heel drops

 when there is a weakening in the lower esophageal sphincter, essentially the location where the esophagus courses through the diaphragm, which is called the esophageal hiatus, there is the possibility that a portion of the stomach herniates through the diaphragm taking up a position within the thorax. This is called a hiatal hernia. 

There are lots of suspicious causes to this condition. However, when we look at it from a visceral perspective we may think of it as a symptom resulting from increased pressure in the thoracic contents and a mechanical weakening in the hiatus of the diaphragm allowing for this migration of a portion of the stomach. 

Often, the portion of the stomach that migrates is the mucosal lining of the stomach, which would be the beginning of the herniation. As things progress larger-and-larger portions of the stomach will migrate above the diaphragm.

Believe-it-or-not about 40% of the population has a sliding hiatal hernia. About 60% of the population above 60 years old are walking around with some degree of a hiatal hernia.

Often, it is asymptomatic. However, it can present with heartburn and reflux as well as chest pain, which is worse with lying supine and especially worse after eating. 

There may also be a feeling of fullness in the chest or neck. Patients will also report a sensation of restricted breathing as well as a difficulty swallowing.

The only way to truly diagnose this condition is through a barium x-ray or endoscopy.

Conventionally, it is considered to be a mostly untreatable condition. Usually patients will be told to change their lifestyle but that "nothing really can be done for it outside of surgery". The surgery is not recommended for most people but as the herniation continues to progress surgery becomes more of an option. 

Now, that's from a conventional perspective. We know better! We have the perfect treatment for this don't we?  You guessed it...your hands.

However, we only get to treat the patient maybe once every 3 to 4 weeks and our sessions are only about 30 minutes long… If even that. Therefore, it is a good thing to provide the patient with some homework to do and that is where heel drops come in.  

They're very simple to do. Recommend that the patient drink about 8 ounces of lukewarm water on an empty stomach. Have the patient stand erect. They then will come up onto their toes and then dropped down suddenly onto their heels. This would be considered one heel drop. I typically recommend my patients do 15-20 heel drops once a day. 

It is surprising how effective this can be in combination with what we do with our hands.