Feature Article

  The issue of adhesions is a very complicated and pervasive issue. It was determined in 1994 that as many as 446,000 surgical procedures were performed in the United States to remove abdominal-pelvic cavity adhesions (Health Care Industry Association, 1994. www.adhesions.org). (this figure does not include surgical procedures for removal of adhesions in other areas of the body.) It is estimated that 93% of individuals who have experienced at least one abdominal surgery experience the formation of abdominal adhesions (adhesions in the "belly" where our guts are located) following abdominal surgeries compared to 10.4% of the general population (Menzies " Ellis, 1900. www.adhesions.org.) These surgeries are very common and include hysterectomies, C- sections, gallbladder removal, bladder suspension, hernia repair surgery, fibroid removal (myomectomy), etc. Despite the prevalence of adhesions following abdominal surgeries, all surgical procedures are possible sources of adhesions.

   Adhesions can be formed any time two surfaces of tissue are shoved together for any length of time such as when the abdominal organs are displaced upward during pregnancy. Adhesions can also form following infections in the abdominal organs such as with diverticulitis, appendicitis, or due to massive infection such as peritonitis. Other times adhesions are formed from disease processes such as endometriosis, a condition in which the material that normally lines the inside of a woman's uterus is laid down outside of the uterus on other tissue. Adhesions can also be created following any orthopedic surgery including common procedures such as carpal tunnel releases, ACL repairs, etc.

   Often for the orthopedic surgical patient, the pain from adhesions will create the perception that surgery was not successful. The patient will settle for having a "bad knee", a "bad back" or a "bad ankle", rather than comprehending that adhesions may be limiting the restoration of pain-free mobility. For the patient who experiences some type of abdominal surgery and develops adhesions, it often appears there is "no logical reason" for their pain until things get so painful that follow-up exploratory surgery is required. Often significant adhesions are found internally - certainly enough to contribute to pain and often enough to contribute to serious medical issues such as bowel obstruction.

   The abdominal (the area below your diaphragm muscle that houses your stomach, intestines, etc.) and thoracic cavities (the area above the diaphragm muscle which houses your heart, lungs, etc.) are a fascinating balance of outward pressure and inward pull. This force is identified by a term that is often used in plant biology called turgor pressure. An everyday analogy of how turgor pressure works is when you have two dinner plates stacked up on one another and there is dishwater in between the two surfaces. The thin layer of water creates outward pressure so the two plates are actually not resting directly on one another; rather they are separated by the thin layer of water that exerts an outward pressure against the surface of the plates. Contrastingly, if you were to pull the plates apart, there appears to be some force that "glues" them together. This is the inward pull created by turgor pressure.

   In the abdominal and thoracic cavities, this pressure system exists because the cavities are pressurized systems, meaning that they are closed off from air moving freely in and out of the cavities. In a healthy individual where the system is functioning ideally, the organs are balanced in this pressurized manner that allows them to stay close to each other while yet not sticking to one another. Instead of dishwater between the organs, bodily fluid slips and slides between the opposing surfaces of the organs with movement triggered in part by our gross motor movements such as walking, bending, twisting, etc. When this pressure system is disrupted such as with surgery (simply by being "opened up" or by removal of structures) or with the pressure shifts created by tumors or cysts, this causes disruption of the serous fluid between the surfaces. Where there is enough disruption of this fluid movement, contact is made between two surfaces and adhesions can quickly form. This contact or adhering then makes it possible for more adhesions to form by further disrupting the serous fluid movement.

   Physical therapists and other manual therapists are finding that non-surgical methods of releasing adhesions are effective. One study (Wurn, et al., 2004) demonstrated a significant positive outcome in the treatment of female infertility when abdominal-pelvic cavity adhesions were identified or suspected. This procedure and other similar ones are without negative side effects and are increasingly demonstrating positive clinical outcomes. Here at Homer Physical Therapy, we employ manual techniques to effectively address the formation of adhesions and return our clients to pain-free function.

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Archived Feature Articles: 

What is up with my "CORE"?  The Ice Equation  Why do I need to stretch  Growing Pains 

Adhesions Part I Adhesions Part II
 

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