Principles of scar tissue:

Firstly I want to highlight a principle I think is the most important in my line of work. If you read ‘what is Osteopathy’ in the ‘Osteopathy’ tab on this blog you will see I have written about what I believe Osteopathy is.  There I remark on the principle of motion and that the body is constantly moving.  It is very important to have this in the back of your mind as I try to explain the consequences of an appendectomy or scar tissue in general.

When the appendix is removed an incision is made in the right lower quadrant of the abdomen.  This cut slices through a lot of different layers of tissue.  The appendix is then cut away and the large intestine is stitched up.  More recently they have started using a laparoscopic procedure to remove the appendix – link here. 

The point I want to highlight though, is when the various incisions are stitched up scar tissue will form.  Scar tissue is non flexible, it doesn’t stretch.  All the other layers and tissues that have been cut through can stretch; they expand and relax with the various motions of the body.  They adapt, they live and by this I mean there is cellular exchange and interaction. Scar tissue however cannot move or stretch, it is considered ‘dead tissue’.  I’ll explain more about scar tissue in a different blog.

When you have something that is not flexible blend into something that is flexible it will create tension throughout the tissue that is trying to expand, it will act like an anchor.  When this occurs constantly every minute of every day, stress will eventually build in the surrounding tissues in connection with the scar tissue.  A good picture to paint here is normal tissue acts like a healthy runner.  It can jog for hours not draining the system.  When you get scar tissue the healthy tissue continues to jog, but now it is dragging a car tire behind it.  Stress builds, compensation occurs, function is reduced and ultimately injury can occur. 

Another feature of scar tissue is the production of adhesions.  In very simple terms this basically means that different layers of healthy tissue can stick together and this stops the natural function and mobility of that tissue. 

On an interesting note, injuries can develop years later after surgery or any other kind of trauma.  Just because there are no symptoms now, it does not mean compensation and adaptation patterns are not already occurring due to the increased task load of that tissue.  It is also common to have an apparently non-symptomatic scar tissue trigger into a symptomatic problem when another injury/trauma in the body occurs later on.  This is why someone can often develop a shoulder problem years later after a pelvis or leg injury for example.  Years of compensation build over time and then a new trigger in the form of a new injury/trauma can occur.

Conversely, do not fear that all of a sudden you are going to get serious problems just because you may have had surgery in the past.  I am merely highlighting why sometimes things can suddenly become symptomatic years down the line, when apparently there has been no problem.

So what can happen after an appendectomy?

With an appendectomy, the cecum (beginning of the large intestine) can become fixed to the back wall of the abdomen and the back wall, in this case, would be the transverses abdominis or iliacus muscle.  The cecum is also the junction between the small and large intestine and in some woman it attaches to the right ovary via the ligament of Cleyet.  When I talk about attachments I'm referring to either ligament, fascial or membrane connects between various organs or bodily structures. 

Higher up as part of the ascending colon it attaches to the duodenum (the beginning of the small intestines), the right kidney, liver, gallbladder and finishing up fixing to the diaphragm.  I highlight all these attachments because these can become potential areas of compensation, irritation or sites of 'injury'/symptoms.  So when the inherent movement of the cecum has stopped due to fixation caused by the scar tissue it creates what I call drag.  This is another principle resulting from scar tissue.  This drag almost acts like a gravity field.  Not only is the inflexibility of the scar tissue causing tension to spread through the structure, it also causes other nearby structures associated with it to get pulled towards the scar tissue or fixation. 

[The picture above shows all the attachments of the large colon - indicated by arrows].

Knee and ankle problems can develop:

The cecum attaches to the iliacus muscle of the pelvis, which works to produce flexion and internal rotation of the hip.  If the cecum becomes stuck (it's lost its inherent movement) it can cause the iliacus muscle to pull towards the area of fixation.  It is almost like the two structures start to act as a single structure.  Ultimately this causes the muscle to become chronically contracted and the hip to become more and more internally rotated and flexed.  This will lead to internal rotation of the femur and then internal rotation of the knee joint.  The knee joint will also stay further in flexion.  Both these actions result in the tibia shifting further forward on the ankle joint and inwards towards the medial arch of the foot.  This can predispose to stress on the medial arch, which over time can lead to collapsing of that arch known as over pronation.  Conditions like plantar fascitis and heel spurs can develop.  So with just this simple chain we can see the potential of knee, ankle and foot problems occurring just from a fixation due to an appendectomy.  Remember these are all potentials and NOT definite compensations that will happen to everyone that has had an appendectomy.

Neck problems can develop:

So going back to the other structures that attach directly or indirectly to the cecum.  I'm going to leave out the duodenal and kidney attachments here otherwise I'll end up writing a book rather than a blog.  But let's focus on the liver and diaphragm attachments.  So through fixation of the cecum, the ascending colon is gradually being drawn down towards the cecum area via the drag and this directly pulls on the liver and diaphragm.  Remember the image of the car tire.  Suddenly the liver is having to move with an unnatural force pulling it constantly downwards towards the hip.  The liver has massive attachments to the diaphragm and then with the direct attachments of the ascending colon as well we suddenly find the diaphragm is struggling too.

[The picture directly above and left shows how high the ascending colon goes, sitting directly under the liver and diaphragm.  The picture to the right shows the pleura of the lungs, the grey membrane sitting on top of the red muscle (diaphragm)].

Now on the upper surface of the diaphragm you have the pleura of the lungs (the membrane that covers the lungs) which blends directly into the diaphragm.  On the upper surface of the lungs, the pleura attaches to the vertebral bones of the neck via a fascia called Sibson's fascia.  So with the pull of the diaphragm down, you also get a pull of the pleura, which pulls on the neck.  Neck pain, stiffness and tension can occur. 

I think it is important to clarify here that although I’m talking about one structure pulling on another structure and then that other structure pulling still further on another structure; it is slightly different within the body.  We have to remember the body is living and everything is connected, even if it is not physical, it is still connected by blood, nerves, emotions, hormones and gravity.  It is very difficult to highlight how this represents in the body via words.  It is something I have just learnt to feel – perhaps it is intuition.  In the medical world when we learn anatomy we cut everything down and separate everything to its basic level, so we can learn.  But to grasp how the body truly works we need to build up that anatomy again and see a whole living body once more.  It is very easy to think “how is it possible for the Cecum, which is all the way down near the hip to affect the neck – the two structures are so far away?”  In the body these structure are not far away.  In fact they are touching, but perhaps not in a direct way, but rather in an indirect way.

Low back pain is common:

Here I am going to talk about a structure called ‘toldt’s fascia’.  This structure is a membrane type structure or for understandings sake let’s just say it acts like a piece of ‘cling film’ or ‘shrink wrap’.  This membrane starts from the spine, spreads out and wraps around the ascending colon to then travel back to the spine again.  So when the colon becomes fixed, this can lead to stress and tightness spreading through the fascia, resulting in a pull on the spine.  Over a prolonged period of time it puts a greater demand on the spine and it gradually stiffens up.  This is what happened to the patient I had recently; refer to the ‘Bob the builder story’ on my blog.  The Cecum became fixated due to the scar tissue and adhesions.  This created tension to spread through toldt’s fascia and then lead to tightness and pain in the lower back.  This is why after 4 treatments of manipulation, stretching and pulling on the spine, no improvement was achieved; because all the while his colon was still fixed causing the tightness in the spine to remain.

Signs and symptoms of cecum fixation:

The large intestine works to absorb the remaining water (about 10%) and take in the remaining vitamins (mainly E, K & B12).  Interestingly the large colon has a very high percentage of bacteria which ferments the food (this is very healthy for the body).  This increases gases and therefore smell, but this is normal. 

Depending on whether the fixation of the cecum is in a state of irritation or a state of passivity will depend of the symptom.  An irritation is more an excitatory response and the speed of which peristalsis occurs increases.  Therefore diaherria and dehydration can occur, simply because the stools pass through too quickly for the water to be absorbed. 

If it is passive then think stagnicity.  Constipation, bloating and flatulence can occur because the stools are not passing through quick enough, all the water is absorbed leading to harder, firmer stools, which are difficult to pass.  Stagnicity leads to longer fermentation periods and this obviously produces more gas and bloating, also known as trapped wind, which actually is extremely painful.

Bob the builder: 

I treated a recent patient of mine, Bob (not his real name of course), for a very typical low back problem. After four treatments of the normal stretching, pulling, manipulating, pushing and bending he improved to perhaps 60-70%.  We unfortunately could not breach that final 30%, which would have returned him back to his normal quality of life.  He has tried the usual therapies in the past and they too were getting the same sort of results.  We were all hitting an invisible wall it seemed.

So on one of his treatment I sat down pondering his situation/condition.  He was your typical stiff builder type with very little flexibility and had been suffering with low back pain on and off for 1-2 years.  No neurological symptoms or anything else untoward.  I had been treating a lot in his upper back, rib cage and breathing mechanics too.  On the third treatment I looked at his legs and feet.  Always there was an improvement, but never beyond that 70% mark.

On the fifth treatment I was working on his lumbar spine (low back) when I noticed how stiff it was considering he had had four treatments earlier of stretching, bending and all the above.  It suddenly struck me how odd this was and so I decided to re-read his medical notes, starting with the list of his operations and medical conditions.  This was when I came across his appendectomy (removal of his appendix) some years earlier.  So I sat him down and checked his abdomen.  Sure enough he had a lot of tension around the cecum (beginning of large intestine and appendix.  I treated this area very simply and then stretched toldt’s fascia on both sides.  When I had finished completing these 2 easy techniques the patient remarked on how relaxed his back felt.  
[The picture on the left is an overview of the large and small intestines.  The picture below is a close up of the cecum and appendix; the appendix being held by the metal tweezers].

Sure enough he came back to his next treatment nearly 100% better; the best he had felt since the beginning of his low back problems.  Although this has been a great success, it has also been a solid reflection.  I almost missed this because I assumed he just needed a good stretch and manipulation, which in most cases is exactly what this type of patient needs.  But it was that feeling I felt in his back that just made me very uncomfortable, as if something was wrong.  A back that is stretched and manipulated regularly for a few weeks should change in vitality and composition.  This back however stayed the same since the first treatment. Something completely different needed to be done.

In another blog that will follow shortly in the next few days I will explain the mechanics of what happens to the body after an appendectomy and the reasoning to why this caused Bob a lot of back pain for a year.

Here is a useful tip I learnt the other day.  Take a spoonful of peanut butter perhaps 30-40 minutes before you do a weight training session and you will have more energy to burn.  Obviously if you have allergies to peanuts then don't follow this advice.

Do you remember doing that experiement at school where you set to flame a poor innocent peanut and timed for how long the flame kept alight?  Afterwards you did some maths to determine how much energy was contained within that peanut.  I always remember the peanut burning for quite a long time.

So there you go!!!  Peanuts, they contain a lot of energy.

For the third time today I am completely re-writing this blog piece.  I have spent all day researching the microwave and now, late in the evening, I have finally come across an article I am satisfied with.  Check out the link here.

When you research and study something for so long you pick up the trends, stories, myths, arguments, research and just general know how.  What I liked about this article is that the author covered all the major trends, theories and arguments and then carefully discredited them each in turn.  I thought it was brilliantly written and provides an alternative to the huge number of ‘anti microwave’ reports and websites out there. 

Having read so much today and picked through the various research papers I can safely say she covered the majored topics.  I am actually quite relieved because this piece was turning out to be a monster to write.  The other website that had a good lengthy report on the microwave, and that is anti microwave, is here.  Pick through the evidence and decide for yourself.  I have heard quite a few times within the health industry that the microwave is bad and well here are the facts for you to explore yourself.

Continuing on from this theme of positive thinking, I spent a few hours researching this field and trying to find out what medical research has to say about it.  To cut a long story short I found the name of, probably, the leading expert in this area.  His name is Martin. E. Seligman.  I personally have never heard of him up until now, but I found a website with all of his various papers and it looks very extensive.  Click here:

I have not had time since to explore all of his papers, but I did buy his book which has had many good reviews.  It is the picture above and the book is called; ‘Learned Optimism’.  I am going to read this book and once finished, review it. 

One thought I have had recently and have had many times, especially when it comes to the argument of eating healthy, is the importance of combining positive thinking with eating well.  I believe nutritionists do not give this area of combining positive thinking and eating healthy enough credit or attention.  This is not an attack against nutritionists, far from it.  A lot of medical practitioners leave the mental state of health on the shelf sometimes, for which I too find myself guilty of sometimes.

I am convinced that there is at least a 50/50 balance between the effects of eating healthy and the effects of being positive about what you eat and the possible failings along the way.  I do not have any proof for this and it is just my opinion, but for example, if I ate a healthy salad for lunch and resisted all the urges to have a cake or eat chocolate, then I am naturally going to be pleased with myself.  This pleasure or satisfaction produces endorphins in our brain that numbs pain and reduces stress.  Of course eating the salad and limiting the excess sugar or processed foods will create and provide the body with a fuller nutritional supply.  Therefore the combined effort of eating health, but also thinking positively is optimal.  This piece on endorphins was very interesting:

Further to this is the consequence of negative thinking, which I believe is extremely powerful.  Say I eat that same salad, but I instead decide to eat the cake afterwards for whatever reason.  The guilt and sense of failure is really strong, especially if you are self conscious about your body and believe eating healthy is the answer to getting a better image.  So you have failed on this particular meal time, but the consequence of it lasts way beyond that actual meal.  I believe so strongly that guilt and self-loathing is detrimental to a person’s inner well being.  The internal stress that guilt and condemnation produces, I think, is on a similar level to a physical trauma.  People don’t associate these feelings as an internal stress.  The word stress is often over used and it is unfortunate because there are actually many different types of stress and negative thinking is amongst the strongest stresses you can put your body through.  Again this is just my belief.

If is so important to learn to indentify feelings or even thoughts of failure, worthlessness, insecurity, stupidness, weakness and guilt.  There are many more here I haven’t mentioned, like anxiety or anger, but I want to just concentrate on the thoughts of self.  Once an ability to highlight them is created then the battle to change can really begin.  It is the process of recognizing these thoughts/emotions and not letting them take root, but rather turn 180 degrees around and say the opposite to what you are thinking/feeling.  One day you fail at something or in the past your parents/teachers have told you will never make it, that you will always fail.  It is taking that thought, however many times in arises during the day, and then saying;

“I am not a failure, I can do this”. 

“I am not a waste of space, I am somebody important”.

When we can take these steps; change to the positive is inevitable and I am convinced anybody can achieve these goals in whatever their struggle.  It is important to remember at this point that we will fail at times to keep remembering the steps or may find it extremely exhausting to keep reminding ourselves to work on this process, but it is utterly essential to not beat yourself up and allow guilt to destroy the progress of your work.  Stumbling and getting it wrong is always a part of learning a new thing, like walking as a baby.  Just don’t be hard on yourself, give yourself a little grace.  It is also vitally important to remember that, sometimes, when you have turned 180 degrees around and declared the positive, nothing seems to have changed.  No new emotions can be perceived.  This at times can be very de-motivating, but it is part of the process.  So just keep going.

Positive thinking in this way reduces stress in our lives and it is well known through research that optimistic, ‘happy’ people are healthier and achieve more in life.  They also recover better from injuries and health problems – which makes my job easier.

You can do it.

I was treating a patient the other day when he started talking about a conference he had attended.  The speaker was talking about the power of the mind and positive thinking.  I have heard this kind of talk before and personally, I give it lot of credit.  However I have never really put it into proper action.  I’ve tried in the past once or twice, to rise out of bed and say things like:

“This day is mine” or “I will be successful in everything I do today” or “today is a new day and I am alive”. 

Although I had good intentions behind these thoughts they never really stuck and looking back I am beginning to wonder why.  Perhaps it was simply because I wasn’t ready or I lacked understanding.

Anyway this leads me to my point.  Speaking with this patient and hearing his excitement about what he had heard really struck a chord within me.  I was constantly thinking about this subject over the days that followed.  I became conscious of all the negative thoughts I had and how often I said things like:

“Not now because I have worked hard all day and I deserve a break” or “I’m too tired to do that task now.”

These were really common responses.  I also noticed how much I was complaining, and complaining about the most pointless of things, the weather being the most popular.  Then yesterday happened and I was amazed. 

I’ve had a pretty busy week in general, but more a case of lacking much needed sleep. Yesterday I woke up at 05.30, was at work all day and just felt chronically tired.  At least every hour I kept saying to myself, “I’m too tired to do that task, I deserve a power nap”.  But every time these thoughts arose I squashed them and prevented them from dominating my thoughts.  Therefore the thoughts didn’t lead to any actions.  Further to this, I purposely did the opposite to these thoughts.  If there was a task I didn’t want to do because I felt I deserved a power nap, I made sure I did that task straight away, there and then.  Arriving home around 19:00 in the evening I was still very tired.  By this point I had convinced myself that an evening off was well deserved.  When I finished my dinner I suddenly realized I had some jobs that needed doing that evening.  I huge groan escaped my lips, but I remembered the positive thinking.  So rather than looking over all the tasks I had to do that evening and the pleasures I had to sacrifice as a result, I just went straight into the first task.  While completing the first task my mind desperately wanted to complain and grumble.  It desperately tried to list all the jobs I had to do to highlight to my own self, that the tasks all together were too big a mountain to climb and to just give up.  When I write this I am merely explaining what was happening inside my head.  I’m not trying to have a pity party because there are a lot of people that have it harder than I did yesterday.  My objective here is to highlight the power of positive thinking.

So the first task quickly became the second task and in no time at all I was onto the third, then the fourth and within 2 hours I had finished the tasks that needed to be done.  By the end of this I was feeling very positive, but I was still trying to justify to myself, I deserved a break.  But I stopped at this point and decided to continue doing tasks, to test this positive thinking mindset (does it make a big difference?).  So I sat down at my computer and did a job I have been putting off for months, a job that was not essential and could have waited for another day or so.  So I sat at my computer until 22.30, completing the task and feeling extremely satisfied with myself.

By the time I got into bed I was actually brimming with energy, even though deep down in my body I knew I was actually very tired.  The point here is, I was not denying I was tired, I admitted it.  But I did not dwell on it or allow it to dictate my actions.  By staying positive I gained energy by doing tasks that should have drained me because my mind said they were extremely difficult to do right there and then.

So to summarize:

What happened yesterday was border line remarkable, for me.  I would actually say it was a ‘light bulb’ moment.  Clarity descended and I had a revelation about how truly powerful this positive thinking is.  This is something I will continue to monitor and blog about in the future. 

If this is new to you, how about starting with these ideas.  Highlight in your mind every time you complain about something and why.  Then try and do the opposite to what a negative thought suggests for you to do.  For example; you need to write a letter/email to a friend, but you are too tired.  Instead of agreeing with that thought, say “NO” and then go straight to writing that letter.  The chances are you have the means to do it right there and then otherwise you wouldn’t have thought about it.  Don’t put it on your ‘to do’ list.  There is a difference here between thinking about tasks that need to be done when you are on the move, to your thoughts telling you not to do something now because you are this or that.

When you become better at noticing negativity, you will naturally become better equipped at fighting it with positivity.  Don’t beat yourself up if you fail or notice you complain a lot.  We all do it.

Final note:

If you think about all your friends and the friend that makes you feel the most motivated or alive or free.  The chances are that person is a very positive person, that they believe in themselves and have more confidence.  Positive thinking leads to so many different attitudes, believing you can achieve something or being confident in yourself, are some examples.