For many people, a hiatal hernia is far more disruptive than the standard definition suggests. Although it’s often described as a “small stomach protrusion,” clients frequently report symptoms that go well beyond basic heartburn—things like chest pressure, shortness of breath, ribcage tightness, anxiety, and upper abdominal discomfort. These symptoms can become a constant companion if the mechanics of the diaphragm and ribcage aren’t functioning well.
At Pierce Family Wellness here in Centennial, Colorado, I work with clients every week who are living with these challenges. Many arrive feeling dismissed or confused because their symptoms don’t fit neatly into the typical GERD narrative. A hiatal hernia affects far more than digestion—it influences breathing, posture, stress levels, and the ability of the diaphragm to move freely. When we address the body as a connected system rather than a set of isolated symptoms, people often find relief they didn’t realize was possible.
This article integrates current research with what I see clinically to help you understand hiatal hernias from a whole-body perspective and introduce supportive, non-surgical approaches
What Is a Hiatal Hernia?
A hiatal hernia occurs when part of the stomach—or, in some cases, other abdominal organs—moves upward through the esophageal hiatus, an opening in the diaphragm. This shift changes pressure relationships between the chest and abdomen and can influence breathing and digestion.
There are two broad categories. The first is a sliding hiatal hernia (Type I), where the stomach and lower esophageal sphincter slide up into the chest. This is the type most strongly associated with GERD. The second category includes paraesophageal hernias (Types II–IV), where part of the stomach—or other organs—herniates next to the esophagus and may become trapped. These are less common but more serious, and often require surgical evaluation.
For a clear medical overview of the condition, the Cleveland Clinic offers a good summary:
https://my.clevelandclinic.org/health/diseases/8098-hiatal-hernia
Symptoms That Go Beyond Heartburn
Heartburn and reflux are the symptoms most commonly associated with hiatal hernias, but many clients experience a wider range of issues that don’t always get recognized.
Typical digestive symptoms include reflux, belching, bloating, regurgitation, and upper abdominal pressure. But equally important are the less obvious symptoms—shortness of breath, ribcage tightness, chest discomfort, difficulty taking a full breath, anxiety, upper back tension, and disturbed sleep. These issues often stem from restricted diaphragm motion, altered pressure mechanics, and irritation around the esophagogastric junction.
A hiatal hernia isn’t just a digestive problem; it’s a breathing and mechanical problem as well.
Why Hiatal Hernias and GERD Are Connected
The body uses a dual system to prevent stomach acid from moving upward: the lower esophageal sphincter and the diaphragm. These two structures work together, forming a combined anti-reflux barrier.
When the stomach shifts upward through the diaphragm, the angle, tension, and function of this two-part system weaken. This makes reflux more likely and more persistent. Stress compounds the issue. Anxiety and mood disturbances are shown to increase symptom perception, while ongoing reflux contributes to higher stress levels. For many clients, hiatal hernia symptoms increase during periods of emotional strain, poor sleep, or shallow breathing.
This is where breath mechanics, manual therapy, and nervous system regulation play an essential role.
Evidence-Based Conservative Approaches
Although some hiatal hernias do require medical or surgical treatment, research supports several non-surgical strategies that can help reduce symptoms and improve quality of life.
Manual Therapy
Studies on osteopathic and fascial techniques show improvements in GERD symptoms, esophagogastric tension, ribcage mobility, and overall comfort. These techniques do not “push organs back into place,” but they can improve the mobility of the diaphragm and surrounding tissues, which influences how the stomach behaves during breathing and movement.
Diaphragmatic Breathing
Research shows diaphragmatic breathing can reduce acid exposure, improve the strength of the diaphragm’s role in preventing reflux, reduce reliance on medication, and calm the nervous system. This is especially valuable for clients whose symptoms worsen during stress or shallow breathing patterns.
ELDOA and Spine Decompression Work
ELDOA positions that target the thoracic spine, upper lumbar spine, and ribcage fascia can help decompress the areas where the diaphragm attaches. These movements support more efficient ribcage expansion and improved breathing mechanics, which can reduce strain at the esophageal hiatus.
My Approach at Pierce Family Wellness
At Pierce Family Wellness, I use an integrative, movement-based approach tailored to each client’s presentation. A typical session often includes:
- Manual therapy to release the diaphragm, ribcage, and upper abdominal fascia
- Gentle cupping to improve tissue glide
- Ribcage mobilization and thoracic pumping techniques
- Downward visceral decompression work
- ELDOA positions to help decompress and realign the spine
- Myofascial stretching for the diaphragm and phrenic nerve pathways
- Breathing retraining to support both mechanical and nervous system regulation
Many clients report improvements in breathing capacity, reduced reflux, decreased chest or rib pressure, and better digestive comfort. The goal is always the same: restore mobility, reduce tension, and support the body’s natural mechanics.
If you’d like to learn more about our integrative approach, you can visit our website:
https://piercefamilywellness.com/
When Hiatal Hernias Need Medical Attention
Although conservative care can be effective, certain symptoms require medical evaluation right away. These include severe chest or abdominal pain, vomiting blood, black stools, sudden difficulty breathing, trouble swallowing that worsens quickly, or persistent vomiting. Large paraesophageal hernias (Types II–IV) may require surgical repair, especially if they compromise circulation or create obstruction.
What to Expect in a Session
A hiatal-herna-focused session at Pierce Family Wellness includes a detailed history, breathing assessment, ribcage and thoracic mobility evaluation, and hands-on work targeted at the diaphragm and surrounding structures. Clients are also given personalized ELDOA and breathing practices to use at home. The combination of mechanical restoration, nervous system regulation, and movement education often creates meaningful changes for people who haven’t found relief elsewhere.
Final Thoughts
A hiatal hernia affects more than digestion—it impacts breathing, posture, stress, and overall quality of life. But with a combination of manual therapy, proper breathing techniques, ELDOA, and medical guidance when needed, many people experience significant relief.
If you’re in the Centennial, Colorado area and looking for a natural, integrative way to manage hiatal hernia symptoms, I’d be honored to help you explore what’s possible.
