Balloons - Quite Possibly The Most Underrated Therapy Tool

Balloons. They're good for so many things - decorating a party, making funny sounds when you deflate them, but did you know they can be the "miracle" rehab tool that's been missing from your routine?

To understand why this is one needs to understand the position and function of the diaphragm. The diaphragm is the primary muscle of inspiration and attaches to the back of your lower ribs and the front of your lumbar spine (bones of your lower back). When it's properly positioned, the diaphragm should have a domed shape. As this muscle functions, it flattens drawing air into the lungs and rebounds into a domed position causing air to be passively exhaled.


When our diaphragm is not properly positioned, it cannot work effectively. This can happen for many reasons - chronic sinus conditions, poor posture, and even disorders such as anxiety. When the diaphragm isn't working as well as it should, it tends to flatten out and lose it's natural domed position. Then we will be unable to inhale fully as the muscle's total range of motion has lessened. When this is the case, our bodies will compensate so we can continue to take in air and live. We can do this in a few ways: 1) we will use muscles of our upper trunk and neck such as our sternocleidomastoids and upper traps to attempt to lift the ribcage during inhalation instead of letting our lower ribs move out to the side gently and inflate our upper chests and backs, 2) we will use our lower back extensors to extend, or lean back, our rib cage so that we are able to inflate our abdomens with air or "belly breathe", or 3) a combination of these compensations.

These changes may go unnoticed for a very long time, but when done chronically, they can change our musculoskeletal position and cause muscle imbalance within our bodies and create pain. When someone has breathed this way for a long time, we typically see an arched lower back and pelvis that is tipped forward due to the spinal attachments of the diaphragm pulling the lumbar spine into extension. This can cause irritation of the low back extensor muscles and discs. It also causes our thigh bones to rotate outward which inhibits our gluts from firing and overusage of other hip muscles like the piriformis which can cause pain down the leg.

We also tend to see extended or backward-bent ribcages and flared lower ribs. This will ultimately cause a forward head and poor scapular position as we try to see and manipulate the world in front of us. These deficits can cause neck and shoulder (blade) pain as well as headaches.

So, how does the balloon help? We must utilize our abdominals to help force the air out of our thorax into the resistance of the balloon. This will help take our extended lower spine and ribcage and bias it into flexion, which will ultimately put it in a much more neutral position. Additionally, activation of the abdominals on the front of our bodies causes the muscles on the backs of our bodies, our low back extensors, to inhibit and relax. This can greatly reduce lower back pain and put our pelvis in a better position.

It is not only important to be able to blow air into the balloon, but it's also important that we can keep air in the balloon (keeping the neck of the balloon open) while we breathe in through our noses. This works on eccentric control of the abdominals. This allows our muscles to stay engaged even while they are elongating, such as when the ribcage is expanding as we take air in through exhalation during normal activities. This is very important as our core needs to be active at all times to keep us in good postural alignment and moving properly.  As the abdominals make up 1/4 of the core, it's essential that we don't "turn off" our abdominals with every inhalation throughout the day. Another muscle of the core is the diaphragm itself so its position and function is just as important as our abdominals. (The rest of the core is made of muscles of the lower back and pelvic floor.) This also establishes proper intraabdominal pressure which inherently stabilizes our core.  

What's the take home message? If you cannot blow up a balloon or keep it inflated while you breathe air into your nose (and keep the neck of the balloon open), your diaphragm is not functioning as it should and your body is not performing at it's best. Even if you are in a physical therapy program and are noticing good results, if you are building strength on faulty foundation or on top of compensated breathing patterns, the moment you stop performing your exercise program on a regular basis, you are likely to begin experiencing your symptoms again.

Please contact either Lesley or Nancy at Integrate 360 Physical Therapy if you are unable to blow up a balloon properly and/or have not achieved maximal results with other interventions that did not assess and/or treat your diaphragmatic function as part of your program. Let us make your exercise program work better for you! Email us at , , or call us at 314-733-5000