I’m wondering if you can help me with this small problem. I have two male clients who have very large stomachs. At first sight, you would think it would be very soft fat but its not. Their stomachs are blown out and very hard with hardly any fat on them at all. Both have had hernias: one is in his 30s and the other in his 60s. The older one has had tests done; his doctor said he has a blocked tube and the stomach is full of gas. If that is the case, why can’t they do anything about it? If nothing can be done from a doctor's point of view, how can I help these people with their problem? They are both similar in size: normal chest, arm size and small legs.
By mentioning that the doctor has already diagnosed one of your clients, the situation becomes awkward. We can never go against what a doctor has prescribed or recommended. With that stated, here are some thoughts on the situation. Have you read a previous Q&A involving runners who get stitches (click here)? In some ways, the gas situation is very similar. The stomach empties into the intestines. The intestines have to wrap around your organs, and in certain places, these curves are quite sharp. There is one curve in particular called the splenic curve where the intestines wrap around the spleen. The curve is quite considerable and can trap gas, which can cause pain commonly called a stitch. Your client is probably experiencing something of this nature. We must realize that the large bellies are truly fat.
Although they are hard, the consistency is mostly fat. The fat is compressing the organs and tissues from the inside, causing the abdominal muscles and fascia to stretch. This creates a rather hard exterior of stretched muscle and fascia. The first exercise or assessment you must do involves the respiratory system and how it is functioning. You should perform a respiratory assessment to see if they are “chest” breathers or “belly” breathers. They are probably chest breathers. This means that their transverse abdominus is stretched and is offering no support to the lower back or the rest of the structures. Power and strength must emanate from the core and move outward. You must activate their transverse abdominus before all else. Please refer to Paul Chek’s articles on the Inner Unit and Outer Unit. He gives great advice on some starting exercises to get your clients going.
It follows suit that they have had hernias because their musculature has been stretched and become so weak that normal movements are pulling on connective tissues and other structures to perform everyday tasks. The other advice I can give you is to research the Pilates Method (click here to feware articles on Pilates in the Lifestyle article category). There are a series of movements called the Stomach Massage Series. They involve the lower extremities and truly could “wring out” the abdominal area. Please note where you want to stand or DON’T want to stand when having your client perform these exercises.
It may comfort you to know that there are many clients of mine who come in with the same type of body structure, and these exercises are what we have used to help them very successfully. Remember to always assess the core and its ability to stabilize the spine before all other concerns.