Effective exercises for esophageal hernia: choice, methodology, precautions

A hernia of the esophagus is a protrusion of some organs of the digestive system, located under the diaphragm in the peritoneum, into the chest cavity. We are talking mainly about the lower part of the esophagus, various parts of the stomach and the duodenum. The displacement of these organs provokes an increase in intra-abdominal pressure, which pushes them into the esophageal opening of the diaphragm and, if the latter is weak, a hernia is formed. It would seem that any physical activity and exercise with a hernia of the esophagus should complicate the situation. In fact, proper physical activity helps to treat the disease. But it is important to know which exercises will be beneficial and which can be harmful.

Benefits of Physical Activity for Hiatal Hernia

A hernia of the esophageal orifice of the diaphragm is a pathology that, as it progresses, can significantly complicate the patient's life, and in the case of strangulation, even pose a danger to the patient's life. But in general, it does not make a person disabled and does not require immobilization.

On the contrary, hypodynamia will only harm patients, since this condition provokes stagnation in the digestive system. Their symptoms are:

• retention of food in the stomach and the associated feeling of heaviness and pain in the epigastrium,
• intestinal dysfunction, which is expressed in its atony and chronic constipation,
• fermentation and putrefaction processes in the gastrointestinal tract, manifested in intestinal disorders due to intoxication with food decay products (diarrhea), increased gas formation and bloating.

All of the above will not benefit patients with esophageal hernia. Low physical activity will either contribute to the development and progression of reflux disease, or increase intra-abdominal pressure, pushing the esophagus and stomach into the chest cavity. That is why doctors do not recommend patients to severely limit their movements, refuse to do gymnastics and special physical exercises for esophageal hernia in fear that they will provoke complications of the hernia.

Moreover, within the framework of therapeutic exercise programs, special exercise complexes have been developed that not only will not cause harm, but on the contrary will have a therapeutic effect. Such gymnastics is part of the complex therapy of the disease, because it will be very difficult to strengthen the diaphragm muscles and consolidate the achieved result in other ways. Medicines and physiotherapy mainly relieve pain and improve tissue trophism, promoting regenerative processes, but they are not able to strengthen muscles as much as regular training.

How to do exercises for a hiatal hernia?

Since each patient's body is individual, and the clinical picture of esophageal hernia may differ in different patients, an effective set of exercises should also be individual. The causes that cause esophageal hernia and complicate its course can be corrected through physical exercises, as well as decreased tone of the diaphragm muscles.

Thus, for patients with excess weight, the complex will include exercises aimed at reducing body weight, which in combination with a diet will give fairly quick results. In case of sliding hernia of the esophagus, exercises are included that help return the organs to their normal position without surgery. And also those that help fight reflux and the pain caused by it, belching, hiccups.

If we are talking about a paraesophageal hernia of the esophagus, then exercises in this case will be appropriate after the operation and return of the stomach and intestines under the diaphragm. When it will be possible to start exercises, the attending physician decides based on how quickly the scarring of the sutures at the site of suturing the diaphragmatic opening occurs.

Physical exercises will be aimed at strengthening the muscles of the diaphragm and restoring the contractile function of its opening, which serves as an additional external sphincter for the esophagus and does not allow food to return from the stomach back. These can be either breathing exercises, which directly involve the diaphragm, or regular physical exercises that do not involve increasing the pressure inside the peritoneum. This is exactly the point that you need to pay close attention to, so as not to harm yourself if you decide to select exercises yourself, and not entrust it to a specialist.

When performing any exercises for a hernia of the esophageal opening of the diaphragm, you need to remember several important points:

• In no case should you exercise immediately after eating. It is recommended to do physical exercises in the morning on an empty stomach, and during the day before main meals. Breathing exercises can be done a couple of hours after eating, and if you consider that with a hernia, fractional meals are recommended at intervals of 2.5-3 hours, then again it turns out that the exercises will be done before eating.
• During the exercises (as well as at other times) there should be no sudden movements: bending, turning, bending-unbending, jerking. All exercises should be done slowly, softly and smoothly, listening to your feelings. If the pain intensifies, this is a signal that the exercise is being done incorrectly or the physical load is excessive and rest is required.
• When performing a set of physical exercises, you need to carefully monitor your breathing. Unnecessarily holding your breath, we can thereby provoke an increase in intra-abdominal pressure.
• In case of a hiatal hernia, items of clothing that compress the abdomen are not recommended, and during exercise, clothing should be as loose as possible and not interfere with proper breathing.
• Classes are not held during the acute period of the disease with severe pain syndrome and excruciating heartburn. First, with the help of medications and folk methods of treatment, you need to relieve acute symptoms, and then begin training the diaphragm muscles. This applies to all exercises, except for relaxation ones, which, on the contrary, can relieve acute pain.
• After surgery for a hiatal hernia, physical and breathing exercises are only possible as prescribed by a doctor. In the first days and weeks after surgery to suture the diaphragmatic opening, as well as in the case of esophageal perforation or perforated ulcer, active physical activity can provoke suture divergence.

When choosing exercises for weight loss or maintaining physical fitness on your own, you should avoid those that require abdominal muscle tension, sudden movements, and involve the use of weights.

What exercises should not be done with an esophageal hernia? All those exercises that require straining the abdomen. Doctors do not recommend doing abdominal exercises, lifting the body from a supine position, working with a barbell, squatting with dumbbells, doing the "scissors" exercise that helps strengthen the abdominal muscles, etc. Regular squats, torso bends, spinal twists, basic exercises for the arms and legs are not prohibited for patients with an esophageal hernia, but when doing them, you should avoid overexertion and sudden movements.

If you take all these requirements into account, physical activity with a hiatal hernia will not cause harm, but will only be beneficial, preventing relapses of the disease.

Exercise therapy for esophageal hernia

Well, after discussing when and how to do therapeutic exercise, it's time to move on to the exercises themselves. There is no standard set of exercises for esophageal hernia, but patients can be offered several physical exercises to strengthen the diaphragm and prevent relapses of the disease.

For example, for diseases of the spine and joints, including intervertebral disc herniation, Bubnovsky's exercises are very popular (a set of 20 exercises or separate schemes for treating certain pathologies), but there is no such set for esophageal hernia. There is no point in using the above set for this disease, because it is designed more for training the back muscles and involves tension in the abdominal muscles when performing most exercises. If the patient, in addition to an esophageal hernia, also has osteochondrosis or arthritis, then it will be possible to perform only those Bubnovsky exercises that do not increase intra-abdominal pressure, so as not to cause complications of the hernia.

There are many simple exercises that effectively strengthen the muscles of the diaphragmatic plate, but most of them achieve their goal by increasing intra-abdominal pressure, which is extremely undesirable with a hiatal hernia. Therefore, the choice of effective and safe exercises should be approached with special responsibility and caution.

Here are some exercise options that can be included in a treatment complex for a hiatal hernia:

1. In a standing position, raise your arms up and slightly to the sides. Exhale. Then lean forward, lowering your arms down and inhaling. Do not draw in your abdominal muscles during inhalation and exhalation, which helps maintain normal intra-abdominal pressure. Only the diaphragm should participate in the breathing process.
2. In a standing position, with your arms at your sides, slowly turn your torso alternately to the right and left, trying to keep your pelvis still and your breathing even.
3. With a sliding hernia of the esophagus, it is useful to perform jumping in place, which helps the stomach slide down. Although this exercise is not a serious workout for the muscles of the diaphragm and abdominal press, it helps to combat the symptoms of the pathology, returning the digestive organs to their normal position, at least temporarily.
4. In a kneeling position, bend your torso forward. While bending, inhale air, and while straightening, exhale. Do the same bends to the right and left, inhaling air while bending and exhaling after returning to the vertical position.
5. From this same position, we place our palms on the floor. We lower the upper part of the body to the floor, moving the palms forward. The body also moves forward.
6. We do the same exercise, lowering the pelvis down. We spread the knees slightly to the sides so as not to squeeze the stomach.
7. Arm swings also help strengthen the muscles of the chest and relieve pain. The exercise is performed alternately with one arm, then the other. Move the arm to the side, raise it up, to the side again and lower it, making sure that breathing is not intermittent. The exercise can be performed standing or sitting.
8. In the supine position, it is recommended to perform torso turns (twists) to the left and right. The exercise should be performed at a slow pace, controlling your breathing.
9. Turning on your side, move your free hand as far back as possible behind your back and return it back. Do this several times and turn over to the other side. Repeat the exercise with the other hand.
10. Lying on your back and bending your knees, bend your knees to the right and then to the left, which helps to relax your abdominal muscles. This exercise is good to finish your workout.

When performing any exercises for a hiatal hernia, you need to carefully monitor your breathing, because improper breathing can negate all efforts, increasing the pressure in the abdomen and pushing organs into the chest.

But in the treatment of esophageal hernia, breathing exercises are no less actively practiced, which are often combined with physical activity. A striking example of such a combination are the first and third exercises of the complex described above.

Here are some more examples of breathing exercises for esophageal hernia:

• Lying on your back, inhale, hold your breath for a bit and exhale.
• Chest breathing: standing or sitting, place one hand on your chest and the other on your upper abdomen. Inhale deeply, making sure your chest rises and your abdomen does not change position. Then exhale through your chest. Your abdominal muscles should not participate in the breathing process.
• Lying on your side with your upper body raised (you can rest your forearm on the floor so that the distance from your shoulder to the floor is about 15-20 cm), take a deep breath, pushing your stomach out. Exhale slowly, do not pull your stomach in.
• For more effective training of the diaphragm muscles, it is recommended to draw in the stomach while exhaling, and quite strongly. But such an exercise can be done only at the second stage of training and only with the permission of a doctor.
• Exercise for relaxation and loosening of the abdominal muscles. Lying on your back, begin to breathe slowly and evenly, mentally imagining that your stomach is a sea, on the waves of which a boat floating on it rises and falls. Having felt relaxed, perform a light massage of the stomach, making stroking circular movements with your hand clockwise about 50-60 times.

Breathing exercises for esophageal hernia make the diaphragm muscles tense and relax, thereby training them and increasing the tone of the muscles themselves and the ligaments adjacent to them. These exercises are even more effective than physical ones, because the diaphragm is located deep inside the body, and no bends or arm swings can affect the tone of its muscles if breathing is incorrect.

It is recommended to perform physical and breathing exercises for esophageal hernia 3-4 times a day. 10-15 minutes is enough for exercises, since overexertion is not beneficial for esophageal hernia.

Long walks in the fresh air are also considered good physical and breathing exercises for the diaphragm. For such walks, it is better to choose wooded areas and parks, where you can breathe deeply, thereby training the weakened diaphragm.

Yoga and massage for esophageal hernia

In addition to the generally accepted methods, there are also non-traditional methods of treating esophageal hernia: yoga and massage procedures combined with breathing exercises. At first glance, they only help reduce the symptoms of the disease, but upon closer examination, the therapeutic effect of such procedures is noticeable if they are carried out regularly and correctly.

Unlike physical exercises, the attitude to which in case of a hernia of the esophageal opening of the diaphragm is ambiguous, yoga classes are recommended by many sources, based on the fact that asanas imply maintaining a static position and do not include sudden movements. But the choice of asanas also needs to be approached reasonably. Not all of them can be useful in case of a hernia of the esophagus.

For example, breathing exercises with a weight in the form of a sandbag on the stomach, as well as hatha yoga twists, which increase intra-abdominal pressure and thereby train the diaphragm, will not be the best choice. But inverted poses, when the resistance to breathing is created by the internal organs themselves, located above, can be practiced with the permission of a doctor.

According to some studies, the condition of the diaphragm and its ability to contract are primarily affected by the phrenic nerve, which originates in the cervical plexus. Spastic tension of the scalene muscles of the neck can compress the nerve fibers, indirectly affecting the tone of the muscles of the diaphragm, innervated by the phrenic nerve. In other words, muscle clamps can be considered one of the causes of the development of esophageal hernia. By the way, such a symptom as a lump in the throat can also be a consequence of muscle clamps in the neck.

In order to work on the cervical region and relieve muscle tension, the most promising are simhasana, bhujangasana, dhanurasana, and shalabhasana. But for training the diaphragm, full diaphragmatic breathing is best suited, which, according to yoga theses, should be deep, smooth, even, and silent. The length of the inhalation should correspond to the duration of the exhalation.

For patients with a hiatal hernia, such breathing should become the norm, which is achieved through regular and rather tedious training, because many may find yoga boring and a waste of time, since the results of its use are not immediately visible.

In case of reflux, the practice of kapalabhati, which involves controlling the breath to train the diaphragm (passive inhalation and active exhalation, for which the abdominal muscles are involved), has good results. To improve digestion and gastrointestinal motility, the practice of agnisara kriya is suitable - a method of squeezing the abdominal muscles.

Secretion of digestive enzymes is directly dependent on the state of the central and autonomic nervous system. Relaxation practices allow indirectly affecting the contractile function of the gastrointestinal tract and the secretion of digestive enzymes, which helps to significantly reduce the frequency of reflux and normalize the acidity of gastric juice.

Yoga exercises for esophageal hernia cannot be considered a full-fledged method of treating the disease. These are rather preventive methods, but in combination with drug treatment and exercise therapy, they can achieve good results.

Massage treatments also help with esophageal hernia. Moreover, this can be either manual massage performed by a specialist or individual exercises that you can do yourself at home.

As for the help of manual therapists, it was previously believed that they only treat bone and joint pathologies. Today, manual therapy can treat many diseases of the gastrointestinal tract. It will not be difficult for a professional to restore the normal position of organs in a few minutes or even seconds by pressing on certain points. First, their goal is to relax the diaphragm, and then move the stomach and intestines down through the esophageal opening in it.

In a few procedures, a chiropractor can "train" the gastrointestinal tract to a normal position, correct intra-abdominal pressure, normalize the work of the stomach and intestines, and increase the tone of the diaphragm muscles. The main thing is that this is a specialist in his field, so you need to choose a chiropractor very carefully, based on reviews from other patients and the results of the doctor's work. Ideally, this should be a person with a medical education in the appropriate profile.

But if you don’t have a good manual therapist in mind, don’t despair. In this case, you can act according to the “help yourself” principle, i.e. perform special massage exercises that are accessible to anyone. Here are some examples of such exercises for esophageal hernia:

• We lie down on our back and slightly raise the upper part of the body above ground level using pillows or special rollers. We clench our hands into fists, leaving two fingers straight (usually the index and middle fingers). With the fingers of both hands, we press on the area of the mediastinum under the costal arch in the very center along the axis of the spine, slightly shifting the skin in this place up and to the right, towards the chest.

Taking a deep breath, exhale and at the same time try to gradually push your fingers as deep as possible under your ribs. This should be done slowly, carefully, in several stages. Now, with effort, straighten your fingers, thereby trying to move your stomach down and to the left, where it should be in its normal position.

You can perform the correction of the stomach position strictly on the exhale, repeating the exercise several times. If you do everything correctly, then after 3-5 repetitions, a pulling sensation appears in the throat due to the displacement of the esophagus and the tension of its walls, and the pain in the epigastrium subsides.

• Now we sit down and lean forward a little, bending the thoracic spine. Before doing the exercise, relax as much as possible. Place the pads of the 4 fingers of each hand (except the thumb) under the corresponding costal arch so that the lines formed by the fingers are parallel to each other and to the midline axis of the body. At the same time, the thumbs should remain parallel to the ground and touch the pads through a specially formed skin fold.

Now take a deep breath and try to move the skin under your thumbs up. As you exhale, do the opposite movement, moving and pressing the skin down and toward your spine.

It is recommended to repeat both massage exercises 3 to 6 times, keeping the duration of inhalation and exhalation from 6 to 8 seconds. It is recommended to start and finish the massage with stroking movements in a circle in the upper abdomen. This should be done clockwise. This procedure will help to relax the muscles of the abdominal wall. This exercise is also recommended to improve digestion when a feeling of heaviness in the stomach appears. It prevents stagnation, gently stimulating the motility of the stomach and intestines.

Massage procedures (except for exercises to relax the abdominal wall, which improves the digestive process), like any other exercises for a hernia of the esophagus, should never be performed on a full stomach, because such manipulations can provoke reflux, belching, hiccups and other unpleasant symptoms of a hernia.

Recommendations for choosing a set of exercises

No matter how safe the above exercises may seem, before using them it is recommended to get appropriate medical advice about each of them. After all, what is useful for a sliding hernia of the esophagus can cause harm in its fixed version (paraesophageal hernia), causing, for example, strangulation of the hernial sac. For people with this type of disease, exercises will be useful in the rehabilitation period after surgery, since they are an excellent prevention of hernia recurrence.

The choice of effective exercises also depends on the degree of development of the pathology. Thus, jumping, which helps the stomach and esophagus to take a normal position, will be relevant for 1 and 2 degrees of axial (sliding) hernia of the esophagus, and for 3, massage procedures are more suitable, the movements in which have a strict direction and a more active effect on the organs protruding into the chest than ordinary vibration.

In case of a fixed esophageal hernia, self-massage is quite dangerous, because the digestive organs are already strongly clamped in the diaphragmatic opening, which increases the risk of strangulation, which is dangerous for the patient's life. Therefore, such procedures should be entrusted to specialists.

Therapeutic gymnastics for esophageal hernia is called so because its principle is not "more", but "more often and in moderation". You should not include a large number of different exercises in the exercises and load the body for half an hour or more. It is better to have 3-4 of them, but with a sufficient number of repetitions to fit into a 10-15 minute course, which should be repeated between meals 3-4 times a day.

An active lifestyle, massage procedures, physical and breathing exercises for esophageal hernia are full-fledged methods of treating the disease, which cannot be neglected, especially since they have much fewer side effects than drug therapy. But at the same time, you need to understand that any disease weakens the body, so excessive physical activity will only deplete its strength, so necessary to fight the disease, while moderate ones will help restore them.