Why is it that just about everybody knows that the little purple pill, Nexium is for acid reflux? A large number of Americans over age 40 have or are experiencing the symptoms of acid reflux and are very uncomfortable with it. Additionally, advertising is alluding to long-term damage from the erosion of the esophagus due to acid reflux. As a result, clients’ awareness and fears of acid reflux and hiatal hernias are expanding. It is unfortunate that most people suffering with the malady do not know that there are effective soft tissue treatments that can eliminate the symptoms without drugs, or any other invasive medical procedure.
What are the conditions that trigger these symptoms? Medical diagnoses 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, overeating, or the presence of excess stomach acid.
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 "O" ring with unequal pressure on all its sides, and cannot seal effectively.
Resolving hiatal hernia problems require addressing 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 use the SET three-step deep tissue 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 treatment it is usually noted 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 achieve structural balance, we release this side first so the body will not move 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 tight 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.
Deep tissue SET strokes release the stresses on the diaphragm for treating 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 rigid adhesions, but there will be larger areas of the sheathing part of the muscle that will still be somewhat tight 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 the 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 slowly along the wall of the diaphragm to be very effective in balancing the diaphragm. This, of course, 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 strokes would not be effective if we had not first released the very tight ridging in the diaphragm with previous strokes.