What’s in a breath?

Put simply, a lot!

Next to the heart, the diaphragm is the most important muscle in the body. Recent research shows that dysfunction of the diaphragm is associated with low back pain.  The diaphragm is a large muscle separating the chest from the

abdomen, is the primary breathing muscle, as well as part of the core muscles.

The core muscles are a spherical boundary of muscles that surrounds the abdominal cavity. They include the: diaphragm, pelvic floor, lumbar musculature, abdominal muscles and rectus abdominis. These muscles work together to stabilize the spine, pelvis, hips, and support the function of chest and abdominal organs.


Gray's picture of diaphragm. Note the circumferential attachments to back, ribs, and sternum.

Gray’s picture of diaphragm. Note the circumferential attachments to back, ribs, and sternum.

Proper breathing requires the diaphragm to flatten and descend into the abdomen with inspiration, and doming upwards into the chest cavity with exhalation (there is much more, but to keep it simple we will stop there).  Because the diaphragm connects from the back to the front of the body, it requires coordinated muscle activity from the anterior abdominal muscles and core muscles, in order to function efficiently.

Dysfunction from the diaphragm can occur from a problem with the muscle itself or from any of the components of the core musculature; examples include: smoking, prior abdominal or pelvic surgery, deconditioning, abdominal hernias, open heart surgery, etc.  A less efficient diaphragm leads to overactivity of the secondary breathing muscles (intercostals, scalenes, and sternocleidomastoids), and back muscles.  Dysfunction of the diaphragm can also lead to core dysfunction.  This cascade of events can then lead to back pain, neck pain, pelvic floor problems, hip problems, etc.

Without addressing the function of the diagphram, exercises to treat neck pain, back pain, pelvic floor problems, and hip problems can fail.  Treatment should be aimed at restoring the function of the diaphragm through special breathing exercises that work on coordinating the activity of the diaphragm with core musculature and restoring balance to the secondary breathing muscles.

Valley Sports and Spine Clinic has trained alongside select physical therapists from Blacksburg, Christiansburg, and Radford to develop techniques, adapted from the Postural Restoration Institute, for evaluating and treating diaphragm problems.  If you have neck pain, back pain, urinary incontinence, bowel difficulty, or hip problems, you may need to have your diaphragm function evaluated and treated. We can help!

Good Luck,


Ethan Colliver, DO

Valley Sports & Spine Clinic Giving you Back your Life


Where will the next generation of Physicians come from?

emg2The Practice of Medicine has alwaVCOM students practicing nerve conduction studies on each otherys been a blend of science and art.  Medical school lays the foundations for the science portion; however, the art comes from the guidance given by established physicians. In fact, you graduate medical school with a Medical Degree but cannot practice medicine until you do an internship where you train under the tutelage of an Attending Physician.

VCOM students practicing nerve conduction studies on each other


This week I helped the Physical Medical & Rehabilitation club at Edward Via College of Osteopathic Medicine learn about electrodiagnostic medicine.  This is a group VCOM medical students who have a particular interest in learning about physiatry. Electrodiagnostics include nerve conduction studies and electromyography and all physiatrists learn how to perform them over the course of 3-4 years of training. We discussed  how these studies can help patients with sciatica, carpal tunnel syndrome, neck pain, low back pain, peripheral neuropathy, myasthenia gravis, or myopathy.

After some didactics, I even had a brave volunteer allow us to practice on her so that everyone could see how to perform and interpret these studies!  I was so impressed with the students genuine interest and thoughtful questions.  By the end, all students were able to practice zapping their friends.  This experience will give the students empathy and insight for when they are faced with ordering this test for a patient in the future.

I am fortunate and privileged  to have interested students I can guide along the path to Physician.  Thank you VCOM PM&R club!



Good Luck!

Valley Sports & Spine Clinic Giving you Back your Life

Dr Ethan Colliver


Ouch! My Neck Hurts!

Bicycling is a great non-impact sport that can be enjoyed by many, no matter the age.  I have been an avid bicyclist since I was a resident physician at the University of Utah.  When I started commuting to work, my low back pain improved, as did my overall health and endurance.  I loved the alone time and the beautiful scenery I would otherwise  miss if I drove to work.

After a few years I developed neck pain.  I tried switching bikes and used a bike rack instead of a backpack, but to no avail.  Neck pain is a common complaint

for bicyclists and affects up to 50% of regular cyclists.

When you ride a traditional bike, the rider leans forward to grasp the handlebars and this increases the kyphosis (or flexion) of lumbar and thoracic spine and hyperextends the neck.  This results in overloading of the small joints in the neck and the paraspinal muscles that hold the head up.  Hyperextension of the neck can also cause pinching of the nerves from the neck to the arms, thereby causing arm pain, numbness, and tingling.  If a rider has poor midback flexibility and strength, then the upper neck muscles (upper trapezius, levator scapulae, scalenes, sternocleidomastoid) can become overactive and put additional stress on the neck.  Dr. Janda, a renowned neurologist, referred to this as “upper crossed syndrome”.

Treatment must address appropriate exercise and proper bike fitting.  Cross-training is essential to work on antagonistic muscles and movements to oppose the sustained posture of bicycling. In my case, I should have strengthened my deep neck flexors and mid-back muscles and worked on flexibility of the anterior and upper neck muscles.

I recently took advantage of a professional bike fitting service at a local bike shop, East Coasters.  I saw a dramatic difference in my posture and neck pain while on my bike immediately after the fitting.  At East Coasters, the athlete is carefully measured and examined while on a bike in order to ensure proper seat height, arm elevation and reach, and other factors.

Neck pain that lasts more than a month or results from trauma should be a red flag to go see a doctor for further evaluation.  Severe cases may require a neck injection, manipulation, or even surgical consultation.

Good Luck!

Valley Sports & Spine Clinic

Giving you Back your Life

Dr. Ethan Colliver