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Additionally, the
advertising is alluding to long-term
damage from the erosion of the esophagus
due to acid reflux.
Clients’
fears are expanding, as is their
awareness. This is partially due just to
good old advertising and marketing.
However, it is unfortunate that many do
not know that there are effective soft
tissue treatments that can eliminate the
symptoms without drugs, or any other
invasive medical procedure, and, thus,
have not developed the skills to treat
these conditions.
To treat
hiatal hernia and acid reflux we must
first understand what the conditions are
that trigger these symptoms. Medical
diagnosis include: "Protrusion of the
stomach upward … through the esophageal
hiatus of the diaphragm" (Taber’s
Cyclopedic Medical Dictionary), the
esophageal hiatus is "the opening in the
diaphragm for the passage of the
esophagus and the vagus nerves"
(Dorland’s Illustrated Medical
Dictionary), "sliding hiatus
hernia…the gastroesophageal junction
and a portion of the stomach are above
the diaphragm"
(The Merck Manual, 16th
edition).
Another
form of hiatal hernia is a tearing in
the diaphragm that allows a portion of
the stomach to protrude through the
tear. There can also be damage to the
esophageal hiatus where the esophagus
empties into the stomach. When the
esophageal hiatus is damaged the
sphincter valve at the top of the
stomach cannot function properly, and
the contents from the stomach can then
backflow up the esophagus (acid reflux),
especially when a client is prone
or supine or has a full
actively digesting stomach. Acid
reflux 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
(as can result from spicy food or
overeating), or the presence of
excess stomach acid.
How can
massage therapy effectively treat these
conditions? Well, let’s look at where
the stomach is located and what muscles
have a major effect on both the
esophageal hiatus and the stomach
itself.
The
esophageal hiatus is located in the
center of the diaphragm. The
diaphragmatic muscle attaches on the
sternum, the lower ribs, and extends all
the way around to the back including the
thoracic vertebrae. This leaves it
extremely reactive to any structural
distortion. If the skeletal system
misaligns, that misalignment is
reflected in contractions and
distortions throughout the diaphragm.
The diaphragm itself is a muscle that
responds to the somatic nervous system.
When people are stressed, they tend to
contract the muscle fibers of the
diaphragm, which often exaggerates any
existing structural distortions. The
sympathetic nervous system (which
dominates during stress) will continue
to affect the diaphragm long after the
initial stressor has been reduced. If
this takes place over weeks or months,
the resulting contractions will become
fixed in the diaphragm via the fascia,
and exaggerate any already existing
distortions. Stress and structural
distortions aren’t the only conditions
that affect the diaphragm. If we add
extra weight to the structure, we have
yet another distortion factor for the
diaphragm. If the esophageal hiatus is
constantly stressed by these distortions
and imbalances of tension, it reacts
like an "0" ring with unequal pressure
on all its sides, and cannot seal
effectively.
A tear in
the diaphragm that allows the stomach to
push through creating a hiatal hernia is
equally stressed by structural
distortions and the somatic nervous
system as described above. If this tear
is subjected to all these stresses, it
often worsens allowing more of the
stomach to protrude through the
diaphragm. Often a tear in the diaphragm
will occur when a person lifts weight
when structural distortions or stresses
in the body are also distorting the
diaphragm. It is very possible that the
tearing would not have happened had
there been no structural distortion or
stress.
In order
to resolve hiatal hernia problems it is
necessary that we address both the
structural distortions and the stresses
that involve the diaphragm. The
diaphragm has surface attachments across
the sternum and ribs that attach to the
sternum, but the majority of the body of
this muscle is deep in the abdomen and
below some organs. To treat this area
effectively, I recommend using the
3-step approach starting with the
surface tissue and moving progressively
deeper with successive strokes.
The
intent of these abdominal strokes is to
release the rib cage so it can expand
upward while reducing the distortion and
stress on the diaphragm. The structural
distortions of the diaphragm tend to
pull down on the ribs. During body
reading prior to therapy, you will
notice that the ribs on one side are
pulled down and tighter than on the
other. The floating rib on this side
will be closer to the crest of the ilium
than on the other side. To work for
structural balance, you want to release
this side first so you will not be
moving the body further into distortion.
There are other structural
considerations such as pelvic balancing,
lumbar curvatures, and scoliosis.
However, if the diaphragm is released
from the side where the floating rib and
the ilium are closer together, the other
structural distortions will be reduced
as well. Then, releasing the other side
will tend to bring the ribs further into
balance, and thus release the
distortions of the diaphragm.
In
releasing the diaphragm you are
releasing the stresses that have
accumulated from both the sympathetic
and parasympathetic nervous systems. In
addition, when releasing the left side
of the diaphragm, you will be releasing
the pathway of the vagus nerve, which is
usually very tightened and restricted.
Releasing this often results in a
calming of the stomach and reduction in
the hyperacidity found with acid reflux,
nervous stomach and ulcers.
SET deep
tissue strokes release the stresses on
the diaphragm and will treat hiatal
hernias and acid reflux very
effectively. However, the treatment will
not be complete until we have been able
to smooth the majority of the sheet-like
muscle of the diaphragm. The fingers
will have worked through small areas and
released ridged adhesions, but there
will be larger parts of the sheathing
part of the muscles that will still be
somewhat tightened and imbalanced. This
is where a softer, rounder surface than
the fingertips can smooth and integrate
the diaphragm allowing even more
effective release of the esophageal
hiatus allowing the sphincter valve of
the stomach to close and function
properly, or take the pressure off a
diaphragmatic tear. I find holding a
small hard rubber ball or tennis ball
gently against the diaphragm under the
ribs and very gently rolling it along
the wall of the diaphragm to be very
effective in balancing the diaphragm.
Caution – this needs to be
far enough below the ribs so as not to
pull down on the ribs or in any way
compromise the xyphoid process. The ball
would not be effective if you had not
first released the very tight ridging in
the diaphragm with your previous
strokes.
Clients
generally report immediate improvement
of acid reflux or hiatal hernia symptoms
after just one session. This improvement
may be reported as less pain and
discomfort, less intense or fewer
occurrences, or a general calming of the
area. I usually work one session per
week until the client is symptom free
for the week, then schedule for 10 days
until symptom free, 2 weeks until
symptom free, and space out accordingly
after that.
Don
McCann, founder Structural Energetic
Therapy |
