Dealing With The Past – Part II: Physical Factors

Several years after the surgery of my left Achilles tendon, I still felt stiffness and pain in the area, especially on colder days. Similarly, some of the patients that my team treated could not improve past a certain point even though perpetuating factors (including body mechanics, diet, thoughts/emotions, interpersonal relationships, etc.) were properly addressed.

One thing that my team noticed that was not adequately dealt with was scar tissue. Many clinicians ignore scars since they have already "healed".  But what we see on the skin is just the tip of the iceberg. Beneath is a vast network of tissues that are stuck together because of improper healing - resulting in symptoms of stiffness, itchiness and pain. Just as psychological trauma can trap a person in the past (for more information, please refer to "Dealing With The Past - Part I: Psychological Factors", adhesions and scar tissues can prevent the tissues in the body from working properly; thus, hindering proper rehabilitation.

Let's take a look at how adhesions and scars can affect the body.

Figure 1 – Tissues in the body are typically thought of as distinct parts, but there are tissues such as fascia (the thin, white material over the muscles) that connect the entire body so that movement in one part will affect everything else.

Imagine that you are wearing many layers of form-fitting body suits. These represent the multiple levels of tissues from your bones to your skin. I use the example of a body suit because the tissues in the body are all connected from the top of the head to the tips of the fingers and toes. If the right hand is stretched out, tension will increase through the rest of the body, especially in the right shoulder, neck, chest and upper back. The advantage of this is that the body can move more efficiently as one unit.

In addition to these layers, imagine that there is a network of drinking straws that go through and in between the layers. These represent your nerves and vessels for the blood and lymph. Under normal conditions, fluid can flow freely through these tubes.

Now something happens that causes damage through multiple layers. This could be from a burn, crush injury, laceration or surgery. Even minor sprains and strains can build up adhesions through time. During the normal healing process, the body will naturally clean up the frayed edges of the damaged layers and lay down a substance that acts like glue. As a person goes about their normal activities, this glue will re-mold itself so that all of the layers function as close to normal as possible. But sometimes, the body will lay down an excessive amount of glue that causes several layers of tissues to stick together. This makes it difficult for a person to move normally so the glue cannot re-mold itself. The tissues in this area, such as the muscles, then become smaller and weaker since they are not being used (because they cannot be used) and the problem worsens over time.

Figure 2 – Excess scar tissue can restrict normal movement of tissue and constrain nerves and blood vessels

Just to complicate things, the adhesions between the layers of tissues can also affect the nerves and vessels, potentially leading to pain, numbness and swelling as well as local changes in the skin (discolouration, appearance of brown spots, increased or decreased hair growth, etc.) We have seen these signs and symptoms significantly decrease with treatments targeting the scar tissue.

Parts of the body in a different location from the scar tissues can also be affected. For example, Caesarean sections can affect pain in the low back, or a laceration to the arm can lead to neck and shoulder pain.

Fortunately scar tissues can, to a certain extent, be reshaped externally. We have found manual therapies quite effective in treating scar tissues and adhesions. We have seen people with scars as old as 40 years improve in pain, itching, stiffness, colour, temperature, etc. An added benefit is that the appearance of the scars also tends to improve. Moreover, clinicians can teach clients how to perform some therapies at home in order to speed up healing and save on treatment costs.

Dr. Trung Ngo founded Novah Healthcare in 2017, an interdisciplinary clinic that specializes in the conservative management of acute and chronic pain. His Novah clinic will continue the work he did from 2011 to 2016 at Mount Sinai Hospital, where he led an interdisciplinary team in assessing and treating complex, chronic, non-cancer pain. His Mount Sinai team helped patients decrease their pain, improve their daily and vocational functioning and reduce or eliminate their intake of pain medications (including opioids). Dr. Ngo graduated from the Canadian Memorial Chiropractic College and subsequently pursued a residency program at Hamilton General Hospital in which he furthered his training in orthopaedics and pain management.

Leave a Reply

Your email address will not be published. Required fields are marked *