Many who suffer from acid reflux will be all too familiar with its symptoms and the effect it can have on their daily lives. A burning sensation in your chest the unpleasant sour taste in your mouth and the feeling of being bloated or nauseous are all common symptoms.
Most of us will suffer from an episode of heartburn or reflux from time to time and there’s usually no obvious reason why. Often, an episode can be triggered after eating a heavy meal or certain foods. Certain medications, pregnancy, stress and anxiety can also be factors.
Bur for some, acid reflux can become more chronic, occurring on a regular basis causing pain and discomfort; many will have been prescribed medications to help alleviate symptoms. Many of these medications are designed to reduce or neutralize the acid, the very acid that plays a vital role in health and normal digestion.
Although medication is often required and useful in the management of acid reflux, there can potentially be, other, more natural ways to help reduce it’s effects.
In this blog I’d like to look at this in more detail and what we can do to make a change.
First we’ll look at how acid reflux occurs and some of it’s possible causes.
How Does Acid Relux Occur?
Acid reflux occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (known as the oesophagus). This backwash (acid reflux) can irritate the lining of your esophagus. This is when symptoms such as burning and acidic taste in the throat and mouth.
As can be seen in the image, stomach acid flowing back into the esophagus.
Why Does This Happen?
The cause of heartburn and acid reflux is a biomechanical imbalance, not a chemical one. If the acid from the stomach gets up into the oesophagus, heartburn and acid reflux result. The symptoms are not usually from an excess of stomach acid, but from the acid being in the wrong place, which is controlled by a muscle known as the diaphragm. A properly functioning diaphragm muscle will help keep the acid in the stomach, where it belongs.
To help us understand how the diaphragm can have an effect on acid reflux, we’ll first take a look at the muscle and some of it’s functions in order to give us a better understanding.
What is The Diaphragm?
The diaphragm is main muscle of respiration (breathing); a large, dome shaped muscle the diaphragm sits just below the lungs, separating the abdomen from the chest. The diaphragm is the main muscle of respiration (breathing). The diaphragm contracts rhythmically and continually, and most of the time, involuntarily.
As we breath in, the diaphragm contracts and flattens and the ribs and chest cavity enlarges. This movement creates a vacuum, which then pulls air into the lungs. As we breath out the diaphragm relaxes and returns to its dome like shape, and air is forced out of the lungs.
The diaphragm (pictured above in red) is the main muscle of respiration.
As can be see above, as we breath in and expand our ribs and lungs, the diaphragm moves down into the stomach; as we breath out (as in second picture) our diaphragm will return up into the rib cage to assist in releasing carbon dioxide.
How Can This Cause Acid Reflux?
As mentioned earlier, the diaphragm separates the chest from the abdomen and just below the diaphragm sits the stomach. When we eat our food is passed down the esophagus and enters the stomach. In order to reach the stomach, the oesophagus passes through an opening in the diaphragm call the oesophageal hiatus (hiatus being a medical terms for an opening). Once food is in the stomach this opening (oesophageal hiatus) contracts along with a part of the oesophagus called the lower oesophagus sphincter and assists in closing the oesophagus to prevent stomach acids travelling back up into the oesophagus.
Image above showing opening (hiatus) in the diaphragm along with the lower esophageal sphincter (LES) just below. Both contract when the food enters the stomach to prevent stomach acids entering the esophagus, often the cause of chronic heartburn and reflux.
The diaphragm will need to contract in order to assist in closing the oesophagus. The diaphragm, being a muscle, can become weak, spasm or simply not function as it should and as a result will not be able to contract and assist in the closing of the esophageal hiatus. This can result in the oesophagus remaining open and in turn fail to prevent stomach acids and contents being projected back up into the oesophagus.
As can be seen in the image above, the lower oesophageal sphincter (LES) lies within the diaphragm. When we eat the sphincter contracts, along with the diaphragm, in order to close the oesophagus therefore preventing stomach acids from entering the oesophagus. Weakness or a spasm within the diaphragm can prevent the sphincter from closing, causing the stomach contents to flow back into the oesophagus.
What Can Cause The Diaphragm To Lose Function?
The diaphragm, like any muscle, will become weak and restricted if not used often enough. An example may be if you were to suffer a break to your leg and the leg was placed in plaster for an number of weeks to allow it to heal. Once the plaster is removed you would notice the muscles in the leg have reduced in size and strength and lost their ability to function as they once did. In a similar way, if the diaphragm is not used to its full capacity on a regular basis then it too will begin to weaken, lose tone and functionality.
As the diaphragm is the main muscle we use when breathing, it would make sense that the main reason for the diaphragm to lose strength and functionality is due to incorrect breathing patterns. The most common cause of incorrect breathing is when we breath from our chest rather than from our diaphragm (or belly breathing) When we breath from the chest we will often use the muscles in the neck and chest to try and expand the chest and get air into our lungs. The thing is, these muscles (of the neck and chest) are used to assist in breathing and are not the main muscles of respiration – this is the role of the diaphragm.
Often ,clients who come to see me with acid reflex or abdominal issues will report having tightness in their necks, shoulders and chest – which is often a clue they are not using their diagram to breath, resulting in weakness or spasm in the muscle.
Stress and Poor Diaphragm Functioning
Often, when we are in a stressed state we will begin to breath from our chests. Many of us will testify to having been in a particularly stressful situation and felt our chests tightening and our shoulders rising; in these situations we are using our chest and neck muscles to breath and neglecting the diaphragm. If the stress we are experiencing is short term, then our breathing patterns can return to normal but for those who suffer from ongoing anxiety or stress then chest breathing can become the norm. I have often found in a large proportion of clients who report to having acid reflux or abdominal pain to also be suffering from ongoing stress or anxiety related issues. These clients will often neglect to use their diaphragm, resulting in either a weakening or spasm within the muscle. This can, in turn, increase the inability of the oesophageal sphincter to close which can result in the influx of stomach acid into the oesophagus.
There are many other reasons and complications for acid reflux and abdominal pain; poor posture may contribute and there is the complication o hiatus hernia as well as vagus nerve involvement. Although these a very relevant to the topic, perhaps its something which can be discussed on a future post, otherwise this short blog could become very long!
How Can Myofascial Release Help?
Often, a diaphragm which not been functioning efficiently for some time can become difficult for the client to engage through altering breathing patterns alone. As in the example we used earlier involving the broken leg, the muscle can become weak or lose it’s responsiveness; the diaphragm can also become almost glued to the rib cage. Often the use of myofascial release can help stimulate the muscle and release some of the restrictions, helping the brain to make the re-connection with the muscle. Release of tension and restrictions within the abdomen along with release of the ribs will also help to improve movement and enable expansion of the diaphragm and the lungs (for more information on myofascial release read my myofaacial release blog here )
Coaching and instruction in breathing from the diaphragm and reducing chest breathing is also vital to enable the muscle to continue to function correctly following treatment.