on it.
Should I keep my abs tight all day?
For everyday tasks, you can usually let your effort vary with the job. A deliberate brace can be useful for some lifts. If you feel like you have to hold your stomach in just to sit or stand comfortably, that is worth discussing at an assessment. A lab study comparing bracing and drawing the abdomen inward found different effects on trunk stability during its test conditions. [7]
Can you measure my core pressure during a visit?
The movement assessment looks at how you breathe and move and what changes when we try something different. It does not directly measure pressure inside your abdomen.
Do I need to stop doing planks?
Planks can still be useful if they fit your goals and feel tolerable. We may also practice the actual task you want to improve, such as lifting a bag from the floor. Guidelines and reviews support several types of exercise for ongoing low back pain. [8, 9]
Can breathing exercises fix back pain?
Breathing exercises may help some people move with less effort. Back pain can have several contributors, so we judge whether breathing work is worth keeping by how it helps you do what matters to you. A review found possible benefits for chronic low back pain, with more research needed to determine which breathing approaches work best. [10]
What if I’m already strong?
Tell me what you can do in the gym and which everyday movement still feels harder than it should. I might compare how you stand from a chair with and without a breathing cue. If the cue changes nothing, I’ll look at other contributors, such as how your hips move or how much effort the task takes.