We Treat Adhesions That Cause Pain and Dysfunction
Adhesions form to help the body heal from surgery, infection or trauma. After healing, adhesions may create strong glue-like bonds that last a lifetime.
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 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 decreasing adhesive bonds. Unlike surgery, our treatment does not appear to create new adhesions. Complete the online Request Consultation form
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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. (Liakakos et al., 2001)
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.
At a microscopic level, collagen cross-links (shown in purple) form to create adhesions wherever the body heals. When they attach structures that should be free and mobile, they cause pain or dysfunction. Our therapy focuses on decreasing adhesions by deforming or detaching the collagenous bonds, like pulling the run out of a sweater.
Adhesions may occur on the surface of our bodily structures, or deep within them. They can join any structure in the body to its neighbor, or to distant structures, causing confusing symptoms of pain or dysfunction. 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.
Surgery is a major cause of adhesion formation, when cross-links and adhesions form at and near the surgical site.
Surgery 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. (Liakakos et al., 2001)
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 healing occurs. 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 that may 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.
When adhesions totally block an organ (e.g. bowel or intestinal obstruction), they can become life-threatening. In areas where they impose on pain-sensitive structures, they can cause constant or recurring pain. They may also pull into structures distant from the original tissue trauma, causing distant dysfunction or referred pain – pain experienced in a part of the body other than the source of pain. We have found that adhesions are often the cause of the unexplained or complex pain patterns we see in many of our chronic pain patients.
Adhesions are a major cause of female infertility as they form glue-like bonds within delicate reproductive structures.
When adhesions occur around the uterus, ovaries, fallopian tubes or the delicate fimbriae at the end of the uterine tubes, pain or infertility may result. They may impose upon structures within the female reproductive organs, block a fallopian tube, cover an ovary or cause inflammation on the walls of the uterus. While all of these may decrease reproductive function, they may or may not cause pain. 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.
Click to enlarge. Peer reviewed medical studies show that adhesions form after 55% to 100% of abdominal and pelvic surgeries. (Liakakos et al., 2001)
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)
Learn more about the Wurn Technique® and what to expect during treatment.
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. A report in Lancet
noted 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. (Ellis et al., 1999)
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.
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By Belinda Wurn, PT, National Director of Services, Physical Therapist at Clear Passage Physical Therapy - Gainesville, Florida Area