Which of the following is considered a potential trigger for an esophageal perforation?

Forced respiratory efforts are indeed recognized as a potential trigger for an esophageal perforation. When a person engages in forceful breathing, such as during a coughing fit, strenuous physical activity, or any form of forced respiration, significant pressure can be exerted on the esophagus. This sudden increase in intrathoracic pressure can lead to a rupture, especially if the esophagus is already compromised due to underlying conditions such as esophagitis, prolonged intubation, or structural weaknesses.

In contrast, heavy exercise may lead to strain but does not directly correlate with esophageal perforation. Relaxation techniques generally promote stability and are unlikely to cause such trauma to the esophagus. Similarly, deep tissue massage focuses on muscle and soft tissue and does not pose a risk of perforating the esophagus. Thus, forced respiratory efforts are the most direct connection to the risk of perforation in this context.