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.

 

Disc Herniation | Relieving your Back pain by Physiotherapy

If you suffer from back pain due to herniated disc and are afraid that you might have to live with it. Then it's time for you to relax and get ready to lead a quality life. You can return to your daily routine by availing of Physiotherapy services. Physiotherapy not only helps to enhance the healing process, but reduces pain, and also helps the patient to get back to normal function. This blog will throw some light on the herniated disc and its physiotherapy management.

 

What is a Herniated Disc?

The spine is made up of vertebrae, which are held next to each other by the disc. The disc is a combination of strong connective tissues, made of a strong outer layer, annulus fibrosus, and a gel-like center called nucleus pulposus. The disc may start to lose water content, which makes the disc less effective as a cushion. This may cause herniation through a crack in the outer layer. Disc herniation commonly occurs in the bottom two discs of the lumbar spine. A herniated disc can press on the nerves in the spine and might cause pain, numbness, tingling, or weakness of the leg.

 

Physiotherapy Management:

Physiotherapy management comprises of a number of therapies and techniques like:

 

Cold Therapy:

Herniated disc presses on the nerve in the spinal canal, which causes pain and inflammation along the spinal walls. Cold therapy is found to be effective for pain relief because it constricts the veins along the spine, slowing the circulation and reducing inflammation.

 

Heat therapy:

Heat therapy is a non-invasive pain relief therapy for muscle and joint pain. This therapy is used to promote blood flow, blood helps to heal the area by delivering extra oxygen and nutrients, it removes waste byproducts from muscle spasms reduces pain in the joints, relaxes tight muscles, tendons and ligaments.

 

Kinesio Tape:

Kinesio-tape is a latex-free tape that can be worn for days. Kinesio Tape is applied to the spinal area to facilitate the body's natural healing process while providing support and stability to muscles and joints without restricting the range of motion. It also helps to increase blood flow and reduce pressure on the nerves which helps to decrease pain (localized as well as radiating) and inflammation.

 

Ultrasonic Therapy:

Therapeutic Ultrasound helps to increase blood flow and reduce pain. It uses ultrasonic waves that pass into the skin causing a vibration of local tissues. This vibration causes deep heating in the area without any sensation of heat. As the vibrations created by the ultrasound pass through the soft tissue, this increases heat within the tissue, which in turn increases blood flow, reduces pain, relaxes muscles, increases the extensibility of connective tissues, promotes scar tissue breakdown, and improves flexibility.

 

Vasopneumatic Compression:

Vasopneumatic compression helps to accelerate recovery. It cycles ice-cold water and air through a sleeve which is placed around the affected part of the body. This integrated cold and compression therapy helps to reduce pain, swelling, muscle spasms and enhances lymphatic function and oxygenated blood flow.

 

Transcutaneous Electrical-stimulations:

Transcutaneous electrical stimulations use electrical currents that pass through the electrodes placed directly on the patient's skin. Transcutaneous electrical stimulations cause an increase in the blood flow to promote healing and reduce inflammation. Stimulation act on the pain gate to block the transmission of pain signals, it also causes muscle stimulation for neuromuscular re-education and strengthening.

 

Low-Level Laser Therapy:

Low power laser therapy is effective in the treatment of patients with acute cases of disc herniations. It speeds up the recovery process, decreases inflammation, and pain.

 

Spinal Traction:

Spinal traction is a form of decompression therapy, it helps to relieve pressure from the spine. This type of distraction can be performed with manual techniques as well as machines. Spinal traction is indicated for the treatment of herniated discs, it decompresses spinal discs and facet joints by utilizing traction, distraction, and body positioning.

 

Manual Therapy:

Manipulative treatment for disc herniation is found to be safe, effective, and seems to be as effective as other therapies. It leads to short-term pain relief when suffering from acute low back pain and has an effect similar to NSAIDs. It includes techniques like spinal mobilization, spinal manipulation, massage, myofascial release, etc.

 

Stretching Exercises:

Stretching exercises are included in the treatment plan to decrease soft tissue tightness and improve posture to balance the forces placed on the spine.

 

Strengthening Exercises:

The spine is supported by strong muscles and thus can better handle pain. Core muscle stability is important to regain strength and power. Strengthening exercises help the patient to regain functionality.

 

Treatment of disc herniation is important to control pain, development of disability, prevent a recurrence, and accelerate the return to work. Therefore immediate treatment should be taken before the condition progresses further.

 

Constipation | Managing Bowel Dysfunction with Physiotherapy

Physiotherapy is undergoing rapid growth and development to widen its horizons. A wide variety of diseases are being treated by physiotherapists. One of them is the management of constipation. Constipation occurs when the colon's muscle contraction is slow or sluggish which delays transit time. This results in hard and dry stool that can lead to straining and pain during a bowel movement. It is very important for our health and overall well-being to move our bowels regularly and with ease. In case of constipation if proper treatment is not taken at the initial stage, then it might even lead to life-threatening risks. Exercises to relieve constipation both in the short and long term are found to be effective and without any side effects. Exercises help to increase muscle activity in the intestines and with peristalsis i.e. wavelike movements that push the contents of the digestive tract forward for proper transit in the colon. In this blog, we have discussed physiotherapy management for patients suffering from constipation.

 

Constipation

Constipation is a symptom rather than a disease, the patient suffering from constipation feels bowel frequency fewer than 3 times a week, needs to strain more than 25% of the time during defection, can also have lumpy or hard stools for more than 25% of bowel movements. There is a sensation of anorectal blockage or incomplete evacuation for more than 25% of bowel movements. Constipation can occur due to hormonal changes, neurological problems, rectocele, hyposensitive rectum, stenosis of the internal anal sphincter, irritable bowel syndrome (IBS), colon cancer, sedentary lifestyle, older age, even certain medications, mental health, eating disorders, etc.

 

Physiotherapy Management:

Physiotherapy treatment involves lifestyle modification and regular exercises. The patient is educated about the toileting techniques, to avoid straining during a bowel movement to decrease the risk of developing pudendal nerve dysfunction. These techniques include:

• While sitting on the toilet, the patient should lean forward with feet positioned on a step stool this position decreases the anorectal angle, thus easing the evacuation of stools.
• Another technique helps to move bowels more easily by attaining a squatting position when the knees are higher than the hips.
• The patient is asked to perform huffing or forced respiratory expiration during defecation, this helps to activate the abdominal oblique muscles, which assist in the propulsion of stools.

Propulsive abdominal bowel massage:

Propulsive abdominal bowel massage is a safe, non-invasive technique and can be performed by the patient independently. This technique promotes bowel mobility throughout the colon, this helps in increasing peristalsis in the gut. The patient applies constant moderate pressure to the abdomen with 2 or 3 fingers. Initially small, clockwise circular movements at the right anterior superior iliac spine, located at the base of the ascending colon are recommended. Further progression is made by moving up the ascending colon towards the base of the rib cage, the place where it meets the transverse colon. The circular movements are applied across the transverse colon toward the left upper quadrant of the abdomen and then down over the descending colon toward the left anterior superior iliac spine. This massage should be performed for 10 minutes on daily basis.

 

Pelvic Floor Exercises:

Pelvic floor exercises help to relax and tighten the muscles in the pelvis. Relaxing the pelvic floor muscles at the right time during defecation can help to pass stool more easily. A catheter is inserted into the rectum to measure muscle tension. The physiotherapist guides through the exercises to alternately relax and tighten the pelvic muscles. Relaxing the pelvic floor muscles at the right time during defecation can help to pass stool more easily.

 

Breathing Exercise:

Stress or anxiety can be the major reason for constipation, to relieve it breathing exercises can help relax the mind and relieve stress or depression. There are a wide variety of breathing exercises like diaphragmatic breathing alternate nostril breathing, 4-7-8 breathing, or even the simplest normal breathing can be done by just inhaling and exhaling slowly.

 

Cardio Exercises:

Cardiac exercise is a type of aerobic exercise that can help the cardiovascular system. These exercises increase blood flow, build endurance, and improve bowel movement. These exercises are simple and easy to do and tremendously help get relief from constipation. Common cardiac exercises are walking, running, jogging, cycling, jump- rope and swimming.

 

Bird Dog:

The person is asked to attain a dog posture by placing the hands and legs on the floor. Then asked to raise the left arm and right leg backward in a way such that they are parallel to the floor for a few seconds and then return to the starting position. The patient is then asked to change and raise the right arm and left leg in a similar way for 30 seconds. This exercise should be done 10 times.

 

Bridge:

The patient is asked to lie on the back while the legs are outstretched. Then bend the knees so that both the knees are pointed up with feet on the floor. The patient is then asked to extend the arms along the body's sides with palms facing down. Further, the arms and feet are pushed down while lifting the cheek. This posture should be maintained for 30 seconds.

 

Deep Squat:

Deep squatting exercises have incredible results because it imitates the natural defecation posture of humans. These exercises are done 10-15 times. Initially, the patient is asked to start slowly by raising and lowering the body gently. The squatting posture is held for 10- 15 seconds.

 

Forward Lunges Exercises:

The patient is asked to stand straight with the torso tightened, shoulders and back relaxed. Keep the neck straight and stable while exercising, take a step in the forward direction with one leg, bending both the legs downwards. As the patient lands forward, the knees should make a straight line with the ankle. While the back knee shouldn't be touching the floor. Try shifting the weight on the heels instead, but don't take the strain on the knees. Hold this position for 5 to 10 seconds and then come to the starting position. Repeat the same with the opposite leg. do 10-15 repetitions with each leg.

 

Wind Relieving Pose:

The patient lies on the floor on the back and hands by the sides. Then bends one of the legs and brings it towards the chest such that the knee is touching the chest. Once the leg is brought close, hold and pull the leg with a gentle hand. Hold this position for 10 to 30 seconds and then release the leg and return to the starting position. Repeat the exercise with the opposite leg.

 

The best time to do the exercises is in the morning. Exercising creates adrenaline. It is the type of chemical that is a good remedy for stress, makes the body more relaxed. Keeps the body in a good mood, ready for action. Though some people can exercise in the evening, adrenaline can them keep awake during the first half of the night, as the effect of adrenaline goes after 4-5 hrs.  If the patient feels any discomfort or irritation around the abdominal area, then he/she should stop doing exercise.