Normal breathing should involve up-and-down movement of the diaphragm. In order to evaluate whether this is happening, I place my hands lightly on the sides of the chest at the level of the last two ribs. If there is diaphragmatic breathing, I can detect a lateral movement of the lower two ribs on both sides. However, if there is a hiatal hernia, I can feel lateral movement on the right side but almost none on the left.
