Dominic Stone
Muscle tension can be a cause of acid reflux, which is often overlooked. Trigger points in the psoas muscle can cause abdominal pain that mimics acid reflux but is unresponsive to acid suppression drugs. Acid reflux, or gastroesophageal reflux disease (GERD), occurs when the lower esophageal sphincter (LES) weakens or relaxes, allowing acid to pass back up the esophagus. GERD can cause throat tension, tightness, and pain, which can be treated with medication or lifestyle changes. Esophageal spasms, caused by abnormal muscle contractions in the esophagus, can also lead to difficulty swallowing and regurgitation.
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What You'll Learn
Muscle tension and trigger points
Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Trigger points can be caused by acute trauma or repetitive microtrauma, which leads to stress on muscle fibres and the formation of trigger points.
Some examples of activities that can cause microtrauma are holding a telephone receiver between the ear and shoulder; prolonged bending over a table; sitting in chairs with poor back support; and moving boxes using improper body mechanics. Acute sports injuries, surgical scars, and spinal surgery can also cause trigger points.
Trigger points are often overlooked, and in some studies, up to three-quarters of people attending pain clinics have muscular causes for their pain. Trigger points can cause a generalised 'irritable bowel' type abdominal pain syndrome.
The treatment for trigger points includes physiotherapy with a therapist trained in myofascial release work, hot water bottles, acupuncture or acupressure, and steroid injections.
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GERD and acid reflux
GERD, or gastroesophageal reflux disease, is a severe condition that develops as a result of chronic acid reflux. Acid reflux occurs when the lower esophageal sphincter (LES) weakens or relaxes, allowing stomach acid to rise into the oesophagus and, sometimes, the throat. The LES is a circular muscle that opens to allow food and drink to pass into the stomach and gas bubbles to escape during burping or hiccups. It then closes again to keep substances in the stomach.
Acid reflux can happen after a large, rich meal, or when lying down too soon after eating. While occasional acid reflux is manageable at home, chronic acid reflux can significantly impact one's quality of life and cause long-term damage to the oesophageal tissues. Acid reflux is considered chronic when it occurs at least twice a week for several weeks.
GERD can cause a variety of symptoms, including a burning sensation in the chest (heartburn), throat pain, tightness, and tension. It can also trigger asthma-like symptoms such as chronic coughing, wheezing, and shortness of breath. In babies and small children, GERD may manifest as excessive fussiness, difficulty sleeping, refusing to feed, small vomiting episodes, wheezing or hoarseness, and bad breath.
There are several factors that can contribute to the weakening or relaxation of the LES, leading to acid reflux and potentially GERD. These include:
- Pregnancy: The increased pressure and volume in the abdomen can push, stretch, and weaken the muscles supporting the LES. Pregnancy hormones, including relaxin, estrogen, and progesterone, can also relax the LES.
- Obesity: Similar to pregnancy, obesity increases pressure and volume in the abdomen, affecting the LES. It can also lead to higher estrogen levels due to the secretion of estrogen by fat tissue.
- Smoking: Tobacco smoke relaxes the LES, whether an individual smokes or is exposed to second-hand smoke.
- Certain medications: Specific drugs, such as benzodiazepines, calcium channel blockers, tricyclic antidepressants, NSAIDs (aspirin and ibuprofen), theophylline, and hormone therapy medications, can have a relaxing effect on the LES.
- Foods and drinks: While they may not be the sole cause, certain foods and beverages can contribute to acid reflux. These include chocolate, coffee, alcohol, mint, garlic, onions, and fatty foods. Fatty foods increase stomach acid production and take longer to digest, providing more opportunities for acid to escape.
- Connective tissue diseases: Conditions such as scleroderma can affect the oesophageal muscles.
- Prior surgery: Surgery in the chest or upper abdomen may have caused injury to the oesophagus.
Treatment options for GERD include medication, such as Baclofen, a muscle relaxant that can reduce the frequency of acid reflux, and procedures to tighten the LES, such as Nissen fundoplication, the most common surgery for GERD. Lifestyle changes, home remedies, and alternative treatments like acupuncture or acupressure may also help manage GERD symptoms.
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Muscle relaxants and medication
Muscle relaxants can be used to treat acid reflux, but they are not the first-line treatment. Baclofen, for example, is a muscle relaxant that can help to reduce the frequency of acid reflux by reducing the frequency of LES relaxation events. However, it is important to note that while medication can reduce the symptoms and effects of acid reflux, it does not stop it from occurring. In severe cases of acid reflux or GERD, a more definitive treatment may be required, such as a procedure to tighten the LES.
The decision to prescribe a muscle relaxant is typically made when over-the-counter (OTC) and non-drug therapies, such as physical therapy, stretching, or heat therapy, have proven ineffective in treating muscle spasms or stiffness. Muscle relaxers are prescription medications that help regulate muscle contraction to reduce pain and discomfort caused by muscle spasms and stiffness. They are generally safe and well-tolerated when used short-term and at the recommended doses. However, it is always advisable to discuss potential side effects and risks with a doctor before taking any medication.
In addition to muscle relaxants, certain medications can have a relaxing effect on the LES and contribute to acid reflux. These include benzodiazepines, calcium channel blockers, tricyclic antidepressants, NSAIDs like aspirin and ibuprofen, theophylline, and hormone therapy medications for menopause. Foods and drinks can also contribute to acid reflux, although they are usually not the sole cause. Chocolate, coffee, alcohol, mint, garlic, and onions may relax the LES in higher doses, while fatty foods increase stomach acid and prolong digestion, providing more opportunities for acid to escape.
It is important to note that muscle tension in the throat can also be a symptom of acid reflux or GERD, causing pain, tightness, and tension in the throat. Throat tension can also be caused by other factors, such as allergies, postnasal drip, thyroid conditions, or infections. Consulting a healthcare professional is always recommended to receive a comprehensive assessment and determine the appropriate treatment plan.
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Muscle spasms and esophageal contractions
Muscle tension in the throat can be caused by GERD (gastroesophageal reflux disease), also known as acid reflux. GERD can lead to throat tightness, pain, and tension. It is caused by chronic acid reflux, which occurs when the LES (lower esophageal sphincter) weakens or relaxes, allowing acid to pass into the esophagus. The LES is a circular muscle that opens to allow food and liquid to pass into the stomach and closes to keep substances in the stomach.
Several factors can cause the LES to weaken or relax, including pregnancy, obesity, smoking, certain medications, and specific foods and drinks. For example, pregnancy hormones and obesity can increase abdominal pressure and volume, pushing and stretching the muscles of the diaphragm that support the LES. Smoking and specific foods and drinks, such as chocolate, coffee, alcohol, and fatty foods, can also have a relaxing effect on the LES.
Esophageal spasms, or abnormal muscle contractions in the esophagus, can also contribute to acid reflux. These spasms can make it challenging for food and liquids to pass through the esophagus, leading to symptoms such as regurgitation, chest pain, and difficulty swallowing. Esophageal spasms can be caused by dehydration, strenuous exercise in hot environments, prolonged muscle use, and certain nervous system diseases.
Additionally, muscle trigger points, especially the psoas muscle, can cause heartburn symptoms that mimic acid reflux but do not respond to acid suppression drugs. Trigger points can result in abdominal pain and nausea. Treatment options for trigger points include physiotherapy, hot water bottles, acupuncture, and steroid injections.
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Lifestyle changes and home remedies
- Eating smaller meals: Eating large meals can expand your stomach and put pressure on your LES, a circular muscle that keeps stomach contents from coming back up. Eating smaller meals more frequently, or "grazing," can help reduce reflux.
- Losing weight: Increased weight can spread the muscular structure supporting the LES, decreasing the pressure that keeps it closed. Losing weight can help reduce this pressure and decrease reflux.
- Reducing alcohol and tobacco consumption: Alcohol and tobacco can relax the LES, allowing acid to pass through. Reducing alcohol and tobacco intake may help prevent this.
- Changing sleeping position: Lying down after a large meal can cause acid reflux. Adjusting your sleeping position or waiting some time after eating before lying down may help.
- Avoiding trigger foods: While foods and drinks alone are likely not enough to cause acid reflux, they can contribute to it. Chocolate, coffee, alcohol, mint, garlic, onions, and fatty foods may contribute to acid reflux. Avoiding these or consuming them in moderation may help reduce reflux.
- Stress reduction: Daily stress can affect the ring of muscle in your throat, causing it to become tense. Reducing stress through relaxation exercises, meditation, or psychotherapy may help alleviate throat tension and reduce reflux.
- Hot water bottles: Applying hot water bottles to affected areas can help relieve muscle tension associated with reflux.
- Acupuncture or acupressure: Some people respond well to acupuncture or acupressure for relieving muscle tension and reducing reflux symptoms.
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Frequently asked questions
Muscle tension can be a cause of reflux, but it is often overlooked. Trigger points in the psoas muscle can cause heartburn and abdominal pain.
Reflux, or gastroesophageal reflux disease (GERD), can cause heartburn, chest pain, regurgitation, and nausea.
Muscle tension can be caused by dehydration, strenuous exercise in hot environments, prolonged muscle use, and certain nervous system diseases.
Treatment options include physiotherapy with a therapist trained in myofascial release work, hot water bottles, acupuncture or acupressure, and steroid injections.
Other causes of reflux include obesity, smoking, pregnancy, certain medications, and foods like chocolate, coffee, alcohol, and fatty foods.
