What is a Hiatal Hernia?
A hiatal hernia occurs when the upper part of the stomach bulges through an opening in the diaphragm upward into the chest cavity. It is more common than you may think. As many as 40% of adults have them, and 60% of adults over 60. Hiatal hernias can cause a variety of symptoms: Heartburn, difficulty swallowing, shortness of breath, and chest pain are the common ones. Although surgery is sometimes necessary, non-invasive methods such as Visceral Manipulation can be an effective conservative treatment option.
Visceral Manipulation is an osteopathic manual therapy modality that involves gentle, specifically directed pressure on the soft tissues of the thorax, abdomen and pelvis to improve the mechanical balance and function of the organ systems within. This therapy can help relieve pain, and improve the mobility of organs like the stomach, liver, and intestines.
When it comes to treating a hiatal hernia, Visceral Manipulation can be particularly effective because it focuses around the diaphragm, the primary muscle we use for breathing. The diaphragm separates the chest cavity from the abdominal cavity, but has several small openings in it to allow tube-like structures, such as the aorta blood vessel, or the esophagus, to pass through. Since the esophagus penetrates the diaphragm to meet the stomach in the abdominal cavity below, the mechanical relationship of these structures is very important.
How Visceral Manipulation Helps
Tensions surrounding the diaphragm, esophagus, and stomach must be balanced to keep these structures in their proper places. When they aren’t balanced, part of the stomach can push upward from the abdomen through the esophageal opening in the diaphragm. This happens in part because pressures in the abdomen are higher than in the thorax (chest cavity). When the esophagus doesn’t sit centered in its diaphragm opening and “plug the hole”, the pressure differential pushes the upper part of the stomach out of the abdominal cavity and into the chest cavity.
This is called a hiatal hernia, and when this portion of the stomach goes up into the thorax, but sometimes slides back down into the abdomen, we call it a “sliding hiatal hernia”. Sometimes, adjacent parts of the stomach can also herniate up into the thoracic cavity. These are called paraesophageal hiatal hernias, and are usually more symptomatic. In both bases, the normal pressure controls that help keep the stomach acids out of the esophagus are compromised. Acid reflux/GERD are common complications.
During a Visceral Manipulation session, the therapist uses gentle pressure and stretching techniques to release any restrictions or imbalances that may be affecting the esophagus-diaphragm-stomach system. This can help restore the proper position and function of the stomach and esophagus, reducing the symptoms of a hiatal hernia and minimizing future occurrences.
Visceral Manipulation for Overall Digestion and Organ Health
In addition to directly addressing hiatal hernias, Visceral Manipulation can also help improve the function of other organs in the thorax, abdomen, or pelvis. For example, if the liver or gallbladder is not functioning properly, this can make digestion more difficult because these structures deliver bile to the intestines and help the breakdown of fats. If there are tensions in the ducts that deliver the bile, it can affect how our gut feels when we eat.
Visceral Manipulation is a gentle and non-invasive therapy, and it can be a good option for people who want to avoid surgery or don’t tolerate medications well. By addressing restrictions and adhesions in the abdominal and pelvic regions, this therapy can help restore the proper function of the stomach and diaphragm, reducing the symptoms of a hiatal hernia and improving overall health.
About the Author:
Tim Newton, PT, DPT, OCS, CFMM is a physical therapist who specializes in Osteopathic Manual Therapy to help people with pain, illness, and stress feel themselves again. His expertise is in Visceral Manipulation, Gentle Spinal Manipulation, and Craniosacral Therapy. He is the owner of Inspire Movement Physical Therapy in Columbia, MD.