Scar-like adhesions may require various types of treatments, from medical to chiropractic and massage.
What are Adhesions?
Internal body parts are normally slippery, so that they can move around each other easily. Adhesions are “scar-like tissue that form between two surfaces”, leading them to stick to each other. These can be caused by surgery, injury, or inflammation, and they can occur most anywhere in the body. Common places would be the abdomen, pelvis, eyes, and joints (i.e., shoulder). Arthritis or overuse can also cause adhesions in the joints. The problem comes when the adhesions can pull a body part out of position so that it can’t move as well. While laparoscopic surgery reduces the risk of post-surgical adhesions, typical medical situations that can cause this problem are appendicitis, endometriosis, cancer, infections, and radiation. When tendons, joints, or ligament have these scar-like tissues, they become painful and harder to move. Abdominal adhesions can cause constipation, nausea, bloating, and cramps. Some patients may have long-term or chronic pelvic adhesions and pain. While surgery may be considered an option to separate this sticking together, it also increases the risk for more scarring and future adhesions. Left untreated, however, eye adhesions can become glaucoma, intestinal ones can turn into bowel obstruction, and pelvic adhesions can lead to infertility, for example.1
One type of adhesion, adhesive capsulitis, is also called “frozen shoulder”. The connective tissue around the shoulder has inflammation and restricted motion, in this condition, leading to chronic pain. Recovery is slow, and the pain worsens at night and in cold weather. Even restricted movement is difficult, and small “bumps can cause sudden onset of tremendous pain”. Frozen shoulder can last from months toyears, and it may be triggered by trauma, or possibly an autoimmune problem (the body attacks healthy tissue). The joint also lacks fluid in adhesive capsulitis. As a result of pain and sleeping difficulties, depression, back, and neck problems may occur as well. People most at risk of getting frozen shoulder are those with diabetes, thyroid disease, and connective tissue disorders, or who have had a stroke, or lung and heart disease. Adhesive capsulitis can also happen after accidents, and it is rare in individuals under the age of 40. Traditional treatments may range from physical and occupational therapy, to pain relievers and anti-inflammatory medications (analgesics, NSAIDs), or even surgery. Other treatment options include chiropractic, massage therapy, and manipulation under anesthesia (MUA). With proper treatment, frozen shoulder can resolve itself and, over time, “most people regain about 90% of shoulder motion”.2
Fascia are connective tissue and they may become “entangled”, leading to “impingement”, which can impact muscle movement, nerves, and blood circulation. Massage therapy can help relieve myofascial adhesions and knots (trigger points). It is believed that “movement is essential to break down the adhesions”. Patients can benefit from muscles being warmed, as well as friction, vibration, and compression. Other treatments include traction, proper stretching, and range of motion movements.3 Chiropractors can also employ many of these techniques as well. Patients complaining of numbness, tingling, and pain may be suffering from adhesions. Active Release Technique (ART) may benefit these patients. ART is a specialized soft tissue therapy that is not the same as regular massage; it is “designed for the correction of adhesions and scar tissues”.4 Other chiropractors may employ the Graston or Sound Assisted Soft Tissue Mobilization (SASTM) to treat patients. Patients don’t have to move in order to participate in this therapy as specialized instruments are applied and used with “gentle pressure strokes”. SASTM is considered less painful than ART, both for the patient and the practitioner.5