Adhesions are bands of internal scar tissue that form as we heal from an infection, inflammation, surgery or trauma. Adhesions can cause a number of conditions, including chronic pain, female infertility, bowel obstruction and pelvic problems.
Treating adhesions is at the core of our therapists’ work. To help you better understand how adhesions function, we invite you to listen to our audio visualization “Voyage Through the Body: Adhesions Explained.”
Use the transcript below to follow along as you listen to the visualization.
Hi, I am Larry Wurn, clinical research director at Clear Passage Physical Therapy and one of the founders. As we start your treatment, I’d like to take you through a visual trip through your body.
I think one of the reasons we are so successful here so often is that we really think of you as an expert in your body. You have lived through and endured all the experiences, traumas, falls and surgeries. All the physical and mental experiences of your life are really very well-known to you — more than any of your providers will ever know, more than your spouse or partner will ever know. We’d like to use your knowledge of your life experiences and your feelings about what is going on inside of your body to understand what you’re feeling when we’re treating you. Similarly, we’d like you to understand what we are doing and what we are feeling when we treat you so that you and your therapist can be on the same page. This provides you with a theoretical framework and understanding of the structure that we are treating.
There is no smoke and mirrors about what we do. It’s just a mechanical process that breaks down adhesions. So I want you to understand that, and I want you to be able to converse intelligently and appropriately with your therapist so that you both of you can act closely together as a team.
A couple of practical points before we start…Let us know what you are feeling and thinking. This work can get your attention sometimes. We’d like to know what you’re feeling. If you can give us feedback on a scale of 0 to 10 –“You know, when you’re treating me there — I’m at about a 5 or 4. Or, “you’re getting up to about an 8. Can you lighten up?” “Okay, you’re back at a 4 again. That feels pretty good.” That way, we know and understand more specifically what you are feeling inside your body. Your therapist has excellent hands. She has a vast amount of experience, but if you ever find yourself thinking “You know, that’s almost the place but if you were an inch to the right or on the other side…” — please tell us that.
Similarly, if we are treating somewhere and you feel it somewhere else in your body, please tell us. If the therapist is treating a certain spot and it reminds you of when you slid into second base at 12 years old and pulled that area — let us know. It may seem silly to you, but it often gives us valuable information and insights.
One thing I have learned after 25 years of doing this is that people have good insights and knowledge of their bodies. What you feel about your body and your intuition about what’s going on is so often “right on.” So, we want to hear from you.
What is fascia?
Okay, with no further ado, I’d like to suggest you start by closing your eyes and visualizing a muscle floating in space in front of you shaped like a sweet potato. It’s fatter in the middle and narrow at both ends. This muscle is surrounded by a ‘sweater’ of fascia — tiny strands of collagen, like the threads of a nylon rope, that envelop the muscle like a sweater and become attachments to the ligaments or tendons at either end of the muscle.
Inside your muscle are thousands of cells. Each cell is running pretty much the full length of the muscle. The fascia that surrounds the muscle and all its cells in the muscle is like the white of an orange, so it surrounds and separates all the pieces of the orange all the way down to the pulp, all the way down to the cellular level. In fact if you took all the cells away and left only the fascia, you’d have a three-dimensional sweater that exactly defines the shape and the structure of your muscle.Each cell is also a little fatter in the middle than it is at either end and is surrounded by a sock or sweater of fascia. These tiny strands of collagen are like the threads of a nylon rope, with a tinsel strength of 2,000 pounds a square inch.
Now I’d like to change the scene for a moment and have you imagine yourself standing in front of you. I give you a pair of magic three-dimensional glasses; when you put them on, you become the observer and you see yourself standing there. You can see three dimensionally right through yourself. You can see all of the muscles in your body, including all the organs as you imagine them, all the blood vessels and all the nerves — all the soft tissues of your body. All of those structures are totally surrounded and infused with fascia. The muscles that make up 80 percent of your body mass are all surrounded and infused just like the muscle I described, layer upon layer of tiny strands of collagen.
At the tube-like structures of your body, such as the arteries and veins or a woman’s fallopian tubes, fascia is built similarly to the Chinese finger handcuffs or finger traps we would play with as kids. You’d stick your fingers in these little woven cylinders and they’d get stuck. There is a weave of fascia on the outer wall of each blood vessel or fallopian tube. The strands of fascia separate every cell from the cell next to it. Another weave of fascia is found on the inside wall of the fallopian tube or the artery or vein, separating every cell in the wall of that vessel from others. That fallopian tube is open so that sperm and egg can flow through for fallopian tubes, or so that blood can flow freely in the case of the arteries and veins. We will cover about what happens when these structures become compromised and how we correct any blockage that occurs there later on.
The fascia in hollow structures of your body like the esophagus, stomach and intestines, functions a lot like the fallopian tubes or arteries and veins. It is found, for example, on the outer wall of your intestines. The strands of fascia separates each cell from its neighboring cells, and another weave of fascia surrounds and separates the cells in your intestinal wall, all the way from the top of your intestines all the way down to the bottom.
In the solid organs of your body–your liver, your kidneys and your brain–the fascia is a lot like it is in the muscles. For example, there is fascia surrounding your liver and diving down, layer by layer, cell by cell, separating each cell from the cell next to it, all the way down to what we might call the center of your liver. There is a very strong sheath of fascia that starts at your tailbone, attaches to your sacrum, and then comes up and surrounds your spinal cord, which is that central ‘tree trunk’ of all the nerves of your body as it enters the tunnel of your low back, traveling up through the, inside the vertebrae, through your lower back and up between your shoulder blades. That fascia surrounds this spinal cord, like bark surrounds a tree, all the way up from tailbone and sacrum, and attaches at the top of your neck and the base of your skull. Part of it attaches there, while the rest goes through a hole in the base of your skull about the size of a silver dollar to enter your head, sweeps around the inside of your cranium all the way up to the top of your head, where a sheath of this fascia drops down, and the plane of it divides the left brain from the right. Another plane or sheath of fascia creates the floor of your brain at your eyes and your ears.
And then this fascia, which started at your tailbone and came up to your sacrum to surround your spinal cord like the bark on a tree all the way up to the base of your skull, surrounds your brain. Now it spreads out like a tree to surround and separate literally every cell in your head and brain from every other one.
A very strong surrounding fascia is also found around your pituitary and hypothalamus gland, which is the master gland of the body the master gland of female reproduction. If you have a fall or a surgery that pushes your tailbone, it can actually literally pull down on the entire spinal cord and pull the base of your skull onto the top of your neck. These restrictions, we believe, impose and squeeze structures in the brain. We say this because we have done clinical trials after we saw some unusual positive, effects of treating this structure and measuring hormone levels before and after treatment. These were actually some of our best numbers — in the 90+ percentiles for improving hormone levels. So, there is a direct connection there. Similarly, headaches at the base of the skull also seem to be relieved by treating from the tailbone all the way up.
Fascia surrounds and separates literally every cell in your body. If you go back to the initial visual of standing there in front of yourself, three dimensionally, you can see all of your muscles, organs, nerves and blood vessels. You now know that these structures are all surrounded and infused with fascia. Now I’d like to invite you to take all those structures away and leave only the fascia, and what you’re left with is a three-dimensional sweater that exactly defines the shape and the structure of your body from the top of your head to the bottom of your feet, from the outside of your skin to the very center of you at your spinal cord, layer upon layer of tiny strands of collagen, little strands with a strength 2,000 pounds per square inch that give you your shape and your structure.
Part of the fascia I haven’t told you about is a gel‑like substance that lubricates it so that when you’re walking and you’re moving, these fascia layers glide easily over each other. So if you are taking a walk and are swinging your arms, your heart doesn’t stick to your lungs. Your lungs don’t stick to your ribs. It makes you this magnificent structure because you’re incredibly strong from these 2,000-pounds-a-square inch guy wires, but really lithe and supple and moving easily because of the gel that was lubricating it all. This is how we are when we are born. This is how we are as we start to grow up–and then life happens.
What are adhesions?
I’d like you to think back to when you were about five years old. You are playing in the yard with some friends, having a good time running and carrying on, and maybe you are playing tag. You start running from some people and you hear somebody call you, so you look back over your right shoulder to see who is calling you, and you don’t see a stick in the yard and fall over it and you land on your left hip, giving it a pretty good whack when you land. The first thing that happens when you get a trauma, surgery, infection or inflammation is that hundreds of strands of collagen, made of the same stuff that fascia is made of, come rushing into the area, surround the area that’s been injured to help contain any bleeding that might have started and prevent any bacteria from going into other parts of your body. These little strands of collagen they lay down and attach to the fascia that’s already there; they lay down in a random pattern and sort of pull it together. Next, your white blood cells and your immune system go to work to continue the healing process. During the next few weeks, the injured area may turn interesting colors — black and blue, yellow and purple.
A few weeks after you fell you start to feel pretty good. A couple of months after you fell, you do not really notice it anymore. The skin color has returned back to its normal color and you have pretty much healed. You’ve got your perfect three-dimensional sweater back, perfect except in this one little area on your left hip. Now, some of the fascias that used to glide easily over each other are no longer gliding because of these strands that rush in, with a strength of 2,000 pounds a square inch. These strands that first came in to help you heal, the first step in the healing process, are with you for life if they don’t dissipate in seven to ten days.
As you might imagine, we all develop these things throughout our bodies during life. We never even notice them in most places they develop and never even know that they are there. But when they glue down structures and cause pain or interrupt the normal function of our organs or our bodily processes by gluing down structures, they act like 2,000-pounds-per-square-inch straightjackets in those areas — and then they really get our attention.
When we go to the doctor and ask what’s wrong, the doctor will do a CAT scan or an MRI or X‑ray, but these internal scars don’t show up on any of those tests because they are collagen. So you may be told that there is nothing there, or that “It is all in your head” or “I’m going to have to send you to a different specialist because I don’t see anything I can help with” or you may be told that the doctor can do a surgery and look further. The problem with surgery is that no matter how skilled the surgeon, you have to heal from the surgery.
Most of what we do at Clear Passage is designed to break apart the adhesions that have formed; it does not seem to matter if they formed a year ago or when you were a year old. Our approach is a mechanical process; there is no smoke and mirrors. It is simply the biomechanics of detaching the cross-links that make up adhesions, like pulling apart the strands of a nylon rope in slow motion, layer upon layer. It’s almost like going back in time for those parts of your body that we treat. We know those strands have a strength of 2,000 pounds a square inch. We believe that we are detaching them from the structure that they are attached to; when we do, the strand that remains simply becomes part of the existing collagen that covers that cell or that structure. But now it’s no longer glued to the next one and the next one and the next one. Instead of having curtains or blankets or ropes of adhered tissues, we now have separated collagen strands that are just covering structures the way the collagen naturally covers everything in the body. This process resembles pulling out the run in a three-dimensional sweater. Each time we treat you, it is like peeling another layer off an onion as we go deeper and deeper and further and further.
That is why we ask you to let us know if you feel it pulling somewhere else when we are treating a particular area. This lets us know where the run in your ‘sweater’ is. What we are always seeking to find, and the adventure we invite you to join us on, is to find the runs in your sweater. What areas do we need to free up to give you back pain-free body and your function?
This is why we invite your input. We are certainly capable of treating you without any input at all, but if you do feel something pulling somewhere, please let us know. Similarly, tell us if something during treatment reminds you of a time earlier in life – “That reminds me of when I was 12 years old and I slid into second base…” Even though it may seem silly, we will look into it. We have found, over 25 years of developing our therapy, that patients’ intuition and their inner feelings about what is going on with their bodies is so valuable and generally right on. We would like to tap into your intuition and feelings, inviting you to be a member of the team.