Should You Exhale From the Bottom Up? Suction Up vs Bottom Up, Part 2
Oct 17, 2026
In Part 1, we talked about facilitating an exhale not from the bottom up but by treating the thoracic diaphragm at the top as if it's pulling all the guts up off the pelvic floor, so the pelvic floor doesn't have to work as hard. The idea is that rather than initiating a bottom-up contraction (pelvic floor lifts, deep abdominals), the diaphragm up top creates a suction. In Part 2 I add something we didn't cover: doing this on the right and left sides separately.
Two hemi-diaphragms
We basically have two hemi-diaphragms. On the right, we have a thicker, longer attachment site that goes further down the spine; on the left, the attachment is not as thick. So we often have more ability to pull pressure up off the pelvic floor on the right, and less on the left, where the diaphragm tends to sit in a more inhaled position.
I like to teach pushing yourself over to the right to work on that hemi-diaphragm, and then over to the left to work on the other side, and compare the two sides. Many people compensate by creating more rib flare on one side (usually the right), and then both sides get pushed down, making it harder to create the suction. Starting in an inverted position, where the hips are higher, makes it easier to suction and unweight the pelvic floor, with less need to constantly contract or think about doing a Kegel from the bottom.
Position 1: forearms, hips high
Start with the pelvis a little forward over the sit bones, then drop to your elbows, so the hips are higher, which automatically unweights the pelvic floor. Push with the inside of the palm, the inside of the elbow and the inside of the knee on one side, using those pressure points to shift over without hiking the hip or arching the back. From there, inhale fully and then exhale slowly, thinking of sucking the guts up toward the rib cage. When I push to the right, the right-side diaphragm is more active. Don't tuck under and crunch on the exhale; stay long through the body. Repeat for five to ten breaths on each side.
The left side is harder because the natural position of that diaphragm is more inhaled. Make sure you aren't compensating by flaring the ribs or overly tucking under. Push from the left, hold the position, don't hike the hip, and think of that left diaphragm suctioning everything off the pelvic floor as you exhale and continue to lift.
Position 2: seated at the wall
Sit on a hard surface with your hands on the wall. Tilt forward and back until you find the sit bones on each side. Push gently with your left hand into the medial part of the hand, and with your left inside heel, over to the right. It's a very gentle push; I'm not shoving myself and losing the sit bone. The goal is for one sit bone to be more weighted than the other. Hold those contact points, and focus on the same breath on the right side: inhale, then exhale, suction up and get the rib cage to come down. My spine isn't changing to create the exhale. Then repeat toward the other side, pushing with the right hand and the inside of the right heel and staying heavy on the left sit bone. Keep your head forward. You can try five to ten breaths on each side.
Position 3: standing at the wall
The last position is standing. As you load, you might lose your first metatarsal head as the foot takes a more supinated shape. If that happens, grab a rolled-up sock or a wedge and put it just under the big toe mound so when you move to the outside of the foot you still have good tripod contact. You can also place the wedge under both your big toe and the first metatarsal head.
Start with feet about hip width apart and hands on the wall with soft elbows. Find the inside of the heel on the left and the inside of the palm, and gently push yourself over to the right, not losing that metatarsal head contact. Take an inhale, then exhale, the diaphragm sucking everything up. You should feel the work through the whole side of the body, all the way down. Do it again on the other side, with soft knees and elbows, pushing gently into the inside of the heel.
The left side is a little harder to connect with, so you may want to adjust: turn the left hip slightly forward as you exhale, think of that part of the diaphragm, and take your left hand and drag it down the wall. Repeat for five to ten breaths on each side.
Watch more
Should you cue a bottom-up exhale? Suction up vs bottom up (Part 1)
No More Kegels: 5 things that improve pelvic floor performance without the pelvic floor
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