Dr. David Kulla, DC provides individualized conservative care for patients with hiatal hernia, acid reflux, GERD, and related musculoskeletal or mechanical findings at Synergy Wellness Chiropractic & Physical Therapy in New York City.
With more than 26 years of clinical experience, Dr. Kulla has developed a special clinical interest in the relationship between the diaphragm, thoracic posture, breathing mechanics, abdominal-wall tension, and symptoms that may coexist with hiatal hernia and reflux.
Our Manhattan office is located at 237 First Avenue near East 14th Street, convenient to Union Square, the East Village, and Gramercy.
Important: Hiatal hernia and GERD are gastrointestinal conditions. Chiropractic and manual therapy should complement, not replace, appropriate evaluation and treatment by a primary-care physician, gastroenterologist, or surgeon when indicated.
What Is a Hiatal Hernia?
A hiatal hernia occurs when part of the stomach moves upward through the esophageal opening, or hiatus, in the diaphragm and into the chest cavity.
The diaphragm is the large muscle separating the chest from the abdominal cavity. The esophagus passes through an opening in the diaphragm before connecting with the stomach at the gastroesophageal junction.
The lower esophageal sphincter, together with the surrounding diaphragm, helps limit the backward movement of stomach contents into the esophagus.
Sliding vs. Paraesophageal Hiatal Hernia
There are several types of hiatal hernia.
Sliding hiatal hernia is the most common type. The gastroesophageal junction and upper portion of the stomach slide upward through the diaphragm and may move in and out of the chest.
Paraesophageal hiatal hernia occurs when part of the stomach moves alongside the esophagus while part or all of the gastroesophageal junction may remain closer to its normal position.
Larger paraesophageal hernias deserve medical evaluation because they may cause mechanical complications and may require surgical treatment.
Hiatal Hernia vs. GERD
A hiatal hernia and gastroesophageal reflux disease, or GERD, are related conditions but they are not the same thing.
GERD occurs when stomach contents repeatedly reflux into the esophagus and cause troublesome symptoms or complications.
A hiatal hernia can increase the likelihood of reflux because movement of the gastroesophageal junction above the diaphragm can interfere with the normal anti-reflux barrier.
However, many people with hiatal hernia have no reflux symptoms, and many people with GERD do not have a significant hiatal hernia.
Common Symptoms of Hiatal Hernia and GERD
Small hiatal hernias often produce no symptoms. When symptoms do occur, many are related to reflux.
Symptoms may include:
- Heartburn
- Acid reflux or regurgitation
- Upper abdominal discomfort
- Chest discomfort
- Belching
- Feeling full quickly after eating
- Difficulty swallowing
- A sensation of food or liquid coming back toward the throat
- Chronic cough or throat irritation in some patients
- Hoarseness or frequent throat clearing
Chest pain should never automatically be assumed to come from reflux or a hiatal hernia. New or unexplained chest pain requires appropriate medical evaluation.
What Is LPR?
Laryngopharyngeal reflux, commonly called LPR, describes reflux-associated symptoms involving the throat or voice box.
Possible symptoms may include chronic throat clearing, hoarseness, cough, sore throat, or a sensation of a lump in the throat.
These symptoms are not specific to reflux and may have many other causes. Persistent throat or swallowing symptoms may require evaluation by an ENT physician, gastroenterologist, or other appropriate specialist.
What Causes a Hiatal Hernia?
There is not always one identifiable cause. Factors associated with hiatal hernia may include:
- Age-related changes in the diaphragm and surrounding tissues
- Increased abdominal pressure
- Obesity
- Pregnancy
- Repeated coughing or straining
- Heavy lifting
- Trauma or previous surgery in the area
- Anatomical differences present from birth
Posture, breathing mechanics, and muscular tension may influence how some patients feel and move, but poor posture alone should not be presented as a proven cause of hiatal hernia.
How Is a Hiatal Hernia Diagnosed?
A hiatal hernia cannot be reliably diagnosed by pressing on the abdomen, observing breathing patterns, or performing a manual examination alone.
Medical tests used to evaluate hiatal hernia, GERD, or related symptoms may include:
- Upper endoscopy to examine the esophagus and stomach
- Upper GI or barium imaging to visualize the esophagus, stomach, and position of the hernia
- Esophageal pH monitoring to measure acid reflux
- Esophageal manometry to evaluate swallowing and esophageal muscle function
The appropriate test depends on the patient’s symptoms and clinical history.
Medical Treatment for GERD and Hiatal Hernia
Medical treatment depends on the severity of symptoms, size and type of hernia, presence of complications, and whether reflux is present.
For reflux symptoms, treatment may include:
- Individualized dietary changes
- Avoiding meals shortly before lying down
- Weight reduction when medically appropriate
- Elevating the head of the bed for nighttime reflux
- Antacids for occasional mild symptoms
- H2-receptor blockers
- Proton pump inhibitors, or PPIs
Acid-reducing medications can be appropriate and effective for many patients. Medication decisions, including concerns about long-term use, should be discussed with the prescribing healthcare professional rather than discontinued solely because a hiatal hernia is present.
Manual Therapy and Hiatal Hernia
Dr. Kulla has a particular clinical interest in gentle manual approaches involving the diaphragm, abdominal wall, thoracic region, and surrounding soft tissues in selected patients with medically evaluated hiatal hernia or reflux symptoms.
The aim of this type of conservative treatment is to address musculoskeletal and mechanical findings such as restricted diaphragm movement, thoracic stiffness, breathing mechanics, muscular tension, and postural limitations when those findings are present.
Manual treatment should not be described as permanently repairing the diaphragmatic opening, curing GERD, or eliminating a structural hiatal hernia.
Early clinical research has examined osteopathic and visceral manual techniques in patients with GERD and has reported short-term improvements in symptoms in some studies. However, this remains an emerging area of research, and larger, higher-quality studies are needed.
Dr. Kulla’s Hiatal Hernia Approach
Dr. David Kulla, DC evaluates the musculoskeletal components that may coexist with a patient’s medically diagnosed gastrointestinal condition.
Depending on examination findings, conservative care may include:
- Gentle manual treatment of the diaphragm and surrounding soft tissues
- Thoracic-spine mobility work
- Postural rehabilitation
- Breathing-mechanics training
- Abdominal-wall and trunk mobility
- Appropriate therapeutic exercise
- Coordination with gastroenterology or other medical care
The treatment plan is individualized and should be used alongside appropriate medical management rather than as a substitute for it.
Diaphragmatic Breathing and Reflux
The diaphragm contributes to breathing and also forms part of the anti-reflux barrier surrounding the lower esophagus.
Diaphragmatic breathing exercises may be incorporated for selected patients to improve breathing mechanics and diaphragm function. Emerging research suggests that breathing-based interventions may improve reflux symptoms in some patients, but they should not be viewed as a replacement for appropriate medical treatment.
What About the Vagus Nerve?
The vagus nerve provides important parasympathetic nerve supply to the esophagus, stomach, and other digestive organs.
Because the vagus nerves travel alongside the esophagus through the diaphragm, they are anatomically close to the gastroesophageal junction. However, symptoms such as palpitations, anxiety, abnormal heart rhythm, or changes in stomach-acid production should not automatically be attributed to a hiatal hernia “compressing the vagus nerve.”
Palpitations, chest discomfort, fainting, shortness of breath, or other cardiovascular symptoms require appropriate medical evaluation.
Hiatal Hernia and Acid Reflux Videos
These videos from Dr. David Kulla and Synergy Wellness discuss hiatal hernia anatomy, reflux symptoms, breathing mechanics, and conservative approaches.
Can Hiatal Hernia Require Surgery?
Yes. Most small hiatal hernias do not require surgery, but surgical repair can be appropriate for selected patients.
Surgical consultation may be considered when:
- A large or paraesophageal hernia is present
- Symptoms remain significant despite appropriate medical treatment
- There is significant esophageal inflammation or narrowing
- The stomach is at risk of becoming trapped or twisted
- Bleeding or other complications develop
- The patient’s gastroenterologist or surgeon believes repair is appropriate
Modern hiatal hernia surgery is often performed laparoscopically and may include returning the stomach below the diaphragm, repairing the enlarged hiatus, and performing an anti-reflux procedure when appropriate.
Conservative manual care should not be used to discourage medically indicated surgery.
When Hiatal Hernia or Reflux Symptoms Need Medical Evaluation
Seek prompt medical evaluation for:
- New or unexplained chest pain
- Progressive difficulty swallowing
- Pain with swallowing
- Persistent vomiting
- Vomiting blood
- Black or tarry stools
- Unexplained weight loss
- Severe or persistent upper abdominal pain
- Shortness of breath
- Symptoms that continue despite appropriate treatment
Research on Manual Therapy and GERD
Research into manual and osteopathic approaches for GERD is still developing. Small randomized trials have reported improvements in reflux-related symptoms or quality-of-life measures after osteopathic treatment, but these studies do not establish that manual therapy permanently corrects a hiatal hernia.
- Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial
- Osteopathic Treatment in Addition to Standard Care in Patients with GERD: A Randomized Controlled Trial
Schedule a Hiatal Hernia & Reflux Evaluation in New York City
If you have already been evaluated for hiatal hernia, GERD, acid reflux, or related symptoms and would like to discuss whether conservative musculoskeletal care may complement your existing treatment, Dr. David Kulla, DC can evaluate your breathing mechanics, diaphragm region, thoracic mobility, posture, and other relevant musculoskeletal findings.
Synergy Wellness Chiropractic & Physical Therapy
237 First Avenue, 5th Floor
New York, NY 10003
Near East 14th Street in Manhattan
Call (212) 533-4900 or book an appointment online.