Feature ArticleAdhesions Part I
By Sallie Rediske, MPT
When I was in Physical Therapy school, one of the very first days of my clinical instruction was spent covering "scar mobilization". I still have the notes at the very front of my clinical training notebooks.
After I became a practicing PT, I have always remembered that scar mobilization was one of the first things I learned. I have heeded my instructor's comments that assessing scar mobility was one of the very first things that needed to be done when conducting an evaluation. I believed what they said, but I also had this idea that one reason this material was presented at the beginning of our training was because the technique was simple enough that beginning PT students could easily master the method.
Lack of scar mobility can be an indicator of the formation of adhesions internally. Adhesions are simply defined as the attachment of two surfaces that under normal circumstances are not attached to one another. Adhesions can form due to trauma, infection, post-surgical trauma, and habitual postures that limit mobility in the body. Adhesions prevent the normal gliding and sliding of all kinds of tissue: nervous, skeletal, muscular, integumentary (skin), and visceral (internal organs). When these tissues are restricted from normal movement, pain and loss of normal function can result. Most of the time, the onset is gradual and insidious, but occasionally, the onset is sudden and prolific resulting in dramatic changes in movement, function, and pain level.
Over the years of practicing physical therapy, it has become apparent that this is one of the most basic tools in helping individuals restore pain-free movement following injury trauma, post-surgical trauma, infection, and in restoration of "healthy" posture. It is my opinion that this simplest of techniques is the most overlooked tool for restoring pain-free movement. I am uncertain why there is such an avoidance of instructing post-surgical patients in how to perform self-mobilization of scars. According to the International Adhesion Society web site (www.adhesions.org), "93% of patients who had undergone at least one previous abdominal operation had adhesions, compared to only 10.4% of all patients who had never had a previous abdominal operation" (Menzies and Ellis, 1990). Could it be a possible liability issue? Perhaps if a provider suggests that adhesions may form after surgical work is performed, could they be opening the door for legal complaints? Is the research supporting scar mobilization not penetrating all levels of health care?
Scar mobilization and adhesion prevention in its simplest form can simply be "rubbing" the incision once the incision is on its way to being well closed. More vigorous forms of scar mobilization exist, but most methods are easily performed by the individual experiencing the limitation in movement, however, the individual needs to know how and when to initiate the various approaches. This information is readily available from a licensed physical therapist.
There are more complex methods of scar mobilization and adhesion mobilization/prevention when these simpler methods are inadequate. One of the most successful methods known as Visceral Manipulation, is based on the work by Jean Pierre-Barral, D.O. Barral's work is increasingly influencing the world of physical therapy and manual therapy. The approach is based on gentle, but specific releases applied by the trained practitioner to the area of restriction. Despite the gentleness of the approach, the resulting releases can be profound. Individuals practicing this method have specialized training in Barral's technique.
Homer Physical Therapy readily applies the Visceral Manipulation approach for those individuals requiring more specific mobilization techniques. The approach is integrated with self-management concepts that will enable the individual to remain pain-free long after formal physical therapy has ceased.
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