Month: August 2018

  • Chronic abdominal pain is common in patients who have had c-sections, appendix removal, hernia repairs, reproductive surgeries and various other surgeries to the abdomen. The pain comes in various forms: constant, related to eating meals, related to exercising, lying down or sitting for a long time. Often this pain is caused by abdominal adhesions, which are bands of internal scar tissue which have formed at the site of past surgeries. However, addressing these adhesions is commonly overlooked by health care practitioners. Physical therapy is not commonly thought of as a starting point when looking to address abdominal adhesions.


    Adhesions are defined as abnormal bands of tissue fibers that form between two body structures. These deep internal scars affect soft tissue through all layers of skin, much deeper than the scarring just on the outside of the skin we can see. They adhere to deep structures and can significantly affect the way we move and feel. Imagine a seam being sewn through all layers of bed linens, resulting in the inability of the various layers of bed sheets to slide over each other. In the human body, internal scarring draws together layers of body tissue which need to slide past each other for normal movement. Abdominal adhesions perpetuate poor posture, restrict joint mobility of the spine and hip, and can cause pain with various body movements. Adhesions not only affect the layers of skin, but they can also affect muscle movement, digestion, and other body functions. The end result from the adhesions restricting mobility is often chronic low back pain.



    Signs of possible scar adhesions include:

    • pain at and around the area of a previous surgery or injury

    • puckering or dimpling along a surgical scar

    • pain not explained by x-ray or MRI images

    The term “active scarring,” is a term that is used to define nerve activity that is associated with scar adhesions. Active scars are termed “active” due to their ability to change sensory input to an area of the body because the internal scar is adhered to nerve tissue. The idea is like hitting your funny bone, which is the spot on your elbow that shoots tingling pain into the pinky finger when even slightly bumped in just the wrong way. Internal scars that are adhered to nerve tissue can cause pain in a similar way, by tugging on a nerve. This affects the signals being transmitted from the affected area of the body and can feel like neurologic pain into the legs. This pain can be misdiagnosed as coming from the lumbar spine since back problems often cause pain into the legs. Active scars often go untreated due to lack of knowledge or awareness of the healthcare provider regarding the effects of pathological scarring.


    A large incidence study was conducted in the 1990s that found that 35% of all open abdominal or pelvic surgeries performed in the United States resulted in the patients being readmitted to the hospital more than twice to treat post-surgical adhesions within ten years following their initial surgery. This research signifies that abdominal adhesions are not to be overlooked after surgery and if they are left untreated can result in poor outcomes. A common treatment for adhesions is to surgically cut the adhesions. However, research shows that this type of treatment can create an ongoing cycle of new adhesion formation resulting in a cycle of chronic pain and dysfunction.


    At Premier Physical Therapy, numerous cases of active adhesions in the abdominal region have been identified and successfully treated using myofascial release techniques. Myofascial release is a hands-on therapy technique which is performed by a specially trained therapist. The bands of scar tissue are put on tension and held until a release is achieved, reducing the connections of the scar tissue into the surrounding tissue and lowering pain levels. A typical course of therapy includes first identifying the presence of internal adhesions, providing myofascial scar release, and finally teaching the patient how to provide self-release of their internal adhesions to follow-up at home.


    If you or a loved one has symptoms which may be coming from internal adhesions, give us a call to schedule a Physical Therapy Evaluation to see if we can identify and treat the source of pain.


    Written by:
    Dr. Andrew Beardslee, PT, DPT, MSCS
    Logan Sillies, DPT

  • Are Dry Needling and Acupuncture the Same?

    This is a commonly asked question in our clinic and one answered daily by our therapists. The primary similarity between dry needling and acupuncture is that they both involve the insertion of very thin needles that don’t inject fluid through the skin at strategic points on your body. Both practices aim to treat pain. But the similarity ends there.


    Let’s start with acupuncture, which is a part of ancient Chinese medicine developed 2,500 years ago. Traditional Chinese medicine explains acupuncture as a technique for balancing the flow of energy known as chi, which is believed to flow through pathways called meridians in your body. By inserting needles into specific points along these meridians, acupuncture practitioners believe your energy flow will re-balance. Western practitioners view the acupuncture points as places to stimulate nerves, muscles and connective tissue. Some believe that this stimulation boosts your body’s natural painkillers.


    Dry needling is a specific clinical technique to treat musculoskeletal pain and movement dysfunction. Dry needling was developed in the 1970’s and has progressed today with use of several modalities to improve techniques. Dry needling is primarily used to treat soft tissue pain related to inflammation, sensitized nerves, scar tissue formation, tissue adhesions, and deficiency of blood and lymphatic circulation. It addresses both local and systemic dysfunctions.


    The process of dry needling involves inserting a needle through the skin where it physically stretches soft tissue. The needled tissue activates physiological changes that promote tissue healing. Needling facilitates the remodeling of the inflamed and injured soft tissue and around the needling site.


    Dry needling does not treat diseases, but can restore tissue and systemic homeostasis, and promote improvement in many pathological conditions. Needling provides improvement both locally and systemically.


    The local benefit of dry needling is the remodeling process of soft tissue dysfunction occurring in three ways:

    • Local reduction in tissue tension
    • Reducing local inflammation
    • Replacing injured tissues with fresh tissues of the same type


    It is also hypothesized that this process can assist with the balance of the fight or flight part of the nervous system.


    All local dysfunctions have effects on the entire system. Soft tissue pain can affect the balance and motor patterns regionally and throughout the body.


    Dry needling, especially when utilizing a global approach, as with integrative dry needling, can have systemic benefits. Integrative dry needling addresses the symptomatic areas (myofascial trigger points) and the peripheral nerve and its connection back to the spinal root by needling along the nerve pathway.


    The systemic benefit of dry needling is promoting homeostasis, which is the body maintaining a stable internal environment, despite changes in the exterior.


    Systemic homeostasis is restored through reducing both physical and physiological stress. Needling can also alleviate biomechanical imbalances such as joint and posture imbalance through addressing the soft tissue dysfunctions.


    In our clinic, we have had excellent results when combining dry needling with other treatment modalities such as manual therapy and functional movement training to work toward restoring health and optimal level of performance. We have several therapists trained in dry needling along with advanced manual therapy skills who would be happy to assist you on your path to recovery.


    Written by: Debbie Clarke, PT, MPT, CIDN
    Certified in Integrative Dry Needling