Gastroesophageal reflux disease(GERD) is a prevalent condition associated with many factors. Indeed, being overweight, having bad posture, congenital physiological derangements, and even indulging in specific foods can cause your stomach contents to come back into your esophagus. Nevertheless, a new factor contributes to this condition: the home office and the posture in which we perform computer-based jobs. Nowadays, several case reports discuss how chiropractic alignment and nutritional treatment can relieve the symptoms of this condition. 

Upper cross syndrome: the home office aftermath

Several new studies discuss the secondary effects of working from home after the shelter-at-home order. Although the stay-at-home order was primarily indicated to keep us safe from harm, it also caused several other conditions to rise.  

Over the past two years, the home office modality has been the standard for any desk position. However, working on a computer for 8-10 hours a day has been the culprit for many posture-induced complications. Indeed, the upper cross syndrome is a condition associated with poor posture.

The upper cross syndrome manifests as hyperkyphosis at the thoracic level and encompasses a forward-positioned head and curved shoulders. Even though this condition is often associated with neck pain and discomfort, it can exacerbate other conditions. 

Muscles, bones, and posture issues:

It is common to see a specific form in those patients suffering from UCS. Indeed, several reports are consistent with the finding of weak serratus and lower trapezius muscles. On the other hand, the pectoral area and those muscles found in the neck become tight to counteract the feeble strength of the regions mentioned above. 

Furthermore, this results in the curvature of the spine, neck, and upper back. Overall, the misfunction and tightening of the surrounding structure will constrict the inner organs affecting their purpose.

GER and upper cross syndrome

 As UCS tilts the patient’s head forward and curves the spine inward, the gastric system may get compromised. In fact, over the last couple of years, UCS has been widely associated with gastroesophageal reflux disease.

Gastroesophageal reflux disease:

Gastroesophageal reflux is a prevalent condition. Have you ever belch? Well, that is reflux. GER is the medical term to describe when part of the undigested stomach contents travels to the esophagus, bypassing the lower esophageal sphincter. 

Nevertheless, gastroesophageal reflux disease is diagnosed when these symptoms become troublesome and affect the histological properties of the esophageal lining. 

GERD symptoms:

  • Burning pain in the mid-sternal level.
  • Constant regurgitation of fluid or food.
  • Esophageal inflammation.
  • Coughing and bronchospasms.
  • Swallowing dysfunction.
  • Snoring.
  • Asthma and trouble breathing. 

Gastroesophageal barrier:

Comprised of the intrinsic tone of the lower esophageal sphincter (LES), external pressure, and the angle of His, the gastroesophageal barrier needs to be in perfect balance. Our inner organ structure is perfectly balanced, and the gastroesophageal barrier is no exemption. Nevertheless, several factors -other than posture- affect their purpose; even a food overload can distract the LES’s pressure and allow for contents to travel back to the esophageal region.

  • LES contraction depends on neural, hormonal, and paracrine factors. Indeed, excitatory neurons controlled by acetylcholine and substance will counteract the inhibitory responses coming from the intestinal peptide and nitric oxide. In conclusion, this mechanism allows the LES to open to allow food into the stomach and to contract to keep them in place.

Dietetic approaches to treating GERD

  1. Eliminate acidic, spicy foods and beverages as they may cause direct esophageal irritation.
  2. Quit carbonated beverages to decrease gastric distention.
  3. Avoid coffee, alcohol, and chocolate, which are associated with reduced LES tone.
  4. Reducing dietary fats and carbohydrates can improve LES tome and modulate gastric motility.
  5. Reduce gastric acid production by avoiding late-night meals and significant portions of food.

Case report:

In 2021, the Clinics and Practice journal published a case report of a 35- year old woman working in graphic design on a home office modality. She reported severe neck pain as well as heartburn and acid reflux. Furthermore, an endoscopy revealed mild inflammation in the distal esophagus, which confirmed the GERD diagnosis. On the other hand, she was also referred to chiropractic care who assessed the patient, found consistent symptoms and signs of thoracic hyperkyphosis, and diagnosed the patient with upper cross syndrome. 

Furthermore, the patient was prescribed histamine two receptor blockers, dietary restriction, and antiacids to treat her GERD. In addition, the chiropractor treated the patient with cervical adjustments and soft tissue massage three times a week.

The combination of these therapeutic techniques allowed the patient to recover in one month. Nevertheless, the posture issue was corrected with exercises to strengthen her muscles and lifestyle modifications, such as tuck chin exercises to correct her head posture. 

The Functional Medicine approach

As a Functional Medicine nutritionist, I heavily rely on lifestyle modification and food as my primary treatment. Indeed, eliminating and substituting dairy and acidic foods is my go-to. Furthermore, there is so much our vagus nerve, posture, and mindful eating can do for us. 

Regarding supplements, peppermint oil, licorice root, herbal bitters, a good quality probiotic, and digestive enzymes can go a long way by promoting gastric emptying and food digestion. Oh! and don’t forget to visit your local chiropractor! – Ana Paola Rodríguez Arciniega, MS

Bibliography

Chu, E. C., & Butler, K. R. (2021). Resolution of Gastroesophageal Reflux Disease Following Correction for Upper Cross Syndrome-A Case Study and Brief Review. Clinics and practice11(2), 322–326. https://doi.org/10.3390/clinpract11020045

Newberry, C., & Lynch, K. (2019). The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn. Journal of thoracic disease11(Suppl 12), S1594–S1601. https://doi.org/10.21037/jtd.2019.06.42

Disclaimers

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The information herein on "Upper cross syndrome and Gastroesophageal reflux: A healthy back is a healthy gut" is not intended to replace a one-on-one relationship with a qualified health care professional, or licensed physician, and is not medical advice. We encourage you to make your own healthcare decisions based on your research and partnership with a qualified healthcare professional.

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Dr. Alex Jimenez DC, MSACP, CIFM*, IFMCP*, ATN*, CCST
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