Chronic abdominal pain is common in patients who have had c-sections, appendix removal, hernia repairs, reproductive surgeries and various other surgeries to the abdomen. The pain comes in various forms: constant, related to eating meals, related to exercising, lying down or sitting for a long time. Often this pain is caused by abdominal adhesions, which are bands of internal scar tissue which have formed at the site of past surgeries. However, addressing these adhesions is commonly overlooked by health care practitioners. Physical therapy is not commonly thought of as a starting point when looking to address abdominal adhesions.
Adhesions are defined as abnormal bands of tissue fibers that form between two body structures. These deep internal scars affect soft tissue through all layers of skin, much deeper than the scarring just on the outside of the skin we can see. They adhere to deep structures and can significantly affect the way we move and feel. Imagine a seam being sewn through all layers of bed linens, resulting in the inability of the various layers of bed sheets to slide over each other. In the human body, internal scarring draws together layers of body tissue which need to slide past each other for normal movement. Abdominal adhesions perpetuate poor posture, restrict joint mobility of the spine and hip, and can cause pain with various body movements. Adhesions not only affect the layers of skin, but they can also affect muscle movement, digestion, and other body functions. The end result from the adhesions restricting mobility is often chronic low back pain.
Signs of possible scar adhesions include:
• pain at and around the area of a previous surgery or injury
• puckering or dimpling along a surgical scar
• pain not explained by x-ray or MRI images
The term “active scarring,” is a term that is used to define nerve activity that is associated with scar adhesions. Active scars are termed “active” due to their ability to change sensory input to an area of the body because the internal scar is adhered to nerve tissue. The idea is like hitting your funny bone, which is the spot on your elbow that shoots tingling pain into the pinky finger when even slightly bumped in just the wrong way. Internal scars that are adhered to nerve tissue can cause pain in a similar way, by tugging on a nerve. This affects the signals being transmitted from the affected area of the body and can feel like neurologic pain into the legs. This pain can be misdiagnosed as coming from the lumbar spine since back problems often cause pain into the legs. Active scars often go untreated due to lack of knowledge or awareness of the healthcare provider regarding the effects of pathological scarring.
A large incidence study was conducted in the 1990s that found that 35% of all open abdominal or pelvic surgeries performed in the United States resulted in the patients being readmitted to the hospital more than twice to treat post-surgical adhesions within ten years following their initial surgery. This research signifies that abdominal adhesions are not to be overlooked after surgery and if they are left untreated can result in poor outcomes. A common treatment for adhesions is to surgically cut the adhesions. However, research shows that this type of treatment can create an ongoing cycle of new adhesion formation resulting in a cycle of chronic pain and dysfunction.
At Premier Physical Therapy, numerous cases of active adhesions in the abdominal region have been identified and successfully treated using myofascial release techniques. Myofascial release is a hands-on therapy technique which is performed by a specially trained therapist. The bands of scar tissue are put on tension and held until a release is achieved, reducing the connections of the scar tissue into the surrounding tissue and lowering pain levels. A typical course of therapy includes first identifying the presence of internal adhesions, providing myofascial scar release, and finally teaching the patient how to provide self-release of their internal adhesions to follow-up at home.
If you or a loved one has symptoms which may be coming from internal adhesions, give us a call to schedule a Physical Therapy Evaluation to see if we can identify and treat the source of pain.
Dr. Andrew Beardslee, PT, DPT, MSCS
Logan Sillies, DPT