Reversing Hiatal Hernia With Manual Therapy: Does It Work?

Reversing Hiatal Hernia With Manual Therapy: Does It Work?

Is Manual Therapy Effective at Reversing Hiatal Hernia? 

Key Takeaways

  • There’s no natural treatment that will completely reverse the atypical anatomy that causes hiatal hernia (but there are techniques that can help).
  • The most common symptom of hiatal hernia is reflux (GERD), and treatments that improve GERD often improve the symptoms of hiatal hernia.
  • Manual self-adjustment of the abdominal area has shown improvements in hiatal hernia symptoms in clinical settings.
  • Surgery to repair the abdominal abnormalities that cause hiatal hernias are used in cases of a large hernia and/or severe symptoms.

While there’s no proven way of naturally reversing hiatal hernia, there are some great non-surgical treatments that can help improve symptoms. 

A hiatal hernia is caused by abnormal anatomy, most often when the gastroesophageal junction protrudes up through the hiatus, which is an opening in the diaphragm located in the abdomen [1 Trusted SourcePubMedGo to source]. They can be congenital or acquired, meaning you may be born with it or you may have developed one over time. 

The most common symptoms of hiatal hernia are reflux, a burning sensation in the chest, and a feeling of being full even after a small meal. We’ll get into more details about hiatal hernia symptoms and causes in a bit. However, you’re most likely reading this article because you have been diagnosed with or suspect you have a hiatal hernia and you want to know how to improve your symptoms — so first, let’s talk about reversing hiatal hernia.

Treating and Reversing Hiatal Hernia

When examining how to treat a hiatal hernia, we want to look at the severity of symptoms. Many people have hernias and do not have symptoms (they’re asymptomatic). Generally, in conventional and functional medicine, if a person is asymptomatic, treatment is conservative and mostly involves lifestyle modifications. 

Severe cases with either a large hernia or intense symptoms aren’t as common, but in those cases surgery may be done, as it’s the only way of reversing hiatal hernia. 

Even in symptomatic cases, most treatments don’t involve surgery. Since most hernias are mild enough to not require surgery, let’s first take a look at some of the natural treatment options to improve symptoms [2 Trusted SourcePubMedGo to source].

Types of Manual Therapy

Manual therapy attempts to get the internal anatomy back into the right place through manual manipulation of the outside of the abdomen. There are a few different kinds of manual therapy, two of which are done by a practitioner and have some good research studies behind them. The other can be done on yourself and is a bit similar to the manual therapy done by a practitioner. 

While manual therapy often gets the internal anatomy lined up better, it’s not proven to reverse hiatal hernia, meaning it doesn’t seem to permanently fix the abnormal anatomy that causes hernias.

However, people do see a relief of symptoms. Let’s take a look at those forms of therapy now. 

Self-Adjustment Maneuver 

We’ve been using the self-adjustment maneuver in our clinic at the Ruscio Institute for Functional Medicine, with good success in some of our patients who were continuing to struggle with reflux and other gastrointestinal symptoms, even after diet and lifestyle changes. 

In fact, with one of our patients, while she had seen improvements with an anti-inflammatory diet and probiotics for her gut health, she was still experiencing acne, stomach pain, and reflux. Dr. Joe Mather, MD, medical director of the Ruscio Institute, had her try self-adjustment for a week and she started to feel a bit better. Then one day she noted that when she swallowed her food, it felt like everything suddenly came into alignment, indicating a possible realignment to improve the hernia. After that, she had continual improvement of her acne and gastrointestinal symptoms. 

In the podcast episode that discusses the above patient case, Dr. Joe notes: “I speculate that the vagus nerve can become compressed even in small hiatal hernias, leading to poor motility and constipation. I have now seen several cases where chronic constipation has significantly improved following this maneuver.”

Not only can these maneuvers possibly realign the anatomy of the gastroesophageal junction, but they may also help to regulate the vagus nerve. The vagus nerve travels from the base of the skull to the abdomen and it helps regulate digestion [3 Trusted SourcePubMedGo to source]. 

The self-adjustment maneuver, which you can watch on YouTube, involves applying pressure with the fingers in a downward motion to the area of the abdomen about one inch below the sternum and one inch to the left below the rib cage. This is approximately the area of the gastroesophageal junction (GEJ) and may help stop the GEJ from protruding through an opening in the diaphragm called the hiatus. 

Remember, we are not reversing a hiatal hernia and permanently fixing the anatomical abnormality, but rather creating better alignment. These maneuvers may need to be done periodically to keep things in good alignment.

If you try this maneuver to help resolve your symptoms, do it daily for a week and note any improvements in your symptoms. See if you can feel better alignment of your abdominal cavity. Everyone describes the feeling of food not traveling well from the esophagus to the stomach differently. An improvement of alignment may feel like less pressure when you eat, it is easier to swallow, or food doesn’t feel like it gets stuck anywhere in your system.

While we don’t have research studies on this particular self-adjustment maneuver, it’s based on research about other manual therapies. These other manual therapies are performed by healthcare practitioners in osteopathy and myofascial therapy. 

Osteopath Treatment

In osteopathic manual therapy, the physician applies pressure in the area below the sternum while the patient breathes in and bends forward. The patient then straightens their spine, extends their head back, and breathes out while the physician applies pressure downward. In one clinical trial, patients who received the osteopath treatment had significantly greater improvement in GERD symptoms compared to the control group [4 Trusted SourcePubMedGo to source]. 

In another trial, in a group of people who had GERD, those who received the manual therapy had a 9-27% increase in lower esophageal sphincter pressure as measured by manometry [5 Trusted SourcePubMedGo to source]. People with a hiatal hernia have a decrease in lower esophageal sphincter pressure, indicating that this maneuver may be beneficial for hiatal hernia, but it doesn’t prove that the maneuver resolves the anatomic abnormality of hiatal hernia. 

Myofascial Treatment

In myofascial therapy treatment of GERD, various manual techniques are used by a myofascial therapist around the abdomen to improve mobility of the diaphragm. These techniques, over the course of two weeks, with two treatments a week, resulted in improvement in GERD symptoms, gastrointestinal quality-of-life, and reduced proton pump inhibitor (PPI) use compared to the control group [6 Trusted SourcePubMedGo to source]. Again, this shows improved symptoms and the possibility that it may be improving the anatomical abnormalities of a hernia. 

While manual therapy options can help in the treatment of symptoms of hiatal hernia, there are also some lifestyle changes that have been shown to help treat GERD and thus people living with a hiatal hernia. 

Lifestyle Changes for Symptom Treatment

Because the most common symptom of hiatal hernia is acid reflux, treating GERD is the best way to improve the symptoms caused by hiatal hernia.

Below are some general lifestyle modifications that can help [2 Trusted SourcePubMedGo to source]:

  • In patients for whom obesity is a contributing factor in exacerbating hiatal hernia due to intra-abdominal pressure, weight loss can significantly improve GERD symptoms [7 Trusted SourcePubMedGo to source].
  • Elevating the head of the bed 8 inches during sleep can help keep contents of the stomach down.
  • Avoiding meals two to three hours before bedtime, so that food is farther down in the digestive system before sleep, can be helpful to reduce acid reflux that may keep you awake.
  • Eating several smaller meals throughout the day instead of large meals if you feel full quickly when eating.
  • Eliminating common reflux trigger foods such as caffeine, chocolate, alcohol, spicy foods, citrus, and carbonated drinks may also be helpful.

Many of these lifestyle changes are typically suggested in conventional treatment, and at times surgery or medication is recommended.

When Is Surgery Recommended?

Surgery is the only way of reversing hiatal hernia and is typically reserved for severe symptoms or if a large hernia is found [8 Trusted SourcePubMedGo to source]. Fundoplication is a hiatal hernia surgery where part of the fundus of the stomach is wrapped around the base of the esophagus, which reinforces the sphincter to lessen the possibility of acid or food coming back through to the esophagus [1 Trusted SourcePubMedGo to source, 2 Trusted SourcePubMedGo to source, 9 Trusted SourcePubMedGo to source]. 

Most hiatal hernias fall into the less severe category, and in conventional medicine may be treated with medications to decrease stomach acid, such as proton pump inhibitors (PPI), H2 blockers, or antacids.

Understanding Hiatal Hernia

A hiatal hernia is when either the upper part of the stomach or another internal organ pokes through an opening in the diaphragm (muscle in the abdomen that assists with breathing) called the hiatus [1 Trusted SourcePubMedGo to source]. The hiatus is where the esophagus passes through to connect with the stomach.

It’s estimated that 10-50% of adults have a hiatus hernia [10 Trusted SourcePubMedGo to source]. Many of these hernias are small, do not cause any symptoms, and do not need to be surgically addressed.

If the hernia gets bigger, the most common symptom is reflux, or gastroesophageal reflux disease (GERD). In fact, hiatal hernias are the most common cause of GERD [1 Trusted SourcePubMedGo to source, 11 Trusted SourcePubMedGo to source]. This is because when the stomach pushes up through the diaphragm, this loosens the lower esophageal sphincter, allowing food and/or stomach acid to come back up into the esophagus, causing reflux. 

Most people are diagnosed with a hiatal hernia after looking into symptoms of reflux or chronic abdominal issues. Common symptoms of a hiatal hernia are heartburn or chest pain, pain above the belly button, feeling full soon after eating, chronic cough or clearing of the throat, asthma, and difficulty swallowing [1 Trusted SourcePubMedGo to source, 2 Trusted SourcePubMedGo to source].

Hiatal hernias are not usually diagnosed by physical examination. A few common diagnostic tests are endoscopy, barium swallow study, and esophagography. Treatment will depend on the severity of symptoms and severity of the hernia. 

There are four types of hernias: sliding type, paraesophageal, combination of paraesophageal and sliding, and type 4 — when the upper stomach and part of another abdominal organ protrudes into the chest cavity [1 Trusted SourcePubMedGo to source]. 

Sliding type is the most common, representing 95% of all hiatal hernias [1 Trusted SourcePubMedGo to source].

TypeDescription
Type 1 (sliding type)
Most common 95% of hiatal hernias are type 1
Occurs when the gastroesophageal junction (GEJ) (where the esophagus meets the stomach) bulges upwards through the hiatus.
Type 2 (paraesophageal)
Makes up about 5% of hiatal hernias
Occurs when the upper part of the stomach (fundus) protrudes through the diaphragm and into the area of the chest cavity between the lungs.
Type 3 (paraesophageal and sliding)Occurs when both the GEJ and upper stomach bulge through the diaphragm, which is a combination of type 1 and 2. 
Type 4 Occurs when the upper stomach and part of another abdominal organ (such as the intestines or spleen) protrudes into the chest cavity.

Causes of Hiatal Hernia

Hiatal hernia can be congenital (you’re born with it) or acquired over time [1 Trusted SourcePubMedGo to source]. A hiatal hernia may develop over time due to muscle weakness or laxity of the diaphragm as you age. The incidence of hernia increases as we get older, however only 9% of people with hiatal hernia have symptoms [1 Trusted SourcePubMedGo to source, 12 Trusted SourcePubMedGo to source]. 

Increased pressure in the abdomen from pregnancy, repeated heavy lifting, chronic constipation, chronic obstructive pulmonary disease (COPD), or obesity also increase risk [2 Trusted SourcePubMedGo to source, 13 Trusted SourcePubMedGo to source].

There may also be some genetic factors that contribute to laxity of the muscles, such as laxity of the phrenoesophageal ligament, that may lead to a hiatal hernia [9 Trusted SourcePubMedGo to source, 14 Trusted SourcePubMedGo to source]. We’ve noticed in observation of patients that hiatal hernia may be more common in people with hypermobility disorders such as Ehlers-Danlos syndrome. Hypermobility causes laxity of the muscles and tendons of the body.

We can’t avoid many of the potential causes of hiatal hernia, but living in a way that decreases intra-abdominal pressure, particularly keeping your weight lower, is one area where you do have some agency in your well-being. Various studies show the rates of hiatal hernia in people who are morbidly obese to be between 15-37% [15 Trusted SourcePubMedGo to source, 16 Trusted SourcePubMedGo to source, 17 Trusted SourcePubMedGo to source].

At our clinic, we usually start patients on an anti-inflammatory diet, such as a Paleo diet. This can not only help maintain a healthy weight for you, but also improve any gastrointestinal symptoms that might not only be caused by a hernia. Many gastrointestinal symptoms overlap and if you have issues with leaky gut, you may have symptoms of reflux that may not be due to a hernia. A Paleo diet is a great first step to improve your overall gastrointestinal health and may help if you also happen to have a hernia. 

Living With Hiatal Hernia

If you have symptoms of GERD, feelings of fullness quickly after eating, or indigestion, and/or you know or suspect you have a hiatal hernia, you may want to make some lifestyle changes to see if your health improves.

Because the main symptom of a hiatal hernia is acid reflux — but symptoms of reflux can also be caused by leaky gut or other general poor gut functioning — changing to a more gut-supportive diet for a month is a great first step to healing. 

You can also support feeling a bit better by trying a few of the simpler lifestyle changes, such as eating smaller meals, not eating within a few hours of going to bed, and elevating the head of your bed at night by 8 inches.

While surgery is the only way of reversing a hiatal hernia, you can also use the manual self-maneuver technique to see if it helps align your anatomy better. This may help relieve symptoms, especially if you’ve made dietary and lifestyle changes and are still struggling. 

If you have been dealing with chronic gastrointestinal symptoms and would like help making a plan to improve your health, we are here to help you at the Ruscio Institute for Functional Medicine

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
  1. Smith RE, Shahjehan RD. Hiatal Hernia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 32965871. Trusted SourcePubMedGo to source
  2. Sfara A, Dumitrascu DL. The management of hiatal hernia: an update on diagnosis and treatment. Medicine and Pharmacy Reports. 2019 Oct 25;92(4):321–5. DOI: 10.15386/mpr-1323. PMID: 31750430. PMCID: PMC6853045. Trusted SourcePubMedGo to source
  3. Tindle J, Tadi P. Neuroanatomy, parasympathetic nervous system. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 31985934. Trusted SourcePubMedGo to source
  4. Eguaras N, Rodríguez-López ES, Lopez-Dicastillo O, Franco-Sierra MÁ, Ricard F, Oliva-Pascual-Vaca Á. Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial. J Clin Med. 2019 Oct 19;8(10). DOI: 10.3390/jcm8101738. PMID: 31635110. PMCID: PMC6832476. Trusted SourcePubMedGo to source
  5. da Silva RCV, de Sá CC, Pascual-Vaca ÁO, de Souza Fontes LH, Herbella Fernandes FAM, Dib RA, et al. Increase of lower esophageal sphincter pressure after osteopathic intervention on the diaphragm in patients with gastroesophageal reflux. Dis Esophagus. 2013 Jul;26(5):451–6. DOI: 10.1111/j.1442-2050.2012.01372.x. PMID: 22676647. Trusted SourcePubMedGo to source
  6. Martínez-Hurtado I, Arguisuelas MD, Almela-Notari P, Cortés X, Barrasa-Shaw A, Campos-González JC, et al. Effects of diaphragmatic myofascial release on gastroesophageal reflux disease: a preliminary randomized controlled trial. Sci Rep. 2019 May 13;9(1):7273. DOI: 10.1038/s41598-019-43799-y. PMID: 31086250. PMCID: PMC6513998. Trusted SourcePubMedGo to source
  7. Singh M, Lee J, Gupta N, Gaddam S, Smith BK, Wani SB, et al. Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: a prospective intervention trial. Obesity (Silver Spring). 2013 Feb;21(2):284–90. DOI: 10.1002/oby.20279. PMID: 23532991. PMCID: PMC3853378. Trusted SourcePubMedGo to source
  8. Rosen RD, Winters R. Physiology, lower esophageal sphincter. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 32491384. Trusted SourcePubMedGo to source
  9. Watson TJ, Moritz T. Hernia, Sliding (Paraesophageal). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2017. PMID: 29083633. Trusted SourcePubMedGo to source
  10. Scarpato E, D’Armiento M, Martinelli M, Mancusi V, Campione S, Alessandrella A, et al. Impact of hiatal hernia on pediatric dyspeptic symptoms. J Pediatr Gastroenterol Nutr. 2014 Dec;59(6):795–8. DOI: 10.1097/MPG.0000000000000536. PMID: 25141229. Trusted SourcePubMedGo to source
  11. Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22(4):601–16. DOI: 10.1016/j.bpg.2007.12.007. PMID: 18656819. PMCID: PMC2548324. Trusted SourcePubMedGo to source
  12. Hyun JJ, Bak Y-T. Clinical significance of hiatal hernia. Gut Liver. 2011 Sep;5(3):267–77. DOI: 10.5009/gnl.2011.5.3.267. PMID: 21927653. PMCID: PMC3166665. Trusted SourcePubMedGo to source
  13. Menon S, Trudgill N. Risk factors in the aetiology of hiatus hernia: a meta-analysis. Eur J Gastroenterol Hepatol. 2011 Feb 1;23(2):133–8. DOI: 10.1097/MEG.0b013e3283426f57. PMID: 21178776. Trusted SourcePubMedGo to source
  14. von Diemen V, Trindade EN, Trindade MRM. Hiatal hernia and gastroesophageal reflux: Study of collagen in the phrenoesophageal ligament. Surg Endosc. 2016 Nov;30(11):5091–8. DOI: 10.1007/s00464-016-4858-1. PMID: 27005292. Trusted SourcePubMedGo to source
  15. Che F, Nguyen B, Cohen A, Nguyen NT. Prevalence of hiatal hernia in the morbidly obese. Surg Obes Relat Dis. 2013 Dec;9(6):920–4. DOI: 10.1016/j.soard.2013.03.013. PMID: 23810611. Trusted SourcePubMedGo to source
  16. Assakran BS, Alrakbi K, Alharbi MA, Almatroudi MA, Alshowaiman A, Alromaih AH, et al. Prevalence of asymptomatic hiatal hernia in obese patients during preoperative upper gastrointestinal endoscopy assessments and correlation with body mass index. Cureus. 2021 Feb 17;13(2):e13396. DOI: 10.7759/cureus.13396. PMID: 33758697. PMCID: PMC7978160. Trusted SourcePubMedGo to source
  17. Pandolfino JE, El-Serag HB, Zhang Q, Shah N, Ghosh SK, Kahrilas PJ. Obesity: a challenge to esophagogastric junction integrity. Gastroenterology. 2006 Mar;130(3):639–49. DOI: 10.1053/j.gastro.2005.12.016. PMID: 16530504. Trusted SourcePubMedGo to source

Need help or would like to learn more?
View Dr. Ruscio’s additional resources

Get Help

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

Leave a Reply

Your email address will not be published. Required fields are marked *