Thought provoking and beautiful in many ways, the “Real Bodies” exhibit that I visited in Las Vegas this month, explores perfectly preserved human bodies and helps me connect in a deeper sense, to what it means to be alive.  With so many intricate and vital organs packed into our bodies and all the conscious and unconscious actions that occur, it’s a wonder to me how we live, breathe and move every single day, seemingly effortlessly.

As a PT I have a nerdy interest in anatomy and understanding our inner workings.  Something that really resonated for me in this exhibit, and that has a direct impact on you, is the diaphragm and its vital function in our lives.

It’s well known that breathing is an activity that crosses cultural, racial and gender lines. We are all required to breathe in order to survive.  “Without oxygen, brain cells begin to die within five minutes.”  (Body – the Complete Human  ~National Geographic)


This longitudinal section of a body was on display at the exhibit. The diaphragm-that I’m pointing out here-looks like a thin layer of muscle which sits below the lungs and heart and separates the thoracic cavity from the abdominal cavity. It’s sitting just above the liver and is the major muscle of respiration. In its resting state, it looks like the shape of a mushroom or parachute and when it contracts, if flattens out moving downward creating more space for the lungs to fill on an inhalation. During exhalation, the diaphragm passively relaxes and returns to its original dome shape.

Mindful controlled breathing can be used as a tool to calm our nervous system and control our blood pressure. If we are stressed, our sympathetic nervous system (think fight or flight) is triggered causing our respiratory rate, blood pressure and heart rate to go up. Our breathing becomes  shallow expelling more carbon dioxide and inhaling less oxygen.  If we’re continually stressed for long periods, our body adapts to this faulty breathing pattern thinking this is the new normal. It causes our diaphragm to weaken resulting in overuse of our breathing accessory muscles (scalenes) and our shoulder muscles. This will, over time lead to neck and shoulder pain.

Research shows that improving our diaphragmatic breathing can help decrease our stress and conditions related to stress such as high blood pressure, headaches, neck pain and anxiety (Ehrer et al 2012).

Pilates and Breathing
Of course I can’t help but draw parallels between the use of the diaphragm and Pilates.

Did you know the primary breathing muscle, the diaphragm, is also a key core muscle providing spine stability along with several layers of abdominals, the multifidi in our backs close to our spine, pelvic floor muscles and fascia?  Anatomically, the diaphragm has origins on the xiphoid process (bottom of sternum), the upper lumbar vertebra and the lower 6 ribs with their costal cartilage (which by the way interdigitate with Transverus abdominus (TA).  The insertion is the central tendon that has no bony attachment.  The diaphragm is primarily a muscle of inspiration, contracting to get air in and the abdominals and intercostals (muscles between the ribs) assist primarily with exhalation. (Kendall, F. Muscles Testing and Function 1993)


As the diaphragm contracts, it also helps to stiffen and stabilize the thoracolumbar junction by pulling on the tendon that attaches to the upper lumbar vertebrae. In addition as the diaphragm contracts and lowers, the increase in intra-abdominal pressure is met by an increase in TA and pelvic floor  or “core” muscle activation to allow trunk stability during breathing and movement. From this we can ascertain that the diaphragm is integral to core stability. Also important to note is when the aforementioned muscle groups work out of sync, it can lead to low back pain and problems of lumbopelvic instability

Joseph Pilates is quoted as saying,  “Above all, learn to breathe correctly!” He highlighted the importance of breath in his system, inventing exercises like “the Hundred” to create an internal shower for the body, heating the body up from the inside out and improving circulation. (Pilates, Return to Life 1945)

When we apply diaphragmatic breathing and adapt it for Pilates-otherwise known as “Pilates breathing”, we maintain focus on the 3 dimensional expansion of our lungs/ribcage seen in diaphragmatic breathing, however, instead of expanding the belly, we maintain abdominal control and do not puff the belly. This provides safety and stability for the spine when doing exercises like “bird dog” on all fours, where we lift opposite arm and leg in the air and need to keep a stable spine.  It’s also important in many other exercises including “the Hundred” to keep the spine from arching or the pelvis from rocking.  Similar to diaphragmatic breathing, we encourage a multi dimensional expansion of our ribs allowing for greater lung capacity and rib cage mobility.  Does this mean we hold the stomach in taut in at all times in Pilates?  No, there are times when relaxed expansion is fine, it’s all specific to the exercise and what your goal is at the moment.

Try this exercise with me to feel your own rib cage expansion

  • Lying down with knees bent-feet flat on the floor, wrap your hands around your  rib cage on either side.  (include the front, sides and back of your ribs) Try both grasps illustrated to see which grasp is more comfortable and gives you more proprioceptive feedback. I prefer most fingers in back (bottom picture) for more feedback of posterior and lateral expansion of the ribs.
  • As you inhale, experience your ribs expanding and widening front, side and back.  As you exhale, feel your ribs relax back toward your spine. Imagine in your minds eye, an accordian or bellows slowly expanding and contracting. Minimize chest rise as you do this and maintain tone in your belly rather than clenching the abdominals which might make you tuck your pelvis.
  • Try putting a bag of rice on your belly as you practice this and attempt to keep the rice from lifting and lowering. For a greater challenge try the Hundred exercise with the bag of rice, keep your head down at first and just pump your arms and focus on keeping the rice still. (

When do we exhale and inhale during an exercise in Pilates?

I get this question a lot and according to what I believe, there are suggested ways of breathing for particular exercises that support the movement. For instance, when you do extension-think the “Swan” exercise (lying on your belly and lifting your head and chest), an inhalation will help and support extension.  If you are lying on your back and doing a chest lift (curl up of the head and shoulders) the exhalation supports this movement and triggers the activation of your core muscles to assist in the rise.

With that said, there are many exercises, like footwork on the Pilates Reformer, where different breathing cues are taught by different schools of thought.  Instead of adhering to one school of thought, I look at the person in front of me to see which breath pattern best supports their movement, promotes a neutral spine position and is most organic to them.  That is the breath pattern we choose.

If you find that you’re stressed about which way to breath for every exercise, you may find yourself holding your breath  and that will work against you.  Bottom line, when in doubt, just breathe!

Allow me to share with you, an excerpt from an inspiring quote featured in the Real Bodies exhibit.


Life begins with a gasp, a sudden rush of air into the lungs followed by the harsh cry of a newborn “I am ready”. And so it begins, a lifetime of breaths.

Inhale, exhale, repeat

…Beyond culture, beyond race, beyond religion breathing is an undeniable need shared by all.  This is inspiration, an invitation to the spirit of life to fill the empty sponges within us, yet again. A willful defiant act of our unconscious, it declares I AM, again and again through the cycle of minutes and years. With each breath comes a new beginning making all things possible.

Inhale, exhale, repeat


  1. Photo from Real Bodies exhibit, Las Vegas 2018 Respiratory system
  2. Body: The Complete Human-How it Grows, How it Works, and How to Keep it Healthy and Strong 2009 ~National Geographic
  3. Photo of cross section of body from Real Bodies exhibit, Las Vegas 2018. Detailing of diaphragm-my own insertion
  4. Ehrer et al, (2012). Positive Effect of Abdominal Breathing Exercise on Gastroesophageal Reflux Disease: A Randomized, Controlled Study. American Journal of Gastroenterology. 107, 372-378
  5. Kendall, F. (1993) Muscles Testing and Function.  323-325
  6. Diaphragm illustration credit
  7. Joseph Pilates-Return to Life through Contrology 1945 – Breathing Quote
  8. – reference to rice as feedback with Pilates breathing
  9. Final quote from Real Bodies Exhibit Las Vegas, May 2018