Hypermobility: Achalasia and Hiatal Hernias

By Jennifer Richards, LMT 2026

When we talk about Ehlers-Danlos Syndrome, hypermobility, and connective tissue disorders, most people think of joints: knees, shoulders, hips, ankles, and spines that move too much.

But connective tissue is everywhere — including the digestive tract.

Newer research continues to show that people with hypermobile EDS and Hypermobility Spectrum Disorders have higher rates of gastrointestinal symptoms, including reflux, dysphagia, delayed gastric emptying, esophageal dysmotility, and structural findings such as hiatal hernia. One study of 218 people with hEDS found that 62.3% had at least one GI symptom at diagnosis, and among those tested for motility issues, esophageal dysmotility was found in some patients.   Another Mayo Clinic review found that in EDS patients who had endoscopy, common findings included gastritis, hiatal hernia, and reflux esophagitis.  

What is achalasia?

Achalasia is a rare swallowing disorder where the esophagus does not move food properly and the lower esophageal sphincter does not relax normally. Food and liquid can become stuck instead of passing easily into the stomach. Symptoms may include difficulty swallowing, regurgitation, chest pain, coughing at night, weight loss, vomiting, and even pneumonia from aspiration.  

This can be dangerous because swallowing problems can lead to dehydration, malnutrition, choking, aspiration pneumonia, and weight loss.  

What is a hiatal hernia?

A hiatal hernia happens when part of the stomach pushes upward through the diaphragm into the chest cavity. Small hiatal hernias may cause few symptoms, but others can contribute to reflux, chest pressure, difficulty swallowing, regurgitation, nausea, and discomfort after eating. Larger or paraesophageal hernias can become more serious if the stomach becomes trapped, twisted, or loses blood supply.  

Why does this matter in hypermobility?

In hypermobility populations, symptoms are often dismissed as “just reflux,” “anxiety,” or “stress.” But hEDS/HSD are multisystem conditions. The digestive tract depends on connective tissue support, nerve signaling, smooth muscle coordination, and autonomic regulation. The Ehlers-Danlos Society notes that connective tissue abnormalities in the digestive tract may affect how the gut moves, and dysautonomia such as POTS may also contribute to GI symptoms.  

For massage therapists, this matters.

Especially for therapists trained in abdominal massage, visceral work, lymphatic work, or deep abdominal techniques, we need to remember: not every abdominal complaint is muscular tension. Not every “tight diaphragm” is simply a soft tissue restriction. A client with hypermobility may also have reflux, hiatal hernia, esophageal dysmotility, gastroparesis, or other GI involvement.

This does not mean massage therapists diagnose these conditions. We do not.

But we can ask better questions.

Before abdominal work, consider asking:

“Do you have reflux, difficulty swallowing, hiatal hernia, nausea, bloating, gastroparesis, unexplained chest pressure, or food that feels stuck?”

“Have you ever been evaluated by a gastroenterologist?”

“Do your symptoms worsen after eating or lying down?”

“Do you ever cough or choke at night?”

If a client reports progressive difficulty swallowing, unexplained weight loss, vomiting undigested food, choking, aspiration, severe chest pain, black stools, or symptoms that are worsening, that is not a massage issue — that is a medical referral.

The bigger picture

Hypermobility is not just “being flexible.” It can affect joints, fascia, blood vessels, nerves, the autonomic nervous system, and the gastrointestinal tract. Massage therapists are often the most hands-on professionals a client sees. We may notice patterns before anyone else does.

Our role is not to diagnose.

Our role is to work safely, listen carefully, avoid aggressive techniques when risk factors are present, and refer out when symptoms suggest something beyond our scope.

For hypermobile clients, gentler, nervous-system-aware work is often the safer starting point — especially when the abdomen, diaphragm, ribs, and pelvis are involved.

Disclaimer

This post is for educational purposes only and is not medical advice. Massage therapists do not diagnose or treat achalasia, hiatal hernia, EDS, POTS, MCAS, gastrointestinal disease, or swallowing disorders. Clients with difficulty swallowing, unexplained weight loss, chest pain, vomiting, aspiration, severe reflux, or worsening GI symptoms should be referred to a qualified medical provider or gastroenterologist.