Acid Reflux and Hiatal Hernia

 by Don McCann, MA, LMT, LMHC, CSETT
September 1, 2007

In order for massage therapists to be able to effectively help clients with a hiatal hernia and acid reflux, they must first understand how tension in the soft tissue from stress and structural imbalance contributes to these conditions.

One form of hiatal hernia is a tearing in the diaphragm that allows a portion of the stomach to protrude through the tear. There also can be damage to the esophageal hiatus where the esophagus empties into the stomach. When this sphincter valve of the esophageal hiatus is affected by stress or structural imbalance, it is not able to function properly. This improper function allows the contents from the stomach to flow back into the esophagus (acid reflux). Symptoms can be especially troublesome when a client is prone or supine or has a full, actively digesting stomach.

Acid reflux also can occur, even when there is no significant damage to the esophageal hiatus. This can be due to overactive digestion taking place in the stomach resulting from spicy food, overeating or the presence of excess stomach acid.

How can massage therapy effectively treat these conditions? Let's look at where the stomach is located and what muscles have a major effect on the esophageal hiatus and the stomach.

Massage for Acid Reflux: The Basics

The esophageal hiatus is located in the center of the diaphragm at the top of the stomach. The diaphragmatic muscle attaches on the sternum and lower ribs, and extends all the way around to the back, including the thoracic vertebrae. This makes it extremely reactive to any structural distortion.

If the musculoskeletal system is distorted, the resulting misalignment is reflected in contractions and distortions throughout the diaphragm. Stress affecting the sympathetic nervous system can add to structural distortions that affect the diaphragm. If you add extra weight to the structure, you have yet another distortion factor for the diaphragm.

When the esophageal hiatus is constantly stressed by these distortions and imbalances, it reacts like an "o" ring with unequal pressure on all sides, meaning it can't close effectively. This usually results in acid reflux or a hiatal hernia.

To resolve hiatal hernia problems, massage therapists need to be able to address both the structural distortions and the stresses that involve the diaphragm. My three-step approach includes:

1. Working with deep tissue to help manage this area effectively, starting with the surface tissue and moving progressively deeper with successive strokes.
2. As you're doing this work, remember to follow the principle of "the deeper you go, the slower you go!"
3. Contiue to work deeper into the abdomen, applying just enough pressure to sink in slowly, and only move deeper as the client relaxes and the resistance decreases.

The intent of these abdominal strokes is to release the tension in the diaphragm and stomach and allow the rib cage to expand upward while reducing the distortion and stress on the diaphragm. In releasing the diaphragm, you are releasing the stresses that have accumulated from both the sympathetic and parasympathetic nervous systems. This work often results in a calming of the stomach and reduction in the hyperacidity found with acid reflux, nervous stomach and ulcers.

Applying these massage techniques to release the stresses on the diaphragm may help hiatal hernias and acid reflux. A relaxed diaphragm allows the esophageal hiatus to function efficiently, which will prevent acid reflux by keeping the contents of the stomach where they belong.

A relaxed diaphragm will also allow a tear to heal so the stomach can no longer protrude upward through it. This often is not an overnight solution, but clients usually experience additional relief with each session. This is a great chance to assist your clients with proper therapeutic massage techniques.