We Treat Adhesions that Cause Pain and Dysfunction
Adhesions are the internal scars that form in all of us 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 dysfunction. Clear Passage Physical Therapy® is a world leader with over two decades of experience decreasing adhesions without surgery. Over the last 25 years, we have developed an effective method of dissolving and attaching adhesive bonds. Unlike surgery, our treatment does not appear to create new adhesions. Complete the online Request Consultation form to receive a free phone consultation with an expert therapist to learn if our therapy can help you.
Every one of us develops adhesions, or internal scars, throughout life. Adhesions can form anywhere in our bodies, as the first step in the healing process after an infection, inflammation, surgery or trauma.
Our muscles, bones, nerves, blood vessels and connective tissues are intimately involved structures within our body. Adhesions often join structures from different bodily systems with strong glue-like bonds that can last a lifetime.
As the body’s tissues heal and adhesions are formed, the tissues begin to shrink and pull, which results in restricted movement of the area. This ‘pull’ creates more mechanical irritation, often perpetuating the cycle of adhesion formation.
For example, a fall on the hip or tailbone can cause adhesions to form as the body’s first healing response to that trauma. And while you may only feel the pain at your hip or tailbone after the fall, the adhesions that formed to help you heal from the injury can bind nearby organs such as the bowel, bladder, fallopian tubes or ovaries.
Adhesions may be filmy or coarse, thick or thin. They may be small enough to join individual muscle cells, deep within a structure. Or they may grow so large that they stretch down the torso from neck to waist, bending a person forward so s/he literally cannot stand erect.
SurgerySurgery has been identified as a primary cause of adhesions. A study in Digestive Surgery showed that more than 90% of patients develop adhesions following open abdominal surgery and 55% to 100% of women develop adhesions following pelvic surgery.
As noted above, surgery to remove adhesions has itself been implicated as a major cause of adhesion formation. Surgeries that may cause adhesions or scars to form in and around organs include:
- bowel obstruction repair
- episiotomy or C-section
- laparoscopy or laparotomy
- back or hip surgery
- complete or partial removal of organs
- gastric bypass
- plastic surgery
Many people experience decreased function, increased tissue tension, or loss of range of motion after an injury, surgery or infection. Like scars that form on the skin, adhesions create “internal scars.” They may become painful and inhibit proper function by adhering tissues and organs that are designed to move freely. Mechanical problems can occur in the body due as a result of adhesions that form when the body tries to compensate after the original injury, surgery, or infection.
Inflammation and Infection
Inflammation and infections are frequent causes of tissue damage and adhesions form as the first step in healing. As the body starts the process of healing from inflammation, it can form blankets of collagenous crosslinks to contain the area that has become inflamed. Once the inflammation ends, the blanket of adhesions remains in the affected area.
Inflammatory and infectious processes known to cause adhesions include:
- perforated ulcer
- pelvic inflammatory disease (PID)
- cystitis or vaginitis
- perforated diverticulum, small or large bowel
Adhesion-causing traumas include falls, accidents and physical or sexual abuse. The trauma of radiation therapy can also cause massive adhesion formation at or near the sites of cancer treatment. In addition, inflammation following trauma or radiation therapy may cause adhesions to spread to neighboring organs and symptoms sometimes appear far from the site of the original trauma.
Tiny adhesions that form between muscle cells deep within the cervix may cause pain during sexual intercourse, when the partner hits the cervix. Regardless of whether they cause pain, these adhesions can cause cervical stenosis (closing) or fibrosis (tightness), decreasing fertility and the ease of sperm transport into the uterus.
The cervix is designed to be held in a midline position by four ligaments: to the pubic bones (in front), to the sacrum (in back), and to the pelvic walls (on each side). If any of these ligaments become adhered, the cervix is pulled by adhesions with each step a woman takes.
Clinically, we find that this constant pull can cause inflammation in the uterus. As we now know, the body’s response to inflammation is to send in adhesive crosslinks. In this case, adhesions form on the uterine wall, decreasing the chance for egg implantation and pregnancy.
We have helped many men, women and children overcome ongoing pain or dysfunction due to scars or adhesions. Our therapists use the Wurn Technique®, applying pressure and shearing to detach the crosslinks that adhesions are made of.
Our primary therapy focus is treating adhesions affecting the soft tissues of the entire body:
- the fascia, (the connective tissue that supports and separates all of the body structures, and is the body’s main shock absorber)
- the muscles (which help us move)
- the organs (which help us function)
- the nerves (which alert us to problems, through pain)
- the ligaments (which connect bone to bone)
- tendons (which connect muscles to bone)
Until recently, the only choice medical science offered to repair adhesive damage was a surgical procedure called “lysis of adhesions.” Whether performed by laparoscopy (non-invasive surgery) or open surgery, lysis involves cutting or burning the adhesions. While adhesion lysis can be very effective, it has two major drawbacks:
- surgeons must avoid areas where they might damage delicate underlying structures – something the surgeon cannot see until a patient is under anesthesia.
- despite the best skills of the finest surgeon, the body creates more adhesions to heal from the very surgery designed to remove them.
This second concern was highlighted in a large study of surgery patients. Lancet: The British Journal of Surgery, 1999 (Ellis)1 reported that 35% of all open abdominal or pelvic surgery patients were readmitted to the hospital more than twice to treat post-surgical adhesions during the 10 years after their original surgery. Many follow-up surgeries (22%) occurred in the first year after surgery, and “readmissions continued steadily throughout the 10-year period” of the study.
Like the patients in the study noted above, a number of our post-surgical patients have felt trapped in a cycle of surgery-adhesions-surgery – with no end in sight.
- Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O’Brien F, Buchan S, Crowe AM. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet Br J Med. 1999; 353: 1476-80. PMID 10232313.
- Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal Adhesions: Etiology, Pathophysiology, and Clinical Significance.Dig Surg. 2001; 18: 260-273. PMID 11528133.
By Belinda Wurn, PT, National Director of Services, Physical Therapist at Clear Passage Physical Therapy - Gainesville, Florida Area