The Key to Core Stability: Aligning the Diaphragm and Pelvic Floor for Low Back Pain Relief

Low back pain is one of the most common musculoskeletal complaints, and its root cause often goes beyond just weak core muscles. One of the fundamental principles of Dynamic Neuromuscular Stabilization (DNS) is the alignment of the diaphragm and pelvic floor to create optimal intra-abdominal pressure and spinal stability. When these two structures are not in parallel alignment, the body compensates by overloading the posterior structures of the spine, leading to excessive wear and tear, pain, and even conditions such as spinal stenosis.

Understanding the “Open Scissors” Posture and Low Back Pain

A common postural fault seen in individuals with low back pain is the “open scissors” position—where the ribcage flares upward and the pelvis tips forward into an anterior tilt. This position creates an excessive arch in the lower back, disrupting the ideal alignment between the diaphragm and pelvic floor.

Why is this a problem?

1. Excessive Lumbar Compression – The increased arch places more load on the posterior elements of the spine, particularly the facet joints, which can lead to irritation, inflammation, and degenerative changes.

2. Poor Intra-Abdominal Pressure Regulation – Without proper diaphragmatic engagement, the core loses its ability to stabilize the spine, increasing strain on passive structures such as the ligaments and intervertebral discs.

3. Increased Risk of Spinal Stenosis – Over time, this excessive loading pattern can lead to degenerative narrowing of the spinal canal, a condition known as spinal stenosis, which can cause nerve compression, pain, and mobility issues.

Restoring Diaphragm and Pelvic Floor Alignment for Core Stability

One of the key ways to retrain the body’s natural stability system is to restore parallel alignment between the diaphragm and pelvic floor. This position allows for optimal intra-abdominal pressure distribution, reducing compensatory strain on the lower back.

A foundational DNS-based exercise to begin this process is the “Three-Month-Old Supine Position.”

The Three-Month-Old Supine Exercise

This exercise mimics a developmental milestone seen in infants, where they begin to develop proper core stability and postural control. Regressing to this stage allows adults to reset faulty movement patterns and reestablish proper alignment.

How to Perform the Exercise:

1. Lie on Your Back – Start on a firm surface with your knees bent and feet flat on the ground.

2. Align Your Ribcage and Pelvis – Gently bring your lower ribs downward so that your ribcage is stacked over your pelvis, avoiding excessive flaring.

3. Activate Your Diaphragm – Inhale deeply through your nose, feeling 360-degree expansion in your abdomen and lower ribs. Avoid lifting your chest or tensing your shoulders.

4. Engage the Pelvic Floor Gently – On exhalation, imagine drawing your pelvic floor muscles upward as if closing a zipper from the bottom up.

5. Hold and Maintain – Breathe slowly and maintain this alignment for 5-10 breaths, ensuring that your lower back stays in a neutral position without excessive arching.

Progressing the Exercise

Once proper diaphragm and pelvic floor alignment are restored, functional exercises such as quadruped breathing, side-lying DNS exercises, and functional squat patterns can further reinforce core stability in everyday movements.

For example Dr Powers will demonstrate how to Progress the 3 month Positon with a kettle bell in this video

Conclusion: A New Approach to Low Back Pain Management

If you suffer from chronic low back pain, focusing solely on strength exercises without addressing alignment and breathing mechanics may lead to continued dysfunction. The DNS approach emphasizes restoring developmental movement patterns to improve stability at the deepest level—allowing your core to function as it was designed.

At River Forest Health and Wellness, we integrate DNS principles into rehabilitation and injury prevention programs to help patients achieve pain-free movement. If you’re struggling with back pain and want to experience a more effective approach to core stability, contact us today to schedule an evaluation.

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