Serious pelvic scar tissue and adhesions

[Cap.n1Eye]

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

 

[scooter]

Serious pelvic scar tissue and adhesions

My caseload tends to include many women with the type of issues that you've described. The type of myofascial release that I practice seems to have great benefit from these types of disorders. Manifestation can be low back or sacral pain; pelvic disorders/pain, including elimination and painful intercourse; and more far reaching pain or dysfunction.

Treatment protocols do not exists, as the nature of the scarring and its effect vary so greatly. But, that being said, inclusion of deeper scar tissue releases and more global traditional MFR releases are used.

If you have more specific questions, please let me know.

 

[yellowstar171]

Serious pelvic scar tissue and adhesions

Hmmm....orthopedic work and hip stabilization would not be my first choice of treatment for this one.

Myofascial work to help release scar tissue would seem to be indicated.

Actually I would probably start her with cranio-sacral/somato-emotional release - or maybe would even refer out for
Visceral Manipulation (practitioners listed under IAHP.com)

Unless you deal with the scar tissue, internal adhesions, and (probably) emotional trauma, hip stab will be of little benefit IMO.

 

[taryn]

Serious pelvic scar tissue and adhesions

To the OP: You said "inability to extend her legs"... did you mean to say "inability to extend her hips"?

Have you checked her leg length yet? Can you determine if she has pelvic torsion? She sounds like a good candidate for it.

I tend to agree with the last few posts: Address the fascial issues before getting into the pelvic stabilization work. It doesn't have to be a particular type of MFR - just move with the tissue. With this woman, I would move towards ease first. If you are familiar with positional release methods, these might be very helpful for her as well.

Sight unseen, I expect this woman's hip flexors to be chronicly hypertonic and her glutes inhibited. Her quads and calves are probably also very tight, and she may have knee pain on sitting/standing, or on the stairs. The externally rotated legs and history of lower abdominal surgeries indicate that her hip rotators are also chronically hypertonic. All of these things may respond well to gentle Active Isolated Stretching. I would particularly want to start effecting changes in her hip flexors and rotators, preferably without a lot of deep pressure.

Her body is bracing the area. How can you "whisper" it back into movement? Calm the nervous system and the other tissues will follow.

Sounds like a fascinating case! Wish I was working with her to see it through. :grin: