Yoga and gastroesophageal reflux disease (GERD). Exercises for gastroptosis Exercises for gerb

Massage and physiotherapy Irina Nikolaevna Makarova

Therapeutic exercise and massage for gastroesophageal reflux disease

A manifestation of gastroesophageal reflux disease is erosive reflux esophagitis of varying severity. A common cause of esophagitis is the reflux of active gastric juice into the esophagus due to cardia insufficiency (functional insufficiency of the lower esophageal sphincter). This is the so-called reflux esophagitis, which in most cases is observed with axial esophagogastric hernias of the esophageal opening of the diaphragm. With this type of hernia, the abdominal segment of the esophagus and the proximal part of the stomach are displaced through the esophageal opening of the diaphragm into the posterior mediastinum.

The development of insufficiency of the lower esophageal sphincter and the appearance of reflux is promoted by:

Increased intra-abdominal pressure (with constipation, flatulence, excessive physical activity, etc.);

Slowing down the evacuation function of the stomach;

Significant changes in the pH of the contents expelled from the stomach;

Duodenal-gastric reflux;

Traction of the cardiac part of the stomach into the chest cavity by longitudinal spastic contractions of the esophagus (with esophagospasm) or due to its scar-inflammatory shortening;

Congenital underdevelopment of connective tissue structures that strengthen the esophagus in the esophageal opening of the diaphragm, or age-related dystrophic changes in older people.

When passing through the esophageal opening, the esophagus is connected to the medial legs of the diaphragm by muscle bundles m. phrenicooesophageus and fibroelastic membrane, so underdevelopment or weakness of the legs of the diaphragm can be the cause of hiatal hernia.

The main clinical manifestations of functional insufficiency of the lower esophageal sphincter are heartburn, belching of food, pain in the epigastrium or retrosternal region, and mild dysphagia.

Treatment of insufficiency of the lower esophageal sphincter and gastroesophageal reflux disease in general should be carried out according to the following scheme (modified from R. Siewert et al.).

1. Activities that promote increased contractions of the lower esophageal sphincter:

Protein food;

Physiotherapy;

Drug therapy;

Psychotherapy.

2. Elimination of factors inhibiting contractions of the lower esophageal sphincter:

Fatty foods;

Nicotine and alcohol;

Certain medications, primarily anticholinergic drugs.

3. To exclude factors that increase intra-abdominal pressure, it is recommended:

Eating in small portions, eating slowly, trying not to swallow air, not eating late in the evening, not taking foods that contribute to increased gas formation, if you are overweight, try to reduce it;

Avoid tight clothing;

After eating, do not take a horizontal position;

During sleep - high position upper body;

Treatment of constipation.

Main tasks of exercise therapy

Normalization of the motor function of the stomach and intestines and the fight against flatulence;

Increased contractility of the lower esophageal sphincter, in the formation of which the legs of the diaphragm are involved;

Increasing diaphragm strength.

Exercise therapy classes are carried out no earlier than 2–2.5 hours after eating. At the beginning of the course of treatment, the main starting positions are lying on your back and right side on an inclined plane with the head end raised by 15–20 cm.

Much attention is paid to abdominal breathing. At the beginning of treatment, it is necessary to protrude the abdominal wall forward as much as possible while inhaling, fixing this position for 2-3 seconds. During exhalation, the abdominal wall should not be pulled in; it must be relaxed. This exercise, reducing pressure in the upper abdominal cavity, gradually strengthens the diaphragm and its medial legs. After 5-6 days of training, which should be carried out 3-4 times a day for 10 minutes. (with rest pauses of 20–30 seconds), it is recommended to begin to draw in the abdominal wall during exhalation, gradually increasing the amplitude of movement. The criterion for the correct performance of this exercise and all others is the absence of heartburn or belching during the training. The complex of physical exercises gradually includes leg movements and rotations of the body in an i.p. lying on your back, on your right side, and later on your left side, stomach, knees and standing.

In i.p. on the knees and standing, extension, side bending of the body, turns, squatting, walking, jogging are performed. For a long time, bending the torso and all movements that increase pressure under the diaphragm are not recommended. This rule also applies to training on various machines. After exercises with isometric muscle tension, they are relaxed.

Exercise therapy is most effective for functional disorders and sliding hiatal hernia. It should be carried out regularly for at least 2–3 months. 1–2 times a day with a gradual increase in load.

In order to combat flatulence and constipation, self-massage, massage of the abdominal wall with a hockey (tennis) ball, massage of the lumbosacral area and abdomen, dosed walking, swimming, cycling with the torso upright, games (avoiding tilting the torso forward) are recommended.

Special physical exercise are performed lying on an inclined plane with the head end raised by 15–20 cm and standing.

1. I.p. lying on your back, legs bent at the knees and hip joints, feet supported, one hand on the chest, the other on the stomach. Abdominal breathing. As you inhale, the abdominal wall protrudes more and more each time, and as you exhale, it relaxes. For the first 5–6 days, it is not recommended to retract the abdominal wall to avoid heartburn or belching. Then, in the absence of these phenomena, you can gradually begin to retract the abdominal wall during exhalation. Perform 6–8 times.

2. Lying on your back, legs bent, feet supported. Without lifting your feet from the plane, place your knees to the right, then to the left. Perform 8–12 times in each direction.

3. Lying on your back, arms and legs straight. Alternately lifting slightly bent legs during exhalation (complication - both legs at the same time). 5–10 times with each leg or 8–12 times with both legs at the same time. Don't raise your head, keep your lower back pressed!

4. Lying on your back, arms and legs straight. Spread your arms to the sides - inhale, pull one knee to your stomach with your hands - exhale. Don't raise your head. 6-10 times with each leg (complication - both legs are pulled up).

5. I.p. lying on the right side, right hand under the head, the left one – point-blank in front of you. Abdominal breathing (see exercise 1 for technique). Perform 5-8 times.

6. Lying on your right side. Left hand raised up left leg pulled back. Change the position of the limbs with a swinging movement. Perform 8–10 times.

7. Perform exercise 5 on the left side after 4–6 sessions.

8. Perform exercise 6 on the left side after 4–6 sessions.

9. Standing. Walking with high hips. Run for 30–40 minutes.

10. Main stand. Raise your arms up and at the same time take your leg back, bend over - inhale. I.p. - exhale. 8-10 times with each leg.

11. Standing. Feet shoulder-width apart, arms along the body. The body bends to the sides, the arms slide along it (“pump”). Perform 8–10 times in each direction.

12. Standing. Hands on the belt. Turn the body to the sides while abducting the arm of the same name – inhale. Perform 6–10 times in each direction.

13. I.p. - Same. Squat on toes with a straight back. Perform 8–15 times.

14. Walking with arms moving up and to the sides. Perform for 30–60 seconds.

15. Jogging (in the absence of contraindications).

Does breathing exercises help with reflux esophagitis and how to do it when you inhale, pull your stomach in or vice versa? Galina.

Good afternoon, Galina. Of course, any gymnastics will be useful in the treatment of reflux esophagitis, but it should be performed correctly. Concerning breathing exercises, then it is based on proper breathing in combination with the work of the abdominal muscles. You can also perform it for reflux, both independently and in combination with other types of strengthening the body.

To obtain the effect, you must carefully comply with all requirements. First of all, take a position that is comfortable for you. To do this you need to net or perform gymnastics while standing. Calmly take a couple of deep breaths in and out. Now exhale slowly with maximum participation of the abdomen. In other words, you must “breathe” with your stomach, as babies do in their first year of life. As you exhale, your stomach draws in and pushes out all the air. You need to do 4-5 such exhalations.

Having mastered this exercise, you can move on to the next one. Take a deep breath, slowly and calmly. After this, you need to exhale sharply, releasing all the air at once. This exercise is repeated 10 times.

Let's move on to next exercise. It's more complex. You need to inhale deeply and slowly and hold your breath. Now tense your abdominal muscles, pulling it in. The pause for the first time is no more than five seconds. Gradually, in the absence of unpleasant sensations, you can increase it to 15. Another exercise that is effective for reflux: inhale calmly and deeply. You should exhale in jerks, as if releasing all the air in parts.

All exercises should be performed slowly and intermittently. After taking deep breaths, it is important to rest and breathe as usual. Don't be alarmed if you start to feel dizzy. This is a normal phenomenon, just rest enough and continue after normalization of the condition. It is important to perform the exercises correctly, and not strive to do the entire complex as quickly as possible.

With proper breathing exercises, you can get rid of abdominal pain. In addition, blood circulation and organ function improves. But don't get carried away. Remember that even breathing exercises have their contraindications. You should not perform such exercises during exacerbation of reflux, immediately after eating. Breathing exercises should be done either standing or sitting on a hard chair.

Such gymnastics will help increase the duration of remission, but it is better to see an experienced physical therapy doctor and conduct several sessions under his supervision.

Warsaw gymnastics for GERD is prescribed quite often. Therapeutic exercise only speeds up recovery, keeps the condition stable for a long time, and reduces the amount of medications consumed. However, it will not be possible to cure gastroesophageal disease with gymnastics alone, although the time of recovery will come closer.

The benefits of physical education and the rules for doing it

Exercise therapy for pathologies such as esophagitis and cardia insufficiency is carried out in accordance with the recommendations of specialists, so as not to cause further harm. Gymnastic exercises characterized by the following advantages:

• stimulate the immune system;
• develop the muscles of the human body, which contributes to good nutrition tissues, rapid healing of wounds on the mucous membranes of the gastrointestinal tract;
• breathing exercises, as well as yoga, strengthen the sphincter of the lower esophagus, which does not allow the contents of the stomach to be thrown back;

• reduces reflux disease (its manifestations) at night;
• each exercise also helps to avoid the development of reflux esophagitis, as well as pathology such as cardia failure.

Warsaw gymnastics for GERD must be performed in compliance with certain rules. A specialist should select the complex based on the degree of development of the pathology and the general condition of the patient. Exercise must be combined with diet and other forms of treatment.

Features of breathing exercises

If a person has cardia insufficiency or esophageal disease, there is no need for intense physical training. Correct breathing is needed. The following actions will be useful:

1. Gymnastics must be performed in a comfortable position: sitting. Once the patient has decided, he should slowly take a deep breath and exhale. At the second stage, the internal organs of the abdominal cavity are involved in the process. The exercise should be repeated 4 times.
2. The next movement involves inhaling slowly (deeply). At the same time, you need to release the air quickly. This is done through the abdominal cavity. Number of repetitions - 10.
3. Take a deep, slow breath and hold the air inside for 5 seconds. While simultaneously tensing the abdominal muscles, a gradual exhalation is made. Air retention can be increased over time to 15 seconds.
4. The last exercise is also not difficult. The patient just needs to take a deep breath and then release the air, but in stages. You can even watch a video of exactly how this is done.

Too much oxygen, which comes from doing gymnastics, causes dizziness and even fainting. Therefore, you should be careful.

In addition to breathing exercises, this disorder requires performing aerobic exercises: brisk walking, jogging, cycling. If a person goes in for sports, then he needs to take into account that manipulations that involve a lot of strain are prohibited. abdominal muscles.

Cautions and Indications

To find out whether it is possible to play sports with GERD, it is better to contact a specialist who will conduct an examination and determine the degree of development of the pathology. It is also important to know whether cardia insufficiency has been diagnosed. Changing your lifestyle for GERD can help you recover.

People with this disease must perform exercises carefully, as there are certain contraindications:

1. You cannot do physical exercise if the inflammation associated with esophagitis is severe.
2. Gymnastics is performed on an empty stomach; you should not even drink water.
3. If there is cardia insufficiency, then a person should do gymnastics in a position that will allow him to completely relax and calm down.

If the cardiac sphincter is too weak, it must be strengthened, since it will not prevent the release of stomach contents back into the esophagus. Exercise should be performed to prevent GERD. At the same time, the difficulty level gradually increases. However, too intense training is contraindicated.

People who suffer from gastro-food reflux also do not refuse to exercise. But with such a disease, any training must have a special approach. Gastroesophageal reflux disease, as it is called “scientifically,” brings a lot of trouble to a person, and sports in this case can become a source of relief and bring a lot of benefits to the body. This is also proven by studies that were conducted back in 2004. Then it was noted that all the people who played sports experienced much less symptoms of GERD than all those patients who never became friends with sports. Relieves the symptoms of GERD and the ability to maintain a healthy weight, which is also possible with exercise. With weight gain, the symptoms of the disease noticeably increase and worsen.

It has even been noted that all overweight people suffer from the symptoms of this disease 2.5 times more than people with normal weight. Obese people are more likely to develop digestive tract cancer than people who are not overweight.

In any case, physical exercise has a beneficial effect on the body. They help improve its health in many aspects and reduce the symptoms of GERD. But there is still a risk of aggravating such symptoms, so you should be careful with sports. Although, this does not mean at all that you should put aside your sneakers and immediately put on slippers to sit on the sofa in inactivity. There are more benefits from sports than from inactivity. In this regard, there is no need to give up training at all. It is only important to study a few recommendations and then follow them carefully in order to keep the disease under control, improve your well-being and enjoy the results of sports training.

Rules of conduct for reflux

1. In order for the digestion process to proceed properly, it takes a little time. The weight of a filled stomach itself is a rather serious test for the sphincter. If you add to all this the concussions that occur during sports, it is clear that the symptoms can quickly worsen. Therefore, it is very important to control your food intake and exercise. It is advisable that at least two hours pass between them. Although, it all also depends on the person, as well as on the type of food. If you ate something very light for lunch, then it may take a little less time to digest. If the diet was heavier, then more time will be required before training.

2. Be very careful about what you eat. Food should be quickly digested and quickly absorbed. Fatty foods will take a long time to digest, just like protein foods. Before training, it is better to give preference to a diet rich in carbohydrates. It is also advisable to avoid foods that may cause heartburn. But, in any case, no matter what foods you choose, remember that it will take time to digest them.

3. Take a bottle of water with you, as it tends to raise your energy level. After all, it is water that will prevent dehydration of the body, which often becomes a consequence of too much intense workout. Moreover, water is a great assistant to digest food.

4. Don't pay too much attention intense load, which includes jogging or, for example, intense aerobics. These movements can only aggravate the condition, because during such training the contents of the stomach are actively shaken. It is best to choose more “even” sports that will not contribute to aggravation. Exercises such as yoga, walking, cycling or rollerblading are suitable. There are people for whom exacerbations begin when they take a “lying down” position. In this case, it is important to try to avoid such exercises.

Be prepared to consult a doctor

If none of the recommendations help, you need to consult a doctor. After a little research, the attending physician will tell you what must be done in order to relieve discomfort from physical activity. You may need to undergo an additional course of treatment.

GEBE has symptoms such as chest pain and heartburn. But they can occur not only with BBB, but also become a consequence of other diseases. This especially applies to chest pain, because this symptom may indicate some kind of heart disease. Therefore, if chest pain intensifies, doctors recommend not to ignore it, but to immediately seek advice from a clinic.

Each person has his own characteristics. And the body of each of us is individual. We experience diseases differently, feel symptoms, and everyone has their own level of sensations. Therefore, what is useful for one person can become a big and serious problem for another. And everyone is looking for their own path in sports on their own. This also applies to people who suffer from gastrointestinal reflux. Each of them must find their own preferences in sports. But this is not easy to do; you often have to use trial and error.

Typically, esophageal reflux, or gastroesophageal reflux, is detected late, when inflammation of the inner wall of the esophagus has already developed. This is due to the fact that before the inflammatory process appears, which can be seen during fibrogastroduodenoscopy, it is quite difficult to detect reflux. Available methods: X-ray diagnostics with contrast agents, chromendoscopy, histological examination are not accurate enough at the early stage of the disease. Of course, there are reliable diagnostic methods: many hours of measuring the acidity of gastric juice, measuring pressure, impendansometry of the esophagus - but not everyone has the opportunity to carry them out, and not every patient agrees to a many-hour study using a nasal probe.

Symptoms

The main symptoms of esophageal reflux:

Heartburn;
- belching of air or;
- burning sensation behind the sternum;
- feeling of discomfort in the upper abdomen.

When these symptoms appear on FGDS, areas of inflammation and ulcers can already be detected.

When these symptoms appear on FGDS, areas of inflammation, erosion and ulcers can already be detected.

Since the disease does not go away on its own, it is necessary. But often patients are afraid to take medications, because the esophagus and stomach are a sore subject for them. And they're trying to limit their chemical exposure. In this case, they are interested in treatment with exercise therapy, as well as traditional methods of treatment with wormwood, dandelion and celery. So can reflux be cured by exercise?

Exercises for Reflux

Reflux itself cannot be cured with exercise alone. This is because the causes of reflux are completely different. These include:

Anatomical features of the upper stomach;
- hiatal hernia;
- increased acidity of gastric juice;
- weakness of the lower esophageal sphincter;
- neuroses;
- stress;
- diet violations (fatty, spicy foods, foods that promote gas formation);
- gastroduodenal reflux, when bile and pepsin, which is produced by the pancreas, enter the stomach and then the esophagus;
- other diseases of the gastrointestinal tract.

It is impossible to eliminate these causes with exercises. Therefore, drug treatment is often aimed at treating the disease that provoked reflux. And if neuroses and stress are cured by conservative methods, then a hernia can only be cured surgically.

But this does not mean that exercise therapy is not needed. Physiotherapy helps strengthen the diaphragm, which has a beneficial effect on the lower esophageal sphincter and helps retain gastric contents in the stomach.

Since the exercises are designed to reduce the frequency of reflux, you need to do them correctly and make sure that the process does not cause heartburn, belching or noticeable discomfort.

Since the exercises are designed to reduce the frequency of reflux, you need to do them correctly and make sure that the process does not cause heartburn, belching or noticeable discomfort.

The main thing in exercises is correct breathing, it is this that helps strengthen the diaphragm. Therefore, you need to learn chest breathing, in which the diaphragm is actively involved. In the first couple of weeks breathing exercises performed lying down, for 5-7 minutes, as many approaches as possible. Then, isometric tension exercises are added to them.

The exercises should be selected by a specialist in physical therapy. But in no case should they occur with an increase in intra-abdominal pressure. Therefore, if you feel that during exercise therapy your abdominal muscles are very tense, then this exercise is not for you.

Exercise alone cannot cure reflux. But exercise therapy is a great help that will help strengthen the diaphragm and reduce the incidence of reflux.