"Any of these structures with their associated tendons and ligaments can be victims of an injury"
If you have worked in a chiropractic office for any length of time you likely have heard the term adhesions. In everyday life, we think of adhesives as things like scotch tape or glue. They are elements that bind things together, and for those items, it is a good thing if you are fixing an object or wrapping a package. In the medical realm, however, adhesions are NOT our friends.
Adhesions Defined
Adhesions are bands of scar-like tissue. Our internal organs and tissues (like joints, cartilage, and muscle) normally have slippery surfaces that allow them to shift easily as the body moves. When adhesions occur, they create a binding effect that causes these tissues to stick together. Adhesions form to stabilize an injured, unstable area. However, if allowed to stay attached can cause a lot of damage.
What Causes this Sticky Situation?
As previously stated, adhesions are the result of an injury. In the chiropractic office, we may see adhesions form after sprain/strain injuries from sports, a trip and fall, poor lifting, or a car accident. Whenever soft tissues (muscle, cartilage, tendons, ligaments, vertebral discs) are injured, adhesions can form if they are not appropriately addressed. This phenomenon is often seen around joints where soft tissues provide stability but also allow movement. Joints should be stable but also allow for smooth action.
So, how many joints do we have in our spine? Most of our vertebrae have at least two pairs of facet joints to the posterior, one pair on each side that connect it to the vertebra above and below and allow articulation or movement. In the upper cervical region, we have some 'special' vertebra at Cl and C2 that have unique joints to enable connection to the skull and provide rotational movement in the neck. We also see some vertebrae that connect with ribs and have additional articulations there. Also, don't forget our discs above and below most segments.
Any of these structures with their associated tendons and ligaments can be victims of an injury. Remember to consider all of the levels of muscles that attach up and down the back and spine/skull, and throughout our body. Muscle injuries anywhere in our axial body or extremities can form adhesions.
From a surgical standpoint, adhesions can form from entry and exit wounds and around the tissues where surgery was performed. For example: after a procedure on the abdomen, the scarring might connect the loops of the intestines to each other, to nearby organs, or to the wall of the abdomen. If they restrict the activity of the organ, they are sometimes called 'strictures.' In the chiropractic office, we may see patients post-surgery that are facing this issue not only with abdominal surgeries but also with things like hip or knee replacements.
Why are Adhesions a Problem?
Our bodies are meant to move. In their simplest form, scar/adhesions restrict natural movement. We know that lack of motion is certainly inconvenient. However, depending on the severity of the scarring, they can lead to pain, spasm, and joint degeneration, or even unnatural spinal curvatures over time, which in turn can lead to other complications. Most of our spinal segments consist of a '3-joint complex, which encompasses the disc and both pairs of posterior facet joints. Each joint can affect the other two and changes in one joint can affect the biomechanics of the whole complex. When we have injuries from, say, a car accident, keep in mind that we are not just dealing with one segment, but rather with injury in a series of vertebrae along with their associated joints as well as the attaching musculature. This is profound.
Adhesions can occur anywhere in the body. From a surgical standpoint, they often form after surgery on the abdomen. Almost everyone who has surgery on the abdomen gets adhesions. Sometimes adhesions in the abdomen don't cause any symptoms. Still, more often, they pull sections of the intestines out of place, which can cause a variety of issues ranging from abdominal pain, cramping, vomiting, nausea, bloating, inability to pass gas, constipation, blockage of food from passing through the intestine, or even infertility (by blocking the path for fertilized eggs to reach the uterus).
In the chiropractic office, we may be more apt to see adhesions from something like a hip or knee replacement where a patient may arrive in the office with limited motion and pain due to adhesions.
Addressing Adhesions
The ideal way to address adhesions is at the time of treatment after an injury or surgery. If you follow the doctor's instructions for motion during the healing process, you can prevent them from forming. I had an emergency appendectomy back in 2005. As I healed, I made sure to work my abdominal area with stretching to help prevent adhesions. The same goes for a chiropractor working with a sprain/strain injury and telling the patient to do specific stretches. There is a reason, so please help encourage the patient to follow through.
We will also have patients where the adhesions were not prevented. In those cases, the DC may strive to break up the adhesions after the fact. This is not fun and can be uncomfortable for the patient as they work through stretches, and the adhesions break. Therapeutic ultrasound can be very beneficial in this process as it is a modality that can help soften the scar tissue to make it easier to work the adhesions loose. Once mobility is freed up, patients find a great deal of function restored and discomfort minimized.
One of the greatest services you can provide as a CA to help prevent the issue is to encourage patients post-injury to do all stretches as prescribed to prevent adhesions! Simply say, "Make sure you do your stretches at home to prevent adhesions." If they ask what adhesions are, tell them what you know, "They are small pieces of scar tissue that can form and prevent your injured joints from moving properly after you heal...it is really important that you follow through with what the doctor told you to do at home so that you speed recovery."
An understanding of anatomy and clinical applicability helps CA's better communicate with patients and provide care more safely. Discover coursework designed for CA's at www.cccaonline.com and use AMCHIRO as your discount code during the registration process to automatically provide a $15 discount off the regular price of the program.
Laurie Mueller, BA, DC, CFMP served in private practice in San Diego, California. She was the post-graduate director at Palmer College from 2000-2010; served as the ACC Post Graduate subcommittee chair for 6 years; peer reviewed for the Research Agenda Conference, and wrote the informal role determination study that aided in the development of FCLB's guidelines for chiropractic assistants (CCCAs). Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions LLC, and subsidiaries www.CCCAonline.com and www.fxmedonline.com. She is a clinician, an educator, and an expert in online educational pedagogy.
References:
1. https://medlineplus.gov/adhesions.html
2. www.ncbi.nlm.nih.gov/pmc/artic...
3. Open source image found at https://commons.wikimedia.org/wiki/File:Facet-joints.png
