A hiatal hernia occurs when the upper part of the stomach pushes through the opening (hiatus) in the diaphragm, the large muscle separating the chest and abdomen. When a portion of the stomach protrudes through this gap, it can lead to symptoms like heartburn and acid reflux. While regular physical activity is beneficial for overall health, a hiatal hernia requires careful modification of exercise routines to prevent worsening symptoms. Maintaining fitness is possible, but success depends on avoiding activities that place undue strain on the abdominal area.
General Safety Guidelines for Physical Activity
The most significant factor to manage during exercise is intra-abdominal pressure (IAP). Activities that cause a sharp increase in pressure within the abdomen can push the stomach further through the hiatus, potentially worsening symptoms. To counteract this, practice proper breathing techniques and specifically avoid the Valsalva maneuver, which involves forcibly exhaling against a closed airway and causes a spike in IAP.
Maintaining an upright posture throughout the workout uses gravity to help keep stomach contents down, reducing the likelihood of acid reflux. Hydration is also important, as drinking plenty of water helps dilute stomach acid and lessen irritation to the esophagus. Timing meals appropriately is recommended, with a suggested wait time of at least two hours after eating before beginning strenuous exercise.
High-Risk Movements and Exercises to Avoid
Movements that significantly increase intra-abdominal pressure or compress the abdomen should be avoided. Heavy weightlifting, particularly compound movements like deadlifts and squats, creates immense IAP to stabilize the core and spine. This pressure puts direct strain on the diaphragm and the herniated portion of the stomach. Exercises that require lying flat on the back, such as traditional crunches, sit-ups, and straight leg raises, directly compress the abdomen and can trigger symptoms.
Inverted positions, like headstands or certain yoga poses, are discouraged because they allow stomach acid to flow more easily back into the esophagus. High-impact activities involving jumping, skipping, or intense running cause jarring movements that stress the abdominal wall and diaphragm. Eliminate any exercise that causes straining, intense core flexion, or rapid, forceful movement of the body to prevent further irritation or displacement of the stomach.
Safe Low-Impact Activities and Movement Modifications
Focusing on low-impact activities allows for cardiovascular fitness without placing excessive strain on the abdominal area. Walking is one of the safest forms of exercise, promoting digestion while performed in an upright position. Cycling, either outdoors or on a stationary bike, and gentle swimming minimize pressure on the core. The buoyancy of water during swimming supports the body, reducing overall impact.
Resistance training can continue with modifications, such as utilizing lighter weights with higher repetitions. This strategy builds strength while reducing the IAP associated with maximal lifting efforts. When performing bench presses or overhead movements, using an incline bench helps maintain a more upright torso, reducing the risk of reflux compared to lying completely flat.
For core strengthening, exercises should focus on deep core activation without flexion. Examples include diaphragmatic breathing, pelvic tilts, and modified planks performed on the knees. These movements strengthen supportive muscles while avoiding the direct abdominal crunching that can aggravate the hernia.
Recognizing Warning Signs and When to Seek Medical Advice
During physical activity, monitor the body for signs that the exercise is exacerbating the hiatal hernia. Worsening symptoms of gastroesophageal reflux disease (GERD) are a key indicator. These symptoms can manifest as:
- Increased heartburn
- A sour taste in the mouth
- Regurgitation of food or acid after a workout
- Difficulty swallowing or a sensation of a lump in the throat (globus sensation)
Experiencing sharp or intense pain in the chest or upper abdomen, which may feel similar to cardiac pain, necessitates immediate attention. The development of a new or enlarging bulge, especially if it becomes painful or does not recede when changing position, requires urgent medical evaluation. Consult with a physician or physical therapist before starting a new exercise regimen to ensure the activities are safe and appropriate.