Scar Tissue - An Osteopathic Understanding

For months now I have been writing this article about scar tissue. I have found quite a lot of information, but as usual nothing on a deeper level. A lot of books and websites will say scar tissue can create blockages, but I want to know why and how. So I hope what I have written will provide some of these answers.

What is scar tissue?

In my line of work we tend to use other phrases like abdominal adhesions or fibrosis to accurately explain scar tissue.  Abdominal adhesions are pretty specific to internal workings of the body, usually linking an organ to an organ or tissue to an organ. Adhesions are fibrous bands that connect one tissue to another tissue, forming a connection that physiological shouldn’t be there. These bands are fibrous, meaning they are tougher and less flexible than their surrounding tissues to which they make the connection. Hence the phrase ‘fibrosis’.

When adhesions form between two different organs it can create a tethering, much like an anchor on a boat. One organ becomes partially fixed and therefore permanently struggles to expanded, stretch, move or glide. Sometimes a tether can also behave like a torsion and actually constrict an organ, creating a physical blockage. This is especially true in tubular organs. Within both of these examples, movement and physiological function is lost. I want to focus on the movement aspect first. Reduced movement in anything, especially with regard to the body, is a bad thing. Whenever there is a reduction in movement there is also a reduction in nutrient supply and reduction to toxin expulsion. Too much toxin build or not enough nutrient supply can lead to cell death. Any form of death in the body automatically triggers an inflammatory response. Similarly if stagnicity is present then there is a much greater chance of infection. Stagnicity indicates a lack of sufficient blood supply and therefore a lack of immune response to the targeted area via the blood supply.

So what happens?

In the case of surgery, the natural healing process is kick started by inflammation. Inflammation brings all the materials needed for repair and clears the site from harmful microbes. Fibrin is then laid down, acting like glue and eventually creates a fibrosis. Collagen is the last substance to be introduced.

Collagen is present in pretty much every tissue of the body and is usually laid down in a random, chaotic pattern [picture to the left]. 

However in scar tissue, collagen is laid down in heavy concentrations in a linear pattern or a straight line pattern. This is what gives scar tissue that white smooth linear look [pictures below].

When collagen is laid down in thick fibrous bundles the blood supply becomes very insufficient. Collagen is very inflexible and together with the poor blood supply, it makes an area of scar tissue quite lifeless. So the vitality that was once present in the healthy tissue pre trauma (operation) becomes a rigid, tense and almost lifeless area.

If you think that collagen is the primary ingredient in bones and ligaments you will begin to understand the far reaching consequences of putting a material like this directly into a healthy functioning tissue, especially an organ.

Here is an example to try and explain the consequences of abdominal adhesions:

Imagine taking a normal balloon, it blows up normally and evenly. Now imagine putting a strip of duck tape on it, like a plaster. When you blow up the balloon again, everywhere expands except the area of duck tape, which stays fixed. The balloon then expands around the duck tape and forms an asymmetrical blob. It no longer looks like a normal balloon. This is how scar tissue or collagen functions when laid down in places not originally designed for that purpose. This leads on to the model of Osteopathy I’ve tried to explain before. Everything is motion, moving, fluid, and breathing. Put a fixed, fairly lifeless structure into this system where it is not designed to be and it will start to become a stress on the system, all bit a minor stress to begin with.

So what are the consequences of surgery?

When surgery is performed external air will get into the abdomen and this dries out the natural lubrication and viscosity of the various abdominal organs and tissues. Often blood is split  and becomes sticky, producing the same consequences. When the layers become dry or lack lubrication, this will increase the friction of movement between the layers. The various layers are now pinned together, and the once free movement upon each other, is now dictated by the scar tissue. They can no longer slide and glide upon each other. This increases the friction between the various layers.
If you take two glass panels and put water between their two surfaces and slide them over each over, it is effortless. Remove the water and slide the glass again and it becomes a lot less smooth. This is the principle here. The viscosity changes after trauma or surgery and so in time this can add small repetitive stresses. [see video below - laparoscopic appendectomy].

I want to thank 'Kiplinght' for permission to use his video.

The other aspect here to consider is when an organ becomes unnaturally fixated its axis of movement changes. This has far reaching effects on the other organs because the organs all rotate and move to a certain rhythm. The ascending colon has attachments to the kidney, duodenum and liver. All these organs move and they move together, effortlessly and cohesively. When the axis of movement changes, say at the ascending colon for example, then instantly the colon will pull away from its natural pattern of movement and therefore pull on the other 3 organs just mentioned. In time this can put stress on these organs and they can go into dysfunction too.

If the axis of movement to which an organ rotates around changes, then this can also alter the dynamics of the mechanoreceptors. Mechanoreceptors are neurons that pick up changes to pressure or stretch. So if a stretch or distortion exists that shouldn’t exist, then this could unnaturally trigger the mechanoreceptors. The feedback goes to the spine/brain and comes back resulting in spasms to the muscles of the organ.

In the stomach, when the mechanoreceptors are triggered, the stomach begins to release hydrochloric acid (HCL). So if there is a fixation on the stomach, due to some external input, the mechanoreceptors can fire and produce more HCL acid. This increases the acid production which in time can lead to possible ulcerations or a hiatus hernia. The mechanoreceptors are designed in this case to be triggered when the stomach is becoming stretched as a result of food entering it, not through other stimuli.

So here comes the million dollar question; can scar tissue be treated?

Yes I believe scar tissue can be treated after surgery. But first we must look at scar tissue from a slightly broader perspective. When the body heals from a wound, it usually has some consequences that stick around after the healing processes have finished. The wound site is often bigger than the resultant collagen scar tissue. There is nearly always an affected area around the scar that usually presents with stiffness, reduced vitality and reduced function. It is this area that is treatable.

By pulling, stretching, twisting or lifting an organ we can release the tensions spreading in and around the site of scar tissue. During an appendectomy a cut is made down to the large intestine from the skin, through a fat layer, through fascial layers, through the abdominal muscles and then finally into the abdominal cavity (recently they have started using laparoscopy, which minimalises scarring). The cut to reach the Cecum is actually relatively small and often the resulting scar tissue is small. However we often find that the entire Cecum and ascending colon is fixated and has lost its functional movement. So the area of injury or trauma is no longer actually focused towards to the site of scar tissue. The aim would therefore to be to lift the Cecum off the posterior abdominal wall, stretch the iliocecal ligaments located inferiorly and to also stretch the ascending colon. This often nearly always clears up the problem and functional movement returns to almost normal. I do not believe however that the physical scar tissue, made of collagen is treatable. But this is just my opinion.