Effective exercises with hernia of the esophagus: choice, technique, precautions

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

The benefits of physical activity in the hernia of the esophagus

The hernia of the esophageal opening of the diaphragm is a pathology that, as it progresses, can significantly complicate the patient's life, and in case of infringement even pose a danger to the life of the patient. 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 stagnant phenomena in the digestive system. Their symptoms are:

• the delay in food in the stomach and the associated feeling of heaviness and pain in the epigastrium,
• disorders of the intestine, which are expressed in its atony and chronic constipation,
• the processes of fermentation and putrefaction in the digestive tract, manifested in the disorder of the intestine due to intoxication with products of food decay (diarrhea), increased gas production and bloating.

All of the above is in no way beneficial to patients with a hernia of the esophagus. Low physical activity will either contribute to the development and progression of reflux disease, or to increase intra-abdominal pressure, pushing the esophagus and stomach into the chest cavity. That's why doctors do not recommend patients to severely restrict themselves in movements, refuse to perform gymnastics and special physical exercises with a hernia of the esophagus in fear that they will provoke complications of the hernia.

Moreover, within the framework of curative physical education programs, special sets of exercises have been developed that will not only not harm, but even vice versa will have a therapeutic effect. Such gymnastics is a part of the complex therapy of the disease, as it is very difficult to strengthen the muscles of the diaphragm in other ways and fix the achieved result. Medications and physiotherapy basically relieve pain and improve trophism of tissues, promoting regenerative processes, but they are not able to strengthen muscles like regular training.

How to perform exercises with a hernia of the esophagus?

Since the body of each patient is individual, and the clinical picture of the hernia of the esophagus in different patients may differ, an effective set of exercises should also be individual. The causes that cause the hernia of the esophagus and complicate its course can be corrected through physical exercises in the same way as the lowered muscle tone of the diaphragm.

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

If we are talking about the parasophageal hernia of the esophagus, then the 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 the exercises, the attending physician decides on how quickly the scarring of the sutures takes place at the site of suturing the diaphragmatic opening.

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 both exercises of respiratory gymnastics in which the diaphragm is directly involved, as well as ordinary physical exercises that do not involve raising the pressure inside the peritoneum. It is at this point that you need to pay close attention, so as not to harm yourself, if you choose to do exercises by yourself, rather than entrust it to a specialist.

Performing any exercises with a hernia of the esophagus of the diaphragm, you need to remember a few important points:

• In no event should you practice immediately after a meal. Physical exercises are recommended to do in the morning on an empty stomach, and during the day before the main meals. Respiratory gymnastics can be done a couple of hours after a meal, and when you consider that with a hernia is recommended a split meal at intervals of 2.5-3 hours, then again it turns out that the exercises will be performed before meals.
• During classes (however, as well as during the rest of the time) there should not be any sharp movements: slopes, turns, flexions-straightening, jerks. All exercises should be done slowly, gently and smoothly, listening to your sensations. If the pain intensifies, this is a signal to the fact that the exercise is performed incorrectly or physical activity is exceeded and rest is required.
• Performing a set of physical exercises you need to closely monitor your breathing. Without the need to delay the exhalation, we can thereby provoke an increase in intra-abdominal pressure.
• When the hernia of the esophagus is not recommended to compress the belly garments, and during training clothes should be at all free and do not interfere with proper breathing.
• Classes are not conducted in acute period of the disease with severe pain syndrome and excruciating heartburn. First, with the help of drugs and alternative therapies, you need to remove acute symptoms, and then begin to train the muscles of the diaphragm. This applies to all exercises, except for relaxation exercises, which, on the contrary, can remove acute pain sensations.
• After surgery with a hernia of the esophagus, physical and breathing exercises are possible only according to the doctor's prescription. In the first days and weeks after the operation to suture the diaphragmatic opening, as well as in the case of perforation of the esophagus or perforated ulcer, active physical activity can provoke divergence of the joints.

Selecting exercises for losing weight or maintaining the physical form yourself, you need to avoid those that require the tension of the abdominal muscles, sudden movements, involve the use of weighting.

What exercises can not be done with a hernia of the esophagus? All those exercises for which you want to strain your stomach. Doctors do not recommend pumping the press, lifting the trunk from lying on the back, working with the bar, crouching with dumbbells, performing an exercise "scissors" that help strengthen the muscles of the abdominal press, etc. Ordinary squats, torso torso, twisting of the spine, elementary exercises for the hands and feet of patients with hernia of the esophagus are not prohibited, but performing them should avoid overwork and sudden movements.

If you consider all these requirements, physical activity with a hernia of the esophagus will not do harm, but will only benefit, warning the relapse of the disease.

LFK with hernia of esophagus

Well, after discussing when and how to conduct physical therapy classes, it's time to go directly to the exercises themselves. The standard complex with a hernia of the esophagus does not exist, but patients can be offered several physical exercises to strengthen the diaphragm and prevent relapse of the disease.

For example, with diseases of the spine and joints, including the herniation of the intervertebral discs, Bubnovsky's exercises (a set of 20 exercises or individual schemes for the treatment of certain pathologies) are very popular, and there is no such complex in the hernia of the esophagus. To apply the above complex with this disease does not make sense, because it is designed more for training the muscles of the back and involves the tension of the abdominal muscles during the performance of most exercises. If, in addition to hernia of the esophagus, the patient also has osteochondrosis or arthritis, then only Bubnovsky exercises can be performed, in which there is no increase in intra-abdominal pressure, so as not to cause complications of the hernia.

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

Here are some exercises that can be included in the treatment complex with a hernia of the esophagus:

1. In the standing position, raise your hands up and slightly to the sides. Doing thus exhaling. Then we lean forward, dropping our hands down and taking a breath. The muscles of the abdomen during inhalation and exhalation are not retracted, which helps maintain intra-abdominal pressure in the norm. In the respiratory process, only the diaphragm should be involved.
2. In the standing position, hands at the seams slowly turn the trunk alternately to the right and left, trying to keep the pelvis still and the breathing equal.
3. With a sliding hernia of the esophagus it is useful to perform jumps in place, which help the stomach slide down. This exercise, although not a serious training for the muscles of the diaphragm and abdominal press, but helps to combat the symptoms of the pathology, returning the digestive organs to a normal position, at least temporarily.
4. In the standing position on the knees we perform the torso of the trunk forward. During the inclines, breathe in the air, and exhale - exhale. The same inclines are made to the right and left sides, breathing in the air when tilting and exhaling after returning to the vertical position.
5. From the same position, we put our palms to the floor. We lower the upper part of the trunk to the floor, shifting the palms forward. The body also moves forward.
6. The same exercise is done by lowering the pelvis downward. Knees slightly divorced in the sides, so as not to squeeze the stomach.
7. Strengthening of the muscles of the thoracic region and the removal of pain are also facilitated by the swings of the hands. Exercise is performed one by one, then the other hand. We take the hand to the side, raise it up, again to the side and lower it, controlling that the breathing is not intermittent. You can perform the exercise standing or sitting.
8. In the supine position on the back, it is recommended to perform twisting of the body (twisting) to the left and to the right. Perform the exercise at a slow pace, controlling your breathing.
9. Turning on his side, the free hand is taken as far back as possible and returned back. We do it several times and turn over on the other side. We repeat the exercise with the other hand.
10.  Lying on his back and bending his knees, we deflect knees in the right and then in the left, which helps to relax the muscles of the abdomen. It's good practice to finish this exercise.

Performing any exercises with a hernia of the esophagus, you need to closely monitor your breathing, because wrong breathing can reduce all efforts to no, increasing pressure in the abdomen and pushing the organs into the chest.

But in the treatment of hernia of the esophagus, respiratory gymnastics, which is often combined with physical activity, is also actively practiced. A vivid example of such a combination is the first and third exercises of the complex described above.

Here are a few examples of exercises of respiratory gymnastics with a hernia of the esophagus:

• In the supine position on the back, take a breath, hold our breath a little and exhale.
• Chest breathing: in the standing or sitting position, we put one hand on the chest, the other on the upper abdomen. Deeply inhale the air, controlling that the chest rises, and the stomach does not change its position. Then we exhale all the same way with the chest. The abdominal muscles should not participate in the respiratory process.
• In the supine position on the side with an elevated upper body part (you can rest your arms on the floor, so that the distance from the shoulder to the floor is about 15-20 cm) take a deep breath, protruding your belly. Exhale is slow, the stomach is not retracted.
• For more effective training of the muscles of the diaphragm on the exhalation, it is recommended to draw in the stomach, and strongly enough. But such an exercise can only be done at the second stage of the exercises and only with the permission of the doctor.
• Exercise for relaxation and relaxation of abdominal muscles. Lying on his back, we begin to breathe slowly and evenly, mentally imagining that our belly is a sea on whose waves the boat sailing down and rises. Feeling the relaxation, we perform an easy massage of the abdomen, making the stroking circular movements by hand clockwise about 50-60 times.

Breathing exercises with a hernia of the esophagus causes the muscles of the diaphragm to strain and relax, thereby training them and increasing the tone of the muscles themselves and the adjacent ligaments. These exercises are even more effective than physical ones, because the diaphragm is deep inside the body, and no slopes and flies with hands can affect the tone of its muscles if breathing is wrong.

Performing physical and breathing exercises with a hernia of the esophagus is recommended 3-4 times a day. It takes 10-15 minutes to practice, since overfatigue with a hernia of the esophageal opening of the diaphragm does not work.

Good physical and respiratory gymnastics for the diaphragm are also considered long walks in the fresh air. For such walks, it is better to choose wooded areas and parks where you can breathe in full breasts, thereby training a weakened diaphragm.

Yoga and massage with hernia of esophagus

In addition to the generally accepted, there are also non-traditional methods of treatment of hernia of the esophagus: yoga and massage procedures combined with respiratory gymnastics. At first glance, they only contribute to reducing the symptoms of the disease, but on closer examination, the therapeutic effect of such procedures is noticeable if they are carried out regularly and correctly.

Unlike physical exercises, the attitude towards which is mixed with a hernia of the esophageal aperture of the diaphragm, yoga is recommended by many sources, based on the fact that asanas imply the preservation of the static position and do not include sudden movements. But the choice of asanas also need to be approached reasonably. Not all of them can be useful for a hernia of the esophagus.

For example, breathing exercises with weighting in the form of a bag with sand on the abdomen, as well as twisting hatha yoga, increasing intra-abdominal pressure and thus training the diaphragm will not be the best choice. But inverted poses, when the resistance to breathing is created by the internal organs at the top, can be practiced with the permission of the doctor.

According to some studies, the diaphragmatic nerve, which originates in the cervical plexus, affects the diaphragm state and its ability to contract. The spastic tension of the stair muscles of the neck can squeeze the nerve fibers, indirectly affecting the muscle tone of the diaphragm, innervated by the diaphragmatic nerve. In other words, muscle clamps can be considered as one of the reasons for the development of hernia of the esophagus. By the way, such a symptom, like a lump in the throat, can also be a consequence of muscle clamps in the neck.

With the aim of working out the cervical region and removing the muscle clamps, the most promising are Simhasana, bhujangasanu, dhanurasana, shalabhasanu. But for the training of the diaphragm the full diaphragmatic breathing, which according to the theses of yoga should be deep, smooth, smooth and soundless, fits perfectly. The length of the inspiration should correspond to the duration of exhalation.

For patients with a hernia of the esophagus, such breathing should become the norm, which is achieved by regular and rather tiring training, as many yoga can seem like a boring and useless waste of time, because the results of its application are not immediately apparent.

With reflux, good results are the practice of kapalabhati, implying breath control for diaphragm training (passive inhalation and active exhalation, for which abdominal muscles are involved). To improve digestion and motility of the gastrointestinal tract, the practice of agnisar kriya - the technique of constricting the abdominal muscles - is suitable.

Secretion of digestive enzymes has a direct dependence on the state of the central and autonomic nervous system. Relaxation practices can indirectly affect 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.

In itself, yoga exercises with a hernia of the esophagus can not be considered a full-fledged method of treating the disease. These are rather the methods of the preventive plan, but in combination with drug treatment and exercises of exercise therapy with their help you can achieve good results.

Help with hernia of the esophagus and massage procedures. And this can be both manual massage performed by a specialist, and individual exercises that you can do yourself at home.

With regard to the help of manual therapists, it was previously thought that they treat only the pathology of bones and joints. To date, manual therapy is subject to many diseases of the gastrointestinal tract. It will not be difficult for a professional to restore the normal position of the organs in a few minutes or even seconds, pressing on certain points. First, their goal is to relax the diaphragm, and then move the stomach and intestine down through the esophagus in it.

For several procedures the manual therapist can "accustom" the gastrointestinal tract to a normal position, adjust the intra-abdominal pressure, normalizing the work of the stomach and intestines, and increase the muscle tone of the diaphragm. The main thing is that it should be an expert in your business, so choosing a manual therapist should be very carefully, based on the feedback of other patients and the results of the doctor's work. Ideally, it should be a person with a medical education of the appropriate profile.

But if a good chiropractor is not there, do not despair. In this case, you can act on the principle of "help yourself", i.e. Perform special massage exercises, accessible to any person. Let's give examples of such exercises with a hernia of the esophagus:

• We lay down on the back and the upper part of the body with the help of pillows or special rollers a little raised above the ground level. Hands clenching into fists, leaving two fingers straight (usually, index and middle). The fingers of both hands are pressed against the mediastinum area 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, we breathe out the air and at the same time we try to put our fingers as little as possible under the ribs. Do it slowly, carefully, in a few visits. Now, with an effort to unbend fingers, thereby trying to move the stomach down and to the left, where it should be in its normal position.

To perform correction of the position of the stomach can be strictly on exhalation, repeating the exercise several times. If everything is done correctly, then after 3-5 repetitions there is a pulling sensation in the throat due to the displacement of the esophagus and the tension of its walls, and the pains in the epigastrium subside.

• Now sit down and bend forward a little, bending the thoracic spine. Before the exercise, we relax as much as possible. Pads 4 fingers of each hand (except the large one) are placed under the corresponding costal arch so that the lines formed by the fingers are parallel to each other and to the median axis of the body. In this case, the thumbs should remain parallel to the ground and touch the pads through a specially formed skin fold.

Now take a deep breath and during it we try to move the skin under the thumbs up. On exhalation we do the reverse movement, shifting and pressing the skin down and to the spine.

Both massage exercises are recommended to be repeated 3 to 6 times, holding the duration of inspiration and expiration from 6 to 8 seconds. Begin and end the massage is recommended stroking movements in a circle in the upper abdomen. You need to do this clockwise. This procedure will help relax the muscles of the abdominal wall. This same exercise is recommended to do to improve digestion when there is a feeling of heaviness in the stomach. It prevents stagnant phenomena, gently stimulating the motility of the stomach and intestines.

Massage procedures (except for the abdominal relaxation exercises, which improves the digestive process), like any other exercises with a hernia of the esophagus, can not be performed on a full stomach, because such manipulations can provoke reflux, belching, hiccough and other unpleasant symptoms of a hernia.

Recommendations for choosing a set of exercises

No matter how safe the above exercises seem, it is advisable to get the appropriate consultation of a doctor about each of them before using them. After all, what is useful with a sliding hernia of the esophagus, can cause harm with a fixed variant (paraeophagous hernia), causing, for example, infringement of the hernial sac. For people with this type of disease, exercises will be useful in the rehabilitation period after surgery, as they are an excellent prevention of hernia recurrence.

The choice of effective exercises depends on the degree of development of pathology. So jumps that help the stomach and esophagus to take a normal position will be relevant at 1 and 2 degrees of axial herniation of the esophagus, and for 3 massage procedures are more suitable, movements in which have a strict direction and a more active influence on the organs that extend into the chest, than ordinary vibration.

With a fixed hernia of the esophagus, self-massage is quite dangerous, because the digestive organs are already strongly clamped in the diaphragmatic opening, which increases the risk of pinching, which is life-threatening to the patient. Therefore, such procedures should be entrusted to specialists.

Therapeutic gymnastics with a hernia of the esophagus is so called, that its principle is not "more", but "more often and in moderation". It is not necessary to include in the exercises a large number of different exercises and load the body for half an hour or more. Let them be better 3-4, but with enough repetitions to meet the 10-15 minute course, which is worth repeating between meals 3-4 times a day.

Active lifestyle, massage procedures, physical and breathing exercises with hernia of the esophagus are full-fledged methods of treatment of the disease, which can not be neglected, especially since they have much less side effects than medical therapy. But it should be understood that any disease weakens the body, so excessive physical exertion will only deplete its forces, so necessary to fight the disease, while the moderate will help restore them.