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Massage Today
March, 2009, Vol. 09, Issue 03

Massage for Surgical Adhesions and Scar Tissue: A Case Study

By Don McCann, MA, LMT, LMHC, CSETT

Weekly, I receive inquiries from massage therapists and potential clients asking for help with the pain they are experiencing from surgical scar tissue and adhesions. Scar tissue and adhesions can be effectively released. The following case study is one such example.

Case Study

Sarah, a 63-year-old, was a disabled office worker. Her problems started 20 years ago when she donated a kidney for her daughter. The surgical incision was halfway around her body. Six months after the removal of the kidney, Sara had an additional surgery for the removal of surgical adhesions that had resulted from the initial surgery, and four months later had another surgery for surgical adhesions. The adhesions produced significant pain, preventing her from returning to work.

By the time she was referred to me, she had undergone a total of seven surgeries for adhesions over a 20-year period and was still unable to work. Her overall vitality and health reflected the 20 years of medication and pain, and she appeared older than her 63 years. Upon evaluation, she was severely bent over to her right side in an acute collapse of the core distortion pattern and could not rotate her upper body to the right. She was not able to fully straighten up due to the restrictions deep in her abdomen from the surgical adhesions. When I palpated the surgical adhesions and scar tissue, I found them to be fibrous, thick and hypersensitive from the surface tissues in the rectus abdominus, obliques, and latissimus dorsi all the way through the soft muscle of the intestines, and into the psoas and quadratus lumborum of the deep intrinsic stabilizing muscles. In addition, she had significant pain in the lower lumbar region of the spine, hip, neck and shoulders as a result of the structural collapse. She was also depressed due to the fact that she had not been able to work or take part in activities that she enjoyed.

Treatment

image - Copyright – Stock Photo / Register Mark The goals for the initial treatment sessions were to lessen the sensation in and around the surgical adhesions and scar tissue, release the buildup of fluid and toxins associated with the pain and inflammation, clear trigger points and soften surface layers of scar tissue to prepare the areas for deeper treatments as therapy progressed.

The strokes were applied in specific sequences and directions that would facilitate the release of the structural distortion to initiate the structural balancing. These initial strokes were lighter, milking strokes which were applied very slowly to allow more change in the tissue with less threat and less sensation for a client who is in severe pain.

In the next phase of treatment, one of the goals was to unwind the myofascial holding patterns of the structural collapse, not only in the adhesions of the scar tissue, but also in the restrictions throughout the rest of her structure that had been pulling her structure further into collapse. This would help reduce the pain in her hip and lower back from the structural collapse. We were also working to release some of the hardened fibrous adhesions and their compression on nerve tissue which was one of the significant causes of her pain. Another goal was to increase her range of motion as the fascia and scar tissue restrictions were released and mobilized.

After seven sessions, Sara was standing straighter with a significant reduction of the structural collapse. She was more mobile and was able to participate more freely in her daily life activities. Her energy was better, and her spirits were high because she was finally feeling and seeing the improvement: she was able be more active, having more fun, and feeling more satisfaction in her accomplishments. The pain was reduced both from the release of the direct pressure of the surgical adhesions on nerves, and from the release of the structural collapse causing the low back pain. She was experiencing less pain in her neck and shoulders due to the fact that she was no longer bent over, and her neck and shoulders were now more supported by a straighter spine.

The goals here were going to be specific release of the fibrous tension of the surgical adhesions, release of the shortened fibers and adhesions in the psoas and quadratus lumborum (to release nerve entrapment and allow structural balance), release other fibers in the pelvis that supported the structural collapse, and increase range of motion back to normal function. After seven more sessions that incorporated the deep individual fiber release to sufficiently lengthen and balance Sara's structure, take the pressure off the nerve entrapments and return range of motion to normal, we were able to accomplish the long-term goal of pain free living.

It was by setting goals, using them as observable and obtainable measurements allowing us to track improvements, that we were able to achieve successful resolution of Sara's long-time chronic condition.

Three-Step Approach

The three-step approach of first releasing ischemia, fluids and toxins, then applying directed myofascial unwinding strokes, and finally releasing individual fibers allowed me to work with Sara staying within her pain thresholds even during the most intense phase of her rehabilitation. Using this three-step approach, the deepest of the surgical adhesions were able to be released, which ultimately released her structure into balance. Sara has gone back to work, and is finally happily participating in activities that had given her such enjoyment before the kidney donation.

As always, please be careful to work within your skill level and expertise, and refer out if necessary.


Click here for more information about Don McCann, MA, LMT, LMHC, CSETT.

 

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