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Serious pelvic scar tissue and adhesions
This is both an orthopedic massage AND a myofascial release question. But first some background...
I've got an Orthopedic Massage client who is dealing with pelvic stabilization/alignment issues that may also be impacting "frozen shoulder"-like symptoms (both shoulders). The client is in her mid-50s.
The client has had numerous surgeries in the pelvic bowl (primarily reproductive) going back 25 years and continuing forward to recent years. One of the surgeries alone left a long lateral scar across her lower abdomen (NOT a c-section). The client first started experiencing hip pain immediately after the first surgery, but "lived with it" for several years before deciding to seek a remedy. She also has had soft tissue issues resulting from endometriosis.
To date she has tried all kinds of things, including (presently) lengthy physical therapy, and in the past she's even had "internal work" done by a doctor to attempt to reduce her pain and discomfort. She already disciplines herself to do 45 minutes of exercises a day (including core strength) as prescribed by her PT. They have made slow progress towards realigning her pelvis. She's started to come see me to see if I can help speed the realignment ... and hopefully later move onto her shoulder issues.
She hurts more when she is still (standing or sitting) than when she is moving. She sleeps on her side, wakes during the night, rotates and falls back to sleep ... only to repeat the cycle.
I've done Ortho assessment on her and most notable is her inability to extend her legs (prone, knee bent 90˚, lifting towards ceiling) more than about 5˚ off the table. Normal ROM is 30-45˚. (She also has poor adduction and lateral/external rotation of the hips.) The difficult hip ROM tests seemed to cause a "great pull" (her words) on scar tissue and adhesions in the abdomen and pelvic bowl, or on the outer hips and glutes.
I attempted to pursue Waslaski's hip protocol with her (as I have done with numerous clients), but even after focusing on the hip capsule and surrounding structures, I couldn't seem to make any headway on improving her hip extensions. I suspect the scar tissue and other fascial restrictions/adhesions are hindering my work as well as the physical therapists. I did give the client some stretches for the hip flexors and QL (left side), and a strengthening exercise for the lateral hip rotators.
I'm considering having the client come in just to do some MFR work on her lower abdomen, maybe just 30 minute sessions of focused work over a few closely-spaced sessions, before moving back into the orthopedic massage work.( I was trained in MFR in massage school, though it wasn't specifically Barnes or Dalton's methods.)
Has anyone else dealt with a client who has had many reproductive surgeries? How have you addressed the scar tissue/fascial adhesions issue? I'm eager for stories, suggestions and feedback! Thanks in advance to anyone who can comment.
Best,
Marlene
I've got an Orthopedic Massage client who is dealing with pelvic stabilization/alignment issues that may also be impacting "frozen shoulder"-like symptoms (both shoulders). The client is in her mid-50s.
The client has had numerous surgeries in the pelvic bowl (primarily reproductive) going back 25 years and continuing forward to recent years. One of the surgeries alone left a long lateral scar across her lower abdomen (NOT a c-section). The client first started experiencing hip pain immediately after the first surgery, but "lived with it" for several years before deciding to seek a remedy. She also has had soft tissue issues resulting from endometriosis.
To date she has tried all kinds of things, including (presently) lengthy physical therapy, and in the past she's even had "internal work" done by a doctor to attempt to reduce her pain and discomfort. She already disciplines herself to do 45 minutes of exercises a day (including core strength) as prescribed by her PT. They have made slow progress towards realigning her pelvis. She's started to come see me to see if I can help speed the realignment ... and hopefully later move onto her shoulder issues.
She hurts more when she is still (standing or sitting) than when she is moving. She sleeps on her side, wakes during the night, rotates and falls back to sleep ... only to repeat the cycle.
I've done Ortho assessment on her and most notable is her inability to extend her legs (prone, knee bent 90˚, lifting towards ceiling) more than about 5˚ off the table. Normal ROM is 30-45˚. (She also has poor adduction and lateral/external rotation of the hips.) The difficult hip ROM tests seemed to cause a "great pull" (her words) on scar tissue and adhesions in the abdomen and pelvic bowl, or on the outer hips and glutes.
I attempted to pursue Waslaski's hip protocol with her (as I have done with numerous clients), but even after focusing on the hip capsule and surrounding structures, I couldn't seem to make any headway on improving her hip extensions. I suspect the scar tissue and other fascial restrictions/adhesions are hindering my work as well as the physical therapists. I did give the client some stretches for the hip flexors and QL (left side), and a strengthening exercise for the lateral hip rotators.
I'm considering having the client come in just to do some MFR work on her lower abdomen, maybe just 30 minute sessions of focused work over a few closely-spaced sessions, before moving back into the orthopedic massage work.( I was trained in MFR in massage school, though it wasn't specifically Barnes or Dalton's methods.)
Has anyone else dealt with a client who has had many reproductive surgeries? How have you addressed the scar tissue/fascial adhesions issue? I'm eager for stories, suggestions and feedback! Thanks in advance to anyone who can comment.
Best,
Marlene
Views: 413
Replies to This Discussion
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Permalink Reply by Hans Albert Quistorff, LMP on
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I have worked with a man that had three abdominal surgeries finally having a mesh embedded in the layers to prevent herniation. The problem was that different sections of the abdominals did not interact with each other productively due to the scar tissue and nerve connections cut.
I placed the legs on a 45 cm ball [he was short legged, 55 cm ball will work for long legs] This allows interaction supine between the legs and the core muscles. With my hands on the abdomen working out trigger points and providing feed back as he moved the ball his cerebellum learned to coordinate the abdominal muscles again.
It was similar with a lady that had rods placed on eater side of her spine. the muscles did not reattach at their original insertions and wold pull inappropriately causing severe pain. After a siler set of sessions for a month she was able to take her usual summer tour in Europe and walk without pain. -
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Permalink Reply by Marlene Mayman on
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Hi Hans,
(In your last sentence, is "siler" supposed to be "similar?") Thanks for the info. I don't have a ball that size (just a large one I sit on) but I expect I can prop my client's legs to a similar height on pillows and my bolsters. Perhaps she could still move the legs that way, while I focus on the abdominal work.Worth a try...
Best,
Marlene -
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Permalink Reply by Ray Mingo on
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Hi Marlene
(quote):
The client has had numerous surgeries in the pelvic bowl (primarily reproductive) going back 25 years and continuing forward to recent years. One of the surgeries alone left a long lateral scar across her lower abdomen (NOT a c-section). The client first started experiencing hip pain immediately after the first surgery, but "lived with it" for several years before deciding to seek a remedy. She also has had soft tissue issues resulting from endometriosis.
As you may know endometriosis is a condition that there is no cure for; only relief of pain with the help of surgery, ANSAIDS, and hormone therapy. This condition mimics symptoms associated with asymmetric postural muscular conditions such as low back and pelvic pain. From what I gathered she had multiple surgeries in the pelvic area way before being diagnosed with endometriosis. The instability and alignment issues could be because of scar tissue as the result from many surgeries causing ligaments to become compromised and muscles to become restricted. Compound with her age and weather she was an active person or a sedentary person.
It is out of our scope of practice to treat endometriosis but it is in our scope of practice to help deal with some of the symptoms it leaves behind such as scar tissue. If there is any muscular imbalance I would seek to reducing scar tissue in all soft tissue (make sure your not working on newly formed scar tissue), trigger point therapy, some Swedish to get blood and fluids circulating through every muscle associated with the pelvic ( QL, psoas, hams, quads, add & abductors, erectors, hip rotators, latisimus dorsi and abs) then gradually adding ROM techs and stretch therapy. Do these while staying within her pain limit. Keeping in mind not to worry about where the pain is but bring back stability and symmetry back to the pelvic.
When you try to exercise with dysfunctional muscles it can make things worse. It's like putting new wheels, struts and breaks on a car with poor alignment. So and strength exercise 3, 6 month later (that's your call).
This is not an over night fixer upper it will take patience so don't rush to get from step 1 to step 2. She is a work in progress and I'm sure you'll be with her every step of the way.
I hope I’ve helped in some way.
p.s. It would be good to have her seek the help of a nutritionist.
I wish you well in your pursuit to wellness,
Ray -
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