Abdomino-phrenic Dyssynergia: A Holistic Approach:

Abdomino-phrenic Dyssynergia (APD) is a condition where the diaphragm and abdominal muscles don’t coordinate together as they should, leading to uncomfortable and often times unrelenting bloating. If you’d like to understand the mechanism of APD more indepth, visit our webpage (linked here). In many cases, APD responds well to physical therapy. Your therapist will teach you personalized exercises and techniques to help reset the abdominal and diaphragmatic functioning (and will also take a look at your back, pelvic floor, and even neck or hips!), but treatment often requires a multifaceted approach that includes more than just physical therapy exercises and manual treatment. Here, we will discuss some of the lifestyle changes you can make to start to reduce your bloating that you may not have considered before.

What you eat vs. How you eat: 

Many people with APD have tried elimination diets (like the low-FODMAP diet) with limited success. Identifying and avoiding triggering foods is highly important, and if you haven’t worked with a dietician/gastroenterologist to identify those, that is an important next step. However, while many people consider what they eat, fewer consider how they eat. The process of eating is the start of digestion, and it is important to set yourself up for success: 

• Chew your food thoroughly. Most people do not chew each bite enough, sending food to the stomach that is not mechanically broken down. This makes it difficult for the stomach to do its job, and can contribute to bloating. Chewing your food more will also cause you to eat more slowly, allowing for improved digestion and decreased gas.

• Mind your posture. Do you bring your fork all the way up to your mouth, or do you bring your mouth down to meet your fork? When we chew and swallow sitting upright, our esophagus is oriented vertically, and food can easily move to the stomach with the assistance of gravity. When we are hunched forward, the path to the stomach is less direct and can lead to ingesting air and slower swallowing.

Stress Management:

Did you know your stress levels can have a profound impact on your digestion? The nervous system has two main modes: "fight or flight" (sympathetic) and "rest and digest" (parasympathetic). If you’re constantly in a stress state (even at low levels) your body diverts resources away from digestion and muscular tension can develop or worsen. Our nervous system doesn’t know the difference between being chased by a lion or having a big work deadline, and if it thinks we are being chased by a lion it does not worry about digesting lunch. Reducing stress is important for many reasons (as I’m sure you’ve heard!), and digestion is a major one.

Here are some ways to reduce stress and support your gut health:

• Practice deep breathing or mindfulness exercises- there are endless breathing exercises out there, but the “best” one is the one that you can do regularly. Something as simple as breathing in for a count of 4 and out for a count of 8 is a great place to start. Doing this more frequently for short spurts is more effective than doing it less frequently for longer. 

• Incorporate relaxing activities like yoga, a nice walk, meditation, or spending time with friends. Whatever makes you happy and feel more at peace- try to do more of it! 

• Create a calming bedtime routine to wind down after a long day. This can help improve sleep quality, which can further decrease stress levels (see below!) 

Prioritize Sleep:

Sleep isn’t just for energy — it’s essential for digestion, too! When you’re sleep-deprived, stress hormones (like cortisol) can spike, keeping you in “fight or flight” mode and slowing your gut motility. High cortisol can also increase sugar cravings (and sugar intake increases cortisol- a self sustaining cycle) Aim for 7-9 hours of quality sleep each night to keep things running smoothly.

Exercise: 

As physical therapists, we could shout the benefits of exercise from the rooftops all day! Most people are familiar with how exercise can keep your heart, bones, and lungs healthy, but fewer are familiar with the benefits for our gut. In short, there are very few (if any) body systems that don’t benefit from regular exercise. Here are some ways that exercise can improve your gut functioning and decrease bloating:

• Stimulates digestion- Exercise increases blood flow throughout the body, including to the gastrointestinal tract. A short walk after meal times can really help move things along!

• Decreases stress- Exercise increases “happy” chemicals like endorphins, and decreases stress hormones like cortisol. 

• Improve Sleep- Research has shown that regular exercise improves our sleep quality. It’s all connected! 

• Postural Support- keeping your muscles strong and balanced can prevent one muscle group from overworking. If our back and abdominal muscles are not strong, our diaphragm might try to pick up the slack by tightening up to keep you upright. Regular strengthening exercises can help prevent this. 

Your Next Steps:

Making lifestyle changes can be difficult for many reasons. If this list seems overwhelming, try picking just one category to start to make changes in. Commit to those changes, and see how your body responds. You might notice that if you are able to commit to one small positive change, others will gradually follow. Trying to take on too much at once can lead to feeling overwhelmed, so focus on one step at a time. 

As you start to make these changes, your physical therapist can help discuss your progress and support your journey. Additionally, they will add in highly specific exercises and manual treatments to address the mechanical dysfunction of Abdomino- Phrenic Dyssnergia.