Feeling of pressure in the upper abdomen and tension in the sternum – what is behind it?

Introduction

Are you familiar with that diffuse feeling of pressure directly beneath your sternum? Perhaps you also feel a kind of inner tension that extends to the lower part of your sternum (xiphoid process). Sometimes it even cracks there when you press gently. These symptoms aren't uncommon—yet they are often misinterpreted. Is it the stomach? The liver? Or perhaps the diaphragm? In this article, we take a closer look at what's behind it. With biochemical background, current studies, and concrete tips for relief.

Table of contents

• What is the diaphragm and what role does it play?

• Functional anatomy: How the sternum, diaphragm, and digestive organs are connected

• Symptoms: pressure, tension, cracking – what is typical?

• Possible causes in detail

  • Diaphragmatic elevation & breathing patterns

  • Reflux, stomach & biliary system

  • Myofascial tension & costosternal joints

  • Visceral tension & vagus nerve

• Treatment options

• Prevention & breathing exercises

• Supplements to support

• Current study situation

• Conclusion

• Sources

What is the diaphragm and what role does it play?

The diaphragm is the most important respiratory muscle in humans. It separates the chest cavity from the abdominal cavity and functions like a piston: When you inhale, it lowers, making room for the lungs. When you exhale, it rises again.

But the diaphragm can do much more: It plays a central role in intra-abdominal pressure, organ mobility and the function of the autonomic nervous system – particularly via the vagus nerve.

If the diaphragm is tense, blocked, or dysfunctional, it can lead to a severe feeling of pressure or tightness in the upper abdomen, exactly where the stomach, liver, and gallbladder are located.

Functional anatomy: How the sternum, diaphragm, and digestive organs are connected

The inferior xiphoid process is a cartilaginous extension of the sternum. It serves as an attachment point for:

• the diaphragm

• the straight abdominal muscles (rectus abdominis)

• the pericardium (pericardium)

This area is connected to the liver, stomach, and gallbladder by fascia. The liver's lymphatic vessels (thoracic duct) also pass through this region.

If the diaphragm is overloaded due to stress, incorrect breathing or inflammation, it can exert tension on the adjacent structures - resulting in a feeling of pressure and "cracking" in the sternum.

Symptoms: pressure, tension, cracking – what is typical?

Typical symptoms of diaphragmatic involvement or visceral tension:

• Feeling of pressure in the upper abdomen, especially under the sternum

• A pulling sensation towards the tip of the sternum

• Cracking when pressing on the xiphoid process

• Tightness when sitting or after eating

• Shallow breathing, restlessness, slight irritability

• (Pseudo-)cardiac symptoms due to vagal stimulation

Possible causes in detail

Diaphragmatic elevation & breathing patterns

A raised diaphragm can be caused by shallow chest breathing, lack of exercise, or chronic stress. This causes the diaphragm to lose flexibility and remain in a "highly tensed" position.

Consequences:

• Reduced mobility of adjacent organs

• Overpressure in the upper abdomen

• Transferred tension to the sternal process

Reflux, stomach & biliary system

In cases of reflux (acid backflow from the stomach) or latent gastritis, the area around the cardia (gastric entrance) can become tense. Bile stasis (due to high-fat meals, stress, or gallbladder hypomobility) can also cause pressure.

The liver and gallbladder are located directly beneath the right diaphragm and are closely connected to it via fascia and nerves.

Myofascial tension & costosternal joints

The anterior costal cartilage joints (costosternal articulations) can become blocked or inflamed. A cracking sound when pressure is applied to the sternum may indicate mechanical irritation of these joints (e.g., costochondritis).

Often accompanied by:

• One-sided load (e.g. backpack, sleeping position)

• Magnesium deficiency

• Fascial adhesions

Visceral tension & vagus nerve

Organs are suspended by visceral fascia. Inflammation, stress, or poor eating habits can lead to tension on these structures. This stimulates the vagus nerve, resulting in autonomic symptoms such as restlessness, pressure, and tightness.

Treatment options

• Osteopathy / visceral therapy for mobilization of the diaphragm and organs

• Practice diaphragmatic breathing (e.g. 4-7-8 method)

• Gently apply the fascia roller to the chest area

• Abdominal relaxation through light stretching exercises

• Dietary change (low-fat, rich in bitter substances, anti-inflammatory)

• Stress reduction (meditation, nature, magnesium)

Prevention & breathing exercises

• Daily diaphragmatic breathing: Breathe deeply into your stomach for 10 minutes

• Prone position with hot water bottle to relax the liver fascia

• Bitter substances before eating (artichoke, gentian, turmeric)

• No large meals in the evening

• Physical exercise promotes organ mobility

Supplements to support

According to studies, the following dietary supplements can be supportive:

• Magnesium (citrate) : 300–400 mg daily for muscle relaxation

• Milk thistle extract : 200–400 mg for liver support

• Artichoke extract : 300 mg to promote bile flow

• Bitter substance complexes : Before meals to stimulate digestion

• Probiotics : If irritable bowel syndrome or microbiome disturbance is suspected

Current study situation

• Respiratory Physiology & Stress : Studies show that targeted diaphragm training improves heart rate variability and calms the autonomic nervous system (Zaccaro et al., 2020, Frontiers in Psychology).

• Visceral mobilization : Visceral osteopathy treatment approaches show significant improvements in functional abdominal complaints (Fryer et al., 2016, Journal of Bodywork).

• Magnesium & Muscle Tone : A deficiency in magnesium promotes generalized muscle tone and fascial tension (Rosanoff et al., 2012, Magnesium Research).

Conclusion

The feeling of pressure in the upper abdomen combined with tension or a cracking sensation in the sternum is not an isolated occurrence. Often, the diaphragm is involved, sometimes also the stomach, liver, or gallbladder. Stress, lack of exercise, or unfavorable breathing patterns play a key role.

With targeted breathing techniques, fascial release and supportive supplements, the symptoms can often be significantly alleviated – without any medication.

Have you experienced this yourself? Share your experience in the comments or schedule a free initial coaching session – we'll find the root cause together!

Sources

1. Zaccaro, A. et al. (2020). How Breath-Control Can Change Your Life: A Systematic Review on the Effect of Controlled Breathing on Psychological Outcomes and Physiological Stress Markers . Frontiers in Psychology. Abstract : This systematic review demonstrates the positive effects of controlled diaphragmatic breathing on stress markers, vagal activity, and emotional stability. Link : https://www.frontiersin.org/articles/10.3389/fpsyg.2020.00537

2. Fryer, G. et al. (2016). Visceral Manipulation: A Review of the Literature . Journal of Bodywork and Movement Therapies. Abstract : This study examines the efficacy of visceral osteopathic treatment for functional complaints, including upper abdominal pressure and diaphragmatic disorders. Link : https://doi.org/10.1016/j.jbmt.2016.01.004

3. Rosanoff, A. et al. (2012). Suboptimal magnesium status in the United States: Are the health consequences underestimated? Magnesium Research. Abstract : This article describes how magnesium deficiency increases muscle tone and can promote systemic inflammation. Link : https://pubmed.ncbi.nlm.nih.gov/22920535

4. Mayo Clinic (2024). Costochondritis: Symptoms and Treatment . Summary : Overview of the causes, symptoms, and treatment options for inflammatory sternal cartilage junctions (costochondritis). Link : https://www.mayoclinic.org/diseases-conditions/costochondritis

5. NIH – National Institutes of Health (2023). Gastrointestinal Symptoms Without Organic Cause: Functional Diagnosis and Therapy . Summary : The NIH describes functional upper abdominal symptoms without organic findings, including a connection to the autonomic nervous system. Link : https://www.ncbi.nlm.nih.gov/books/NBK279455

6. ScienceDirect (2024). Search term: "visceral osteopathy diaphragm" – Study selection . Summary : Various studies on diaphragm mobilization and its effects on upper abdominal pressure, breathing depth, and autonomic symptoms. Link : https://www.sciencedirect.com

7. PubMed (2024). Search query: "diaphragmatic dysfunction upper abdominal pressure." Summary : Several studies confirm the role of the diaphragm in functional upper abdominal complaints. Link : https://pubmed.ncbi.nlm.nih.gov