When you think of physical therapy, you may think of rehabbing your knee or elbow after an injury but did you know that there are physical therapists that can help with digestive dysfunction?

Many of my clients are surprised to hear that digestive issues like IBS, SIBO and GERD may have multiple causes or complications that may contribute of symptoms.  While changing your diet can help, we need to address physical dysfunction for maximum relief and lasting results.    

How Can Physical Therapy Help with GERD?

Acid reflux or GERD may be caused by a hiatal hernia, which is diagnosed by a gastroenterologist by an endoscopy.

• A hiatal hernia occurs when the stomach protrudes through an opening in the diaphragm pushing it into the chest cavity. 
• This can move the esophagus higher into the chest, which means it may not close properly.
• When this happens, stomach acid and/or acidic contents from the stomach can move into the esophagus where it does not belong. 
• Symptoms include acid reflux, chest pain, bloating, feeling that food is not digesting, and more. 
• So instead of treating acid reflux with an acid lowering medication, which doesn’t solve the problem, a physical therapist will use manual manipulation or massage techniques to help the stomach lower from the diaphragm and return to its normal position. 

How Can Physical Therapy Help with SIBO?

• If you have ever had abdominal surgery, you may have scar tissue that is in or pressing up against the small or large intestine.  These are called adhesions and can cause “kinks in hose” which can impede the forward motion of digesting food or stool.  Adhesions are a common root cause of SIBO. The adhesions can be loosened and smoothed out by a physical therapist to encourage proper digestive function.
• Another potential root cause of SIBO is a malfunctioning ileocecal valve.  This is the valve located between the small and large intestine.  Its job is to prevent the retrograde movement of stool (and bacteria) into the small intestine.  If it’s not working properly, it may need a “tune-up” via visceral manipulation by a physical therapist. 

How Can Physical Therapy Help with Constipation?

Have you been diagnosed with chronic constipation, IBS-C or SIBO-C?   Constipation can be caused by the adhesions created by abdominal surgery as noted above.  Constipation can also be caused “pelvic floor dyssynergia”.  This happens when the anal muscles constrict instead of relax during a bowel movement.   Evelyn Hecht, a physical therapist specializing in pelvic floor and GI issues at EMH Physical Therapy in New York City, explains that a variety of modalities can be used to help improve constipation including:

• Gentle manual therapies and release techniques to restricted muscles and fascia of pelvic areas
• Visceral mobilization techniques to help the abdominal organs move better and therefore function optimally
• Biofeedback to retrain the pelvic floor muscles so they relax and open fully during a bowel movement and not stay contracted
• Teach breathing techniques and other stretching exercises that stimulates the parasympathetic nervous system (this is the part of the nervous system responsible for the rest and digest functions of the body) 

She also shared a great massage technique you can perform at home to reduce bloat and stimulate bowel movements.

How to Do the “I Love You” ILU massage: 

Apply very light cream to your abdomen region first. With your fingertips, lightly stroke in a clockwise direction as shown starting from the lower right pelvis upwards then across to the left side, then down to the lower left pelvis. Add small circular motions. Repeat for 1-3 minutes or until you hear a “gurgling” of your stomach. 

How Can Physical Therapy Help with Abdominal Distension?

• You know those pictures people post on social media where they look 5 months pregnant after eating or towards the end of the day?   While we may call that bloating, medically it’s referred to as abdominal distension. 
• Doctors refer to bloating as a sensation in which you may register as fullness, heaviness or a general uncomfortable feeling in the lower abdomen.  It may be caused by overeating, by eating foods you don’t tolerate, by dysbiosis or by being constipated. 
• Distension on the other hand, refers to the physical expansion of the abdomen.  While abdominal distension may occur with IBS or SIBO, it may be caused by a condition called “abdomino-phrenic dyssynergia”. 
• In this situation, the bloating sensation sends the wrong signal to the brain.  As a result, the reflex that controls the diaphragm mistakenly sends a signal to press the stomach down when eating instead of the signal to move the diaphragm up to allow the stomach to expand when eating. 
• A physical therapist can use breathing techniques or biofeedback methods to alleviate this condition.

How do You Find a Qualified Physical Therapist?

If you live in New York City, I highly recommend Evelyn Hecht and her team of pelvic physical therapists at EMH Physical Therapy.

If you live outside of New York City, search for a physical therapist that specializes in pelvic floor disorders and/or your specific digestive condition or symptom.

As a nutritionist using the functional medicine approach, my job doesn’t just stop with recommending a diet and supplements.  I help my clients understand WHY they are struggling with digestive issues.  And in some cases of GERD, constipation or abdominal bloating and distension, the root causes may be physical and they may benefit from physical therapy.