Exercises to Improve a Hiatal Hernia

While the primary cause for a hiatal hernia is largely unknown, certain strenuous moves like coughing, lifting and straining can also contribute. If you have a hiatal hernia, exercises should include movements that focus on reducing abdominal strain. Keep reading to learn what exercises our physical therapist recommends.

Breathing Exercises

There is a natural opening in the diaphragm, the muscle that helps you breathe efficiently, to allow the esophagus to pass through to the stomach. This opening is called the hiatus. This opening can become problematic or compromised if the stomach pushes up through the opening.

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Since a hiatal hernia involves the mechanics of the diaphragm, it should make sense that proper breathing is an essential part of prevention and management. These exercises dive into the basics of breathing and how posture and mechanics can affect it.  

Seated Deep Breathing

Being able to breathe deeply and efficiently is key for proper oxygen perfusion and optimal health. It can also reduce strain to the upper neck, diaphragm, and abdomen. This is a simple yet effective exercise for making sure you are properly utilizing the diaphragm.

• First, you need to sit in an optimal posture with your spine lengthened and the crown of your head reaching toward the ceiling
• Focus on breathing deeply into your abdomen with each breath
• To accomplish this, imagine that the ribs will expand away from each other and the belly will move forward to allow a lot of space for oxygen to fill up the lungs
• Make sure your neck and upper body isn’t elevating or tensing up
• Inhale and exhale slowly and mindfully
• Repeat for 10 repetitions
• With time, work on incorporating this breathing technique into your daily activities as often as possible

If this is too difficult and you are having trouble coordinating, try lying down or in a partially reclined position to start.

Shoulder Blade Squeezes

Posture plays an important role in the mechanics of your breathing. If you feel you are spending more time slouched than you should, this can put a serious damper on your diaphragm’s ability to work efficiently and without strain. This simple move can help a lot.

• Sit in a chair without using the back support and both feet flat on the floor
• Adjust your spine to be in an upright position, as if you needed to balance a bucket of water on the top of your head without spilling
• Then, simply imagine there is a quarter between your shoulder blades that you want to squeeze and hold
• Keep the neck and upper shoulders relaxed as you hold for 3-5 seconds
• Repeat for 10 repetitions at a time
• You can also move your arms back as you squeeze too, depending on your preference
• You can do this anytime throughout your day when you feel yourself slouching at your desk, in the car, etc. 
• Complete this exercise at least 3 times per day

More Postural Exercises and Progressions

Yoga Poses

Participating in yoga is a great way to incorporate breathing, flexibility, and core strength all in one fluid move. These yoga poses can give you great relief, help you feel relaxed and boost your overall sense of well-being.

Cat-Cow Stretch

This is a great stretch for working on coordinating your breath with movement. Plus, it will feel great on your entire spine.

• Start on your hands and knees with the hands directly under the shoulders, knees directly under the hips, and spine in neutral
• As you take a deep breath, start to arch the mid-back up toward the ceiling as you bring your head down toward the floor
• Move as far as is comfortable for your back and hold for 3-5 seconds to feel a nice stretch in the mid back
• Next, exhale as you reverse the direction of your spine to drop your belly down toward the floor, extend the low back, and bring the head up toward the ceiling
• Again, hold for 3-5 seconds
• Alternate between these two positions 10 times, keeping it all in sequence with your breath for up to 3 sets

Seated Overhead Reaches

This yoga move is a great progression from seated deep breathing. It will help you learn to coordinate your breathing with arm movement to help with better carry over to your daily activities.

• Sit comfortably on the floor with your legs crossed (if possible; otherwise long sitting is okay too)
• Start by finding good posture by rolling your shoulders gently back and lifting your entire spine up toward the ceiling
• In this position, take a deep breathe as you lift both arms to the side and up overhead
• Hold for 1-2 seconds overhead
• Then, as you exhale bring the arms slowly back to the starting position
• Repeat for up to 10 repetitions for 2-3 sets total

Child’s Pose

This stretch is great for the whole body and can help promote better flexibility for good posture and breathing.

• Start on your hands and knees on the floor
• Shift your butt back toward your heels (as close as possible) as you reach our arms out in front of you and bring your chest down toward the floor
• If possible, rest your lower chest on your thighs and relax your forehead on the ground
• Hold for 30-60 seconds while focusing on breathing deeply for 2-3 sets
• You should feel a stretch in the low back, mid-back, hips, and arms- you can adjust your position to address any particular stiff or sore areas too

Stomach Strengthening Exercises

The abdominal muscles, and other core muscles, play an important role in good trunk stability. When this strength and coordination is compromised, it can lead to unnecessary strain to the abdominal cavity where vital organs and the diagraphms are located. These exercises will help boost your core strength and coordination.

Pelvic Tilt Seated on a Stability Ball

This is a great exercise for learning to coordinate abdominal muscle activation and movement at the same time. Plus, you can also double check that you are breathing well too. This small move can feel hard to coordinate at first but will get easier with time.

• Grab an exercise ball and sit on it to get started
• Keep your entire spine in an upright neutral position on the ball
• First, gently arch (or extend) the low back as you inhale
• Next, reverse the direction of your spine as you exhale and tighten the abdominals- your low back should feel slightly rounded
• Hold for 2-3 seconds and repeat
• Alternate between these two subtle moves, making sure there is only movement in the pelvis and low back and not the upper spine
• Complete 10 repetitions and repeat for 2-3 sets total

Being able to tuck your pelvis is a valuable skill for protecting your low back with abdominal exercise and lifting, ultimately reducing strain on the abdomen and decreasing risk of any type of hernia.

Alternating Leg Straighteners

Anytime you complete a traditional abdominal exercise, it’s important to focus on keeping the low back stable and abs tight. This exercise is one of many ways to practice this.

• Lie on your back to get started
• Tighten the lower abdominals so that your low back feels supported and the stomach is relatively flat
• Bring both legs up to table top position with the hips and knees at 90 degrees and the ankles flexed
• From this active position, start to straighten one leg as you bring it closer to the floor; approximately 6 inches from the ground
• Hold for a beat before returning the leg to the starting position and switching to the other side
• Alternate back and forth for 10 repetitions total on each side
• Repeat for 2-3 sets
• Make sure your abs stay tight, you are breathing comfortably, and the low back stay stable throughout
• If the exercise is too hard, you can modify how close your legs are getting the ground- the further away the easier

How to Maximize Your Exercise Routine

The exercises listed above are a great way to improve your overall quality of life and reduce strain on a hiatal hernia. Here are few more tips to keep in mind to get the most out of your exercise routine:

• Start slowly and build over time. Get in touch with a physical therapist for guidance on a personalized program. 
• Avoid activities that strain the abdomen (i.e. high impact activities, repetitive bending, crunches, situps, and heavy weight lifting).
• Try low impact exercise such as walking, swimming, and biking for weight management or weight loss. (Obesity has been linked to a higher risk of developing a hiatal hernia).
• Talk to a trusted medical professional if you are overweight and/or experiencing a chronic cough, sneezing, or constipation; getting these better managed will help significantly. 
• Eat a diet approved for gastro-esophageal reflux disease (GERD).
• To minimize discomfort and chest pain with digestion, such as acid reflux and heartburn, avoid lying down right after meals. 
• Combine your exercise with other potential home treatment options for hernia.
• One traditional treatment you can try that is moderately supported is a “warm water fix.”
• Drink a pint of warm water in the morning and then complete 10-15 heel raises, forcefully landing on your heels with each repetition. This is theorized to settle the stomach.

Recovering from a Hiatal Hernia

A hiatal hernia can be managed well with proper attention to our daily mechanics, lifestyle changes like diet, and an exercise program. While hernias cannot be reversed, you can prevent a progression and better manage your hernia while avoiding surgery and unnecessary discomfort. If you notice a sudden change in your symptoms or feel they are affecting your quality of life, it is always best to get in touch with your healthcare doctor for further medical advice.

Sources:

https://www.healthline.com/health/hiatal-hernia-exercise

https://www.healthgrades.com/right-care/hernia-surgery/how-can-you-fix-a-hiatal-hernia-yourself#:~:text=Drink%20a%20glass%20of%20warm,your%20mouth%20for%2015%20seconds.

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