Scar and adhesion

A whole session of FRC3 was devoted to scar and adhesion. Gathering scar tissue can be elective or not, adhesion is definitely non-elective.

Adhesions are described as attachments of tissues at non-anatomic sites. They can be filmy or dense, vascular or non-vascular. They can be related to surgery (90% post-colonectomy, 55-100% post-op incidence in gynecology), are equally male and female and can be age related.

It seems that adhesion build ups are very common; they can contribute to pain, interfere with ADLs, cause post-op complications and lead to hospital re-admittance. Various factors influence adhesion build-up and may include an adhesion phenotype, hypoxia and high fibrinogen levels.

Dr Michael Diamond opened with dynamic, if not a little gruesome, video clips of hypodermic needling the whole length of the scar, injecting a substance that made the scar hubble and bubble. The aim was to lift the scar from the underlying tissue and allow fascial continuity to flow both sides of the scar.

Hal Brown, DC explained that even the smallest scars can have 3 dimensional effects. Sometimes one wants to cause damage, as in prolotherpay. But, says Brown, prolotherapy is not about making scar, it’s about making the original tissue.

There was much discussion on the relationship of scar and the sympathetic nervous system; fight or flight impulses coming out of scar. Some said you need to switch this off with local anaesthetic in order to reboot both the ANS and the action potential.

Susan Chapelle RMT (nice to see a Canadian RMT giving a presentation) described her massaging rats tummys after they’ve been opened up and had their organs abraded with a tooth brush. Well, it seems that early intervention (8 treatments in the first 12 hours) using manual rolling of the small intestine can prevent or reduce the build up of adhesions in rats. Abdominal massage may well reduce adhesions and ileus (reduced intestinal propulsion) following abdominal surgeries.

A very interesting poster presentation by Rena Margulis showed a relationship between a C Section scar in a woman and an inguinal hernia scar in a man and severe chronic palmar hand pain! This scar restricted abdominal and thoracic flow, leading to trigger points in pectoralis minor. Pectoralis minor has a classic referred pain zone (RPZ) to the palmar surfer of the hand. The problem was permanently solved it by acupressure on the scar itself.

All this has led me to make extra room for information gathering about scar tissue on our Medical History Intake forms. Old scars may play an important role in current pain and dysfunction.

Cheerio for now,