Acid Reflux | How Physiotherapy Helps In Reducing The Symptoms Of Gastroesophageal Reflux Disease?

If you experience acid reflux frequently and suffer from gastroesophageal reflux disease (GERD) then you may need to do some exercises and make several lifestyle changes.  Exercise may help prevent or relieve the symptoms of acid reflux by helping you lose weight and support good digestion. Your physiotherapist is the professional who can recommend exercises to improve your overall health and increase your quality of life.

What is Gastric Reflux?

Acid reflux is a very common condition in which an individual feels burning pain in the lower chest area, known as heartburn. Heartburn happens when the stomach acid flows back up into the food pipe (esophagus). At the entrance of the stomach, there is a valve with a ring of muscles called the lower esophageal sphincter. When the lower esophageal sphincter does not close or open too often after the food passes from the esophagus to the stomach, the stomach acid flows back up to the esophagus causing acid reflux. In severe cases it is called Gastric reflux disease (GERD) a  condition, where small amounts of the stomach contents move upwards into the esophagus and are associated with severe symptoms, it may take up to hours to get rid of the discomfort. Burning pain in the upper chest or abdomen indigestion causes upset stomach, pain is often worse after eating, in the evening, or when lying down or bending over. Some of the early symptoms of acid reflux include dry cough, nausea, vomiting, pain or difficulty while swallowing food, and pain in the upper abdomen. Medication does not resolve the symptoms for all sufferers and long-term use may cause other health issues.

Physiotherapy Management

A well-trained and experienced physiotherapist designs a program that suits the individual's needs. Certain exercises can decrease blood flow to the gastrointestinal area, which causes gastric fluids to pool, leading to inflammation and irritation. Also, restrictive body positions can put pressure on the stomach and chest, which may trigger symptoms. Given below is the physiotherapy management for acid reflux patients.

Breathing Exercises:

Physiotherapists are trained professionals in breathing exercises, who can help an individual to do exercises correctly to gain the maximum benefit.  Breathing exercises, especially resisted inspiratory breathing exercises, can improve symptoms and reduce reflux. Breathing exercises help to improve diaphragm strength and reduce gastric reflux. Further progressing the exercises by applying resistance to make breathing more difficult can also help in strengthening. It can take more than a month to notice changes in strength and symptoms.

Weight loss:

Extra weight may cause acid reflux, it can push against the stomach and affect the lower esophageal sphincter, which can make the symptoms of acid reflux worse. Therefore losing weight is a priority, maintaining a healthy weight helps to reduce or relieve acid reflux symptoms.  For this exercising and also following a suitable diet plan is recommended. Low-impact exercise can lead to weight loss if done consistently. It may take longer to lose weight, but hopefully, an individual will have less reflux along the way.

Exercises:

Some types of exercise may make the symptoms worse. Though not everyone experiences worsening acid reflux with high-impact exercise. High-impact exercises such as running, sprinting, weightlifting, gymnastics, cycling, jumping rope, and stair-climbing may cause heartburn. Therefore, low-impact exercises should be tried first and see how an individual feels. If the patient doesn't experience heartburn or other symptoms, then he/she should try doing a higher-impact workout. If any discomfort is experienced, then stick to a low-impact regimen. Low-impact exercises keep an individual as upright as possible such as walking, light jogging, stationary biking, and pilates. But, avoid eating two to three hours before exercising.

Cycling:

Bicycling allows one to stay in an upright position, it can be a safe and asymptomatic exercise for sufferers of acid reflux. Cycling can be performed indoors or outdoors. When cycling indoors, a static cycle can be used that allows remaining in an upright position. While cycling outdoors, avoid bumpy terrain as the up-and-down motions can irritate the reflux. While cycling avoids hunching forward on the bicycle. This position places excessive stress on the stomach, which can cause symptoms of acid reflux.

Pilates:

With their gentle stretches and slow movements, Pilates can often be easily incorporated into a GERD sufferer's life. Though, the routines need to be modified to avoid triggering acid reflux. Avoid poses that require lying down, bending forward at the waist, or inverting the body. Although it may seem as though these restrictions rule out all Pilates poses, there are still several poses an individual can attempt. During a Pilates session, get the workout with the Plank, Saw, Side Leg Kicks, and Cat pose.

Walking:

Walking is good exercise for people with acid reflux. An individual can walk indoors or outdoors on a treadmill, around a track, across a beach, or down the sidewalk, these exercises do not involve excessive movement of the stomach and should not trigger reflux. It is important to stay hydrated and avoid drinking too much water during the walk since walking will cause the stomach contents to slosh around slightly. If the stomach is filled with water, this sloshing could easily lead to acid reflux.

Stretching Exercises for the Rib Cage and Sternum to Get Rid of Heartburn:

These exercises can help an individual get rid of the pain and other symptoms. If the pain is still too intense, one should proceed with the program step by step. Make sure to always stretch for 2 to 3 minutes.

• Bring 2 chairs and place them apart so that an individual can reach them with their hands. Place a soft mat between the chairs, kneel on it, and lay the palms on the seats. Be careful so that the arms and back do not form a straight line. The upper body should be positioned lower than the arms.  Then move the upper body to the ground, so that a stretch is felt in the chest and shoulders. Leave the elbows stretched the whole time. Hold this position for 2 to 3 minutes.
• Sit down comfortably on a chair. Take a deep breath and blow all the air out with full force until there is no air in the lungs left.  After exhaling completely, close the mouth and nose with your fingers. Make a move as if trying to suck in the fresh air, even though the mouth and nose are closed. Perform this breathing movement as long as an individual is capable of doing so. Now breathe back in normally and perform this exercise a few times to relax the chest muscles.
• Sit upright in a chair and place a mini ball under the sternum at the xiphoid process, roll in small and spiral-shaped movements along the left and right costal arch. Roll a little lower with each pass and then back to the middle of the chest.

Lifestyle modifications:

• Acid reflux symptoms can be reduced or relieved by:
• Eating smaller meals,
• Not lying down after eating,
• Quitting smoking as smoking impairs the lower esophageal sphincter's ability to function properly,
• Avoid wearing tight-fitting clothes or belts around the waist, which can put  pressure on the abdomen,
• Avoid bending over or exercising immediately after a meal, Reduce stress,
• Weight loss may help decrease symptoms, if the individual is overweight,
• Chewing sugarless gum after meals can help to promote saliva production, which neutralizes the acid,
• Some foods that might produce heartburn are fatty, fried, citrus, tomatoes and tomato-based foods, mint, chocolate, coffee, alcohol, and sodas. A food diary should be maintained to record foods that trigger GERD and avoid those foods

Sleep modification:

Sometimes sleeping might be difficult when an individual suffers from acid reflux. Therefore, some sleeping positions should be tried that may be preferred to ease the sleeping. Some of them are:

• Elevate the head of the bed about 6 inches with a wedge or by tilting the entire bed, do not use extra pillows to raise the head,
• Large wedge-shaped pillow help alleviate symptoms at night,
• Encourage an individual to sleep on the left side, right side-lying allows the acid to flow into the esophagus more easily,
• Head-up positions minimize reflux and reduce intraabdominal pressure,
• Back sleeping should be avoided,

Shaker Head-Lifting Exercise:

An individual should lie in the supine position on a firm and flat surface, without a pillow and arms resting by the sides. The person is asked to breathe slowly and steadily throughout the exercise. The exercise is as follows:

•  Lift the head to look at the toes and hold.
• Only the head lifts, shoulders should be kept flat on the surface.
• Hold this position for 1 minute then the head returns to the starting position.
• Repeat this exercise 2 times, and relax for 1 minute between each repetition.

Head Lift and Lower:

• Lift head to look toward the chin and then return to the start position, resembling a sit-up with the head. Repeat this 30 times and relax

Avoid high-impact activities such as jogging or aerobics that cause stomach contents to splash upward. Also avoid exercises that require bending over, laying head-down on an incline or turning upside-down, lying horizontally like swimming, etc. And always take care not to eat before a workout as it can also trigger acid reflux.