If you’ve been working on your breathing, your core, or even your pelvic floor and things still aren’t improving, it may not be a strength problem. It may be a positioning problem. More specifically, it may be your rib cage.
Most people are taught to think about the diaphragm, the abdominal wall, and the pelvic floor. But the rib cage is what those systems attach to and move within. If it’s not positioned or moving well, everything underneath it has to compensate. And when that happens, pressure stops being managed well. It just gets redirected. And that’s when symptoms start to show up.
The Rib Cage Is Not Just a Structure. It’s a Driver of Pressure
Your rib cage needs to expand and move in multiple directions with each breath, forward, sideways, and most importantly into posteriorly.
When that happens well:
- The diaphragm can descend efficiently
- The abdominal wall responds with controlled expansion
- The pelvic floor can lengthen and recoil appropriately
When it doesn’t:
- Pressure gets pushed forward or downward
- The abdomen loses control
- The pelvic floor takes on more load than it should
Pressure doesn’t disappear. It just moves. And if it keeps getting pushed in the wrong direction the body will eventually let you know. At Femina Atlanta this is one of the most common patterns we see in patients dealing with bloating, pressure, or pelvic floor dysfunction.
Where the Serratus Anterior Fits In
This is where the serratus anterior comes in, and no, this is not about shoulder workouts. The serratus helps control how the rib cage expands and stays positioned during breathing. It allows for more balanced, posterior and lateral expansion instead of everything dumping forward.
When it’s not doing its job well:
- The rib cage flares up and out
- Breathing becomes more chest-dominant
- The system loses pressure control
Which then becomes a downstream issue, not just a local one.
What Happens When Rib Cage Mechanics Are Off
When rib cage position isn’t well controlled, the body will still find a way to breathe but not very efficiently. And when pressure isn’t managed well, it doesn’t just disappear. It shows up as bloating, abdominal distension, and often pain.
We commonly see:
- Excessive abdominal pushing with each inhale
- Overuse of the neck and upper chest
- Loss of abdominal coordination
- Increased pressure into the pelvic floor
If your stomach is pushing way out when you inhale, it’s not better breathing. That’s usually a sign that pressure isn’t being managed well. This ties directly into how the abdominal wall functions, especially the transverse abdominis.
Why This Matters for Pelvic Floor Symptoms
The pelvic floor does not operate in isolation. It responds to pressure from above. If the rib cage and diaphragm aren’t working well, pressure gets redirected downward. Over time, that creates a system where the pelvic floor is constantly responding instead of functioning normally, often becoming more tense and overactive, with increased hypertonicity. And again, that pressure has to go somewhere.
This can look like:
- Pelvic pain
- Pain with intercourse
- A feeling of pressure or heaviness
- Persistent bloating or abdominal distension
This is why symptoms often don’t improve when you only focus on the pelvic floor without addressing the rib cage. It also explains why we frequently see overlap with abdominal distension patterns, like those outlined in our GLP-1 Medications and Bloating blog.
Again . . . common but not normal.
Why Breathing Alone Doesn’t Always Fix It
A lot of people are told to just breathe better. But if the rib cage can’t move well or isn’t positioned well to begin with, breathing drills (like 360 breathing techniques) alone won’t fix the problem.
Breathing is not just about getting air in. It is about managing pressure. If the system you are breathing into is not organized well, that pressure will keep getting pushed into the abdominal wall, the pelvic floor, and often the lower back.
What Actually Helps
At Femina, we don’t just look at the pelvic floor or give isolated exercises. We look at how pressure is created, managed, and distributed through the entire system:
- Rib cage position and mobility
- Diaphragm coordination
- Abdominal wall control
- Pelvic floor response
Because if pressure is not managed well at the top, it will continue to show up at the bottom … i.e. the pelvic floor.
How We Retrain Breathing and Rib Cage Control
One example of how we start to retrain this system is with a simple breathing exercise in a supported position.
A supine breathing with reach helps integrate the serratus anterior with the diaphragm and abdominal wall. By lying on your back with your arms gently reaching toward the ceiling, you create better rib cage positioning and allow for more balanced expansion through the back and sides of the rib cage.
This is not about forcing a deep breath or pushing your stomach out. It is about allowing the rib cage to move well so pressure can be distributed more evenly through the system.
When done correctly, you will often feel:
- Expansion into your back and sides
- Less gripping through the neck and upper chest
- More controlled abdominal movement
This type of drill reinforces what we discussed in our 360 Breathing Technique article and builds on how the abdominal wall functions in coordination with breathing, as outlined in Transverse Abdominis and Core Control.
When to Pay Attention to This
You don’t need to overanalyze every breath but if you’re noticing:
- Your stomach pushes out excessively when you inhale
- You can’t seem to control your core despite “doing all the right things”
- You have persistent bloating or pressure
- Pelvic floor symptoms aren’t improving
It’s worth looking at how your rib cage is functioning.
Pelvic floor symptoms are often not just a pelvic floor problem. They are a pressure management problem. And pressure, whether it is controlled well or not, always goes somewhere.
Care That Looks Beyond the Pelvic Floor
This is exactly why we take a whole-body approach at Femina Physical Therapy. Pelvic floor symptoms are often the result of what’s happening above and around the pelvis not just within it.
If you’re in the Atlanta area and not getting the results you expected from traditional approaches, we’re happy to take a deeper look.
FAQ
Can rib cage position affect pelvic floor symptoms?
Yes. Poor rib cage positioning can disrupt pressure management, increasing load on the pelvic floor and contributing to symptoms.
What muscle helps control rib cage movement during breathing?
The serratus anterior plays a key role in controlling rib cage expansion and supporting efficient breathing mechanics.
Why does my stomach push out when I breathe?
This often indicates poor pressure control, where the abdominal wall is not coordinating well with the diaphragm and rib cage.
References
- Hodges PW, et al. Coordination of the diaphragm, abdominal muscles, and pelvic floor during breathing.
- Kolar P, et al. Postural function of the diaphragm in stabilization.
- Bordoni B, et al. Anatomy, Thorax, Serratus Anterior.
- Lee DG. The Pelvic Girdle: An Integration of Clinical Expertise and Research.