Treatments

Adhesion and Scar Tissue Therapy

Until recently, the only choice medical science offered to repair adhesions and problematic scar tissue were surgical procedures called “lysis of adhesions or ‘scar revision.”  Although Scar revision surgery may reduce tightness and tethering of surface scarring and have aesthetic benefits, the surgical procedure itself causes the formation of more scar tissue and possibly adhesions.

Adhesion Lysis whether performed by laparoscopy or open surgery, involves cutting or burning the adhesions. While adhesion lysis can be very effective, it has two major drawbacks: 1.  surgeons must avoid areas where they might damage delicate underlying structures, a situation they cannot see until you are already under anesthesia, and  2, 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 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 a nylon rope, adhesions are composed of strong, microscopic strands of collagen.

Adhesion formation occurs after trauma to the tissues, and is caused by an inflammatory response to tissue damage. 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.

One reason for the recurrent nature of the problem is that adhesions tend to persist long after the original trauma has healed. In fact, the body does not have a natural remedy – nor does it have any way to decrease adhesions once they have formed. Once they form, adhesions may bind together organs, nerves, muscles, and other neighbouring structures in a strong, glue-like straight-jacket, with a strength approaching 2,000 pounds per square inch.

Adhesions usually form after surgery, infection, inflammation, trauma, or radiation therapy treatment. As shown in the drawing above, adhesions are composed of strong, microscopic strands of collagen. Like a nylon rope made of a thousand tiny strands, these tiny collagen fibres (called crosslinks) bind together to create sheets, ropes, or blankets of tissue in areas of the body that have been injured by infection, inflammation, surgery, or trauma.

Whether the adhered tissues are called crosslinks, micro-adhesions, adhesions or scar tissue, is all a matter of size. Whether they form ropes, sheets, or some other shape depends on how we heal, and how our body moves and pulls against existing adhesions, after trauma to the tissues.

Adhesions may be filmy or coarse, thick or thin. They may be small enough to join individual muscle cells, deep within a structure (as shown in the anatomical box below).

Adhesions may occur on the surface of our bodily structures, or deep within them. They can join any structure in the body to its neighbour, or to distant structures. In doing so, they can cause confusing symptoms, of pain or dysfunction.

When adhesions totally close 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 referred pain or distant dysfunction

Remarkably, when adhesions form in areas that are not highly innervated, they may not cause pain at all. Thus, some people find themselves slowly losing function or range of motion over time, whether or not that loss is accompanied by pain.

Summary

In short, adhesions form as the first step of the healing process, whenever we undergo any trauma or inflammation to our bodily tissues. Crosslinks rush in and lay across each other in a random pattern to help protect and isolate the area that has been injured or inflamed. Adhesions join structures that should be free to move independently. In doing so, they can create unusual symptoms, whether or not accompanied by pain.

Once the body has healed, the adhesions remain in our body wherever we have healed. There, they persist throughout our lifetime, unless removed by a skilled manual therapist, or by a surgeon.

Causes of Adhesions

Adhesions may cause problems near sites of former surgery, inflammation, or trauma.

Surgery

Surgery is 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. Other surgeries that may cause adhesions or scar tissue to form in and around organs include:

• bowel obstruction repair
• appendectomy
• episiotomy or C-section
• laparoscopy or laparotomy
• hysterectomy
• 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 to adhesions from the postures the body takes to compensate after the original injury, surgery, or infection.

When adhesions form around the abdomen, intestines, or digestive tract, dysfunction such as constipation or abdominal pain may result. While the patient may receive a diagnosis of irritable bowel syndrome (IBS), Crohns disease, or other descriptive name, adhesions are often at work, as a cause or perpetuating factor in these conditions.

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 has passed, the blanket of adhesions remains, as a permanent record of the healing that occurred in that area.

Traumas

Adhesion-causing traumas include falls, accidents, or physical abuse. The trauma of radiation therapy can cause massive adhesion/fibrosis formation at or near the sites of cancer treatment. Inflammation following trauma or radiation therapy may cause adhesions to spread to neighbouring organs unless they are removed or diminished by a surgeon, or a therapist trained to treat them. Symptoms sometimes appear far from the site of the original trauma.

Treatment

“Hands-on” Treatment Without Surgery or Drugs

It has been found that adhesions are composed of thousands of tiny strands of collagen, made strong by binding together like a rope or a cloth, made of thousands of individual fibres. After further investigation, it appears that the chemical bonds that attach each of the tiny collagen fibres to its neighbour dissipate or dissolve when placed under sustained pressure over time.  The treatment techniques are similar to Myofascial Release techniques in that it involves a stretch or release of the tissues.  This is very specific to the area(s) involved. The primary goals of this manual therapy are to increase mobility and decrease pain.