The patient, a 46-year-old Caucasian female, presented in January 2025 with abdominal distension persisting for one year. Previous episodes of bloating and distension had resolved through dietary changes and surgery for endometriosis, but this episode had not responded to similar interventions.
She described a severely distended abdomen resembling full-term pregnancy, hypertonic muscle tone, and inability to contract her abdominal muscles. Additional symptoms suggested autonomic nervous system involvement, such as tingling in extremities, hypersensitivity in the abdomen, and transient symptom relief from parasympathetic activation.
Temporary relief occurred with positional changes, bladder emptying and cervical spine manipulation. Supine position flattened her abdomen, which returned to full distension upon standing or sitting. Urination or cervical manipulation would briefly relieve symptoms, supporting the theory of nervous system dysfunction. She experienced persistent burping and chest burning while lying down.
Previous Evaluation / Treatment
A GI specialist, after treatment for SIBO with antibiotics, dietary restrictions and fasting, concluded her condition wasn’t gastrointestinal. Imaging tests were unremarkable, but endoscopy revealed esophageal ulcers. The specialist suggested abdominophrenic dyssynergia (APD) and referred her out.
Pelvic imaging ruled out the return of previous ovarian endometriomas. Central neuromodulators such as Cymbalta and gabapentin provided near-instant, but short-lived, relief. When effective, these medications completely reversed the abdominal distension, restored muscle tone and re-enabled muscle contraction. However, effectiveness diminished rapidly and dosage increases became necessary. The patient eventually discontinued them.
She also underwent eye-movement desensitization and reprocessing (EMDR), which provided three symptom-free days following one session, again suggesting a neural origin.
Her medical history included abdominal liposuction, laparoscopies, appendectomy, and breast reduction. She linked the onset of symptoms to postural changes following breast reduction in July 2023. By January 2024, she had lost abdominal muscle tone and control.
Understanding Abdominophrenic Dyssynergia
The patient’s physician diagnosed APD, a disorder of gut-brain interaction involving abnormal diaphragm and abdominal wall coordination. Treatments including pelvic floor therapy, neuromodulators, diaphragmatic breathing, and psychological support were ineffective except for the brief response to medications. Despite her belief that postural changes contributed to symptoms, chiropractic care was initially not considered.
In an article in the American Journal of Gastroenterology (2023), “Abdominophrenic Dyssynergia: A Narrative Review,” Damianos JA, et al., describe this condition as “a somatic behavioral response associated with …. diaphragmatic contraction and abdominal wall relaxation. This manifests itself as “an abnormal somatic response [that] causes paradoxical movement of the chest and abdominal wall that results in abdominal distension [and] often triggered by the sensation of bloating.”
APD lacks standardized diagnostic criteria and treatment protocols, and its prevalence is unknown.
The authors of a narrative review in the American Journal of Gastroenterology (2022) by Damianos JA, et al., found references to neurological origins of this condition, stating that “there is dysregulation along the gut brain axis, which executes this abnormal response. Although the exact neurologic mechanism is not known, it has been hypothesized that APD develops as a maladaptive response to gastrointestinal pain or discomfort. Mechanosensors in the lumen of the gastrointestinal tract feed information about luminal contents and distension to the brain, which processes the information and in turn influences viscerosomatic physiology, such as by regulating neural and muscular activity and coordinating chest and abdominal wall musculature.”
The patient’s quality of life declined severely, leading to depression and isolation. Seeking answers, she traveled to a top hospital, where further testing ruled out motility disorders. GI specialists there recommended core strengthening, dietary changes, diaphragmatic breathing, and a GI psychologist. They did not support the APD diagnosis or neuromodulator use.
Throughout the year, she noted positional changes, and touching her neck or shoulders affected abdominal distension and tingling, further supporting a neurological link. Eating or drinking had no effect, but dysfunction increasingly impacted digestion and overall comfort. Convinced her spine was involved, she sought chiropractic care.
Chiropractic Care and Outcome
X-rays of her cervical and lumbosacral spine showed minimal degenerative changes. A cervical hypolordotic curve prompted corrective exercises, while lumbar degeneration at L5/S1 had uncertain relevance to APD.
Her chiropractic treatment aimed to correct vertebral subluxations and reduce neurological interference through myofascial release, spinal traction and spinal adjustments. Areas treated included T3-7, L5, S1, and C1-2. She was unable to tolerate Cox flexion-distraction therapy, which was discontinued.
After her first visit, she reported reduced abdominal distension for two days and less chest / abdominal sensitivity. Post-urination relief now lasted minutes instead of seconds. After the second visit, she experienced longer periods of a flat abdomen and partial return of abdominal muscle control.
After the third visit, the abdomen remained flatter for longer durations. Tingling and burping decreased, and she gained greater muscular control. That week, a neurologist suggested she might have central sensitization syndrome (CSS), a condition marked by heightened nervous system responses to normally non-painful stimuli.
Following the fourth treatment, the abdominal distension had not returned. She regained full abdominal muscle control, had minimal tingling, and reduced nighttime burping. She also began emotionally processing the past year of distress.
She began a home regimen of spinal stretches and strengthening exercises. Her abdomen has remained flat, with only occasional tingling and chest burning. Burping persists nightly, but is less severe.
Further studies should evaluate chiropractic spinal manipulation in treating APD. As of May 27, 2025, the patient reports complete resolution of symptoms except for nighttime burping; and is ecstatic to have returned to normal function.
