Scar Tissue And Pain After Back Surgery
The formation of scar tissue near the nerve root is a common occurrence after back surgeryso common, in fact, it is so common that it often occurs for patients with successful surgical outcomes as well as for patients with continued or recurrent leg pain and back pain. For this reason, the importance of scar tissue as a potential cause of postoperative paincommonly called failed back surgery syndromeis controversial.
Scar tissue formation is part of the normal healing process after a spine surgery. While scar tissue can be a cause of back pain or leg pain, in and of itself the scar tissue is rarely painful since the tissue contains no nerve endings. Scar tissue is generally thought to be the potential cause of the patient’s pain if it binds the lumbar nerve root with fibrous adhesions.
Scar Tissue In The Back
Scar tissue in the back can result from significant or repetitive injury to the spinal structures or back muscles. Scarring is a normal part of the healing process and typically strengthens the area against future damage. However, abnormal or excessive scarring can actually cause pain and might even make the affected region more susceptible to further injury in the future.
There are several reasons why scar tissue may be symptomatic. If scarring forms on nerves, neurological dysfunction or chronic pain may develop. If scarring forms on soft tissues, such as muscle, tendon, ligament or fascia, interaction with other structures may cause friction and pain. If scarring forms on bone surfaces or joints, mechanical pain may be elicited when the affected area is mobilized.
One of the typical reasons for problematic scarring to result is spinal surgery. Invasive techniques will leave damage, some of which may be permanent. This is one of the main reasons I always caution patients to learn the risks of surgery before acquiescing. Read more about scar tissue from back surgery.
Can Scar Tissue Cause Pain
Scar tissue may cause pain in several ways. Sometimes, the pain is due to skin tightness, which may make it more difficult to move freely.
In other cases, scar tissue pain occurs due to nerve damage resulting from the original injury. If the wound was deep and affected nerves or tendons, a person might have long-term symptoms, such as pain or numbness, in the affected area.
Some people experience scar tissue pain as a result of fibrosis, which occurs when the body grows an excessive amount of scar tissue. Fibrosis causes adhesions that may lead to ongoing pain, inflammation, and loss of function of the tissue or joint.
Fibroblasts, which are cells that form during scar tissue growth, are responsible for fibrosis. If the fibroblasts do not clear over time, they cause prolonged inflammation.
Other symptoms associated with scar tissue include itching, swelling, and tenderness or sensitivity.
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Can You Massage Away Scar Tissue
Under the right conditions, scar massage and manual therapy techniques can have a significant impact on scar tissue release. It is important to note that your scar must be fully healed before you begin any type of scar massage therapy. If you begin too soon you could cause the wound to reopen or tear, which could cause pain or lead to an infection.
Using massage techniques on scar tissue will be most effective in the first 2 years, while the scar is still forming. During this timeframe, you may notice significant benefits to massaging scar tissue, including:
- Improved blood flow to promote scar healing progression
- Increased range of motion, making the scarred area not feel so tight
- Reduced swelling by draining excess fluid
- Less scar tissue build up, which can reduce muscle stiffness and weakness
- Reduced sensation of numbness and tingling
Massage can reorganize scar tissue, helping your body heal faster, and potentially reduce the appearance of your scar. After consulting with your healthcare provider, you may want to try massaging your scar at home. Here are a few tips to ensure it is done properly:
How Do You Dissolve Scar Tissue Naturally
If you tired all other options, or are just looking for a safe and natural method to reduce or eliminate scar tissue, there are a handful of non-invasive treatment methods you can try at home.
- Get moving as soon as your doctor gives you the green light. This can help prevent stiffness from occurring.
- Stretching will help restore your natural tissue length.
- Massage techniques mentioned above can help with scar management.
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Scar Tissue After Back Surgery 101
There are actually 3 phases of scar formation and healing: inflammatory, proliferation, and the remodelling. During the inflammatory phase, blood clotting starts and the incision looks red and inflamed. A few days after surgery, the proliferation phase begins where new tissue form to close the wound. The third stage, is where the scar tissue forms, and the area feels textured. This phase lasts for several weeks and months after surgery. Its during the remodelling phase that you should begin to work your scar tissue. You should not massage scar tissue until your incision has completely healed .
Exercise and movement after back surgery is the absolute key to reducing scar tissue build-up, avoiding complications associated with scar tissue , and for increasing healing, mobility, reducing tightness & more.
Internal Scar Tissue After Surgery
There is always the risk of getting an internal scar tissue after surgery. This is attributed to the fact that surgery typically involves making incision to tissues and organs. As the body attempts to heal itself of the remaining wounds, a scar tissue is naturally formed.
The scar tissue can then result in an adhesions a scar tissue joining two tissue or organs that are usually separate which can then culminate in pain , restricted movement, and other symptoms such as bowel obstruction, infertility, and urinary bladder dysfunction to name but a few.
As the Australia Better Health Channel reports, abdominal adhesions affect 93% of patients who have had abdominal surgery and 10 percent of people who have never undergone surgery.
Talk to your doctor or surgeon for appropriate treatment option if you experience any symptoms of scar tissue e.g. pain, after undergoing a surgical procedure.
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How To Work Around An Injury
There will be times when you will still need to train while recovering from a pulled muscle or other soft tissue injury. Heres an example of how I re-structured my training while recovering from a recent injury
I broke my toe a little while back the long one next to my big toe on my right foot. I was pulling my boat up onto the trailer at a local boat ramp, and my foot slipped forward and my toe caught on something. It didnt hurt much when I did it, but by the time Id washed the boat down and put it away, my toe had turned a yellow-ee purple color and it was starting to throb.
I stuck some ice on it and sat on the couch with it propped up on a few pillows. Theres not much else you can do for a broken toe: Ive broken my toes a few times in the past and the only advice Ive ever got from a doctor is strap it to the toe next to it.
I wasnt too worried. I tend to heal quite quickly, and lets face it its only a toe. It wasnt going to stop me from doing much But it did stop me from doing one of my favorite pastimes running.
So what do you do when an injury stops you doing the sport you love? Answer: You work around it.
As an Ex professional athlete, Ive had my fair share of muscle tears and strains, and you learn pretty quickly that you cant do the same activity day in, day out. You need variety! You need to let your body rest from some activities and give it different activities to keep your conditioning up and work on areas that would normally be ignored.
Scar Tissue And Continued Pain After Back Surgery
Scar tissue formation is part of the normal healing process after back surgery. While scar tissue can be a cause of pain, actual scar tissue pain is very rare since the tissue contains no nerve endings.
Rather, the principal mechanism of pain is thought to be the binding of the lumbar nerve root by fibrous adhesions, called epidural fibrosis. Postoperative stretching exercises can help decrease the effects of postoperative scarring around the nerve root.
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What Is Scar Tissue
Scar tissue. Adhesion. Fibrosis. The words are different, but the concepts are the same. This dense, fibrous tissue affects us all and is an underlying factor in many injuries. Scar tissue binds up and ties down tissues that need to move freely. As scar tissue builds up, muscles become Shorter and Weaker. Tension on tendons causes tendinosis. Nerves can become trapped. All these problems can cause reduced range of motion, loss of strength, and pain as well as tingling, numbness, and weakness.
Scar tissue forms two different ways. First, if a muscle, tendon, or ligament is torn or crushed, the body creates scar tissue to Glue the torn pieces together. This is a necessary part of the healing process.
The second, more common way for scar tissue to form is by soft tissue in the body not receiving enough oxygen . Hypoxia is more common than one may think. Poor posture, athletic pursuits, repeated use, and sustained pressure all increase muscle tension and result in hypoxic conditions. When muscle tension is increased, blood supply to the area is reduced. A healthy blood flow is so important because blood carries oxygen to muscles. A reduced blood flow means less oxygen and that means hypoxia.
Hypoxia leads to free radical accumulation in muscles. Unfortunately, Free Radicals attract cells that produce scar tissue. These cells begin lying down scar tissue and over time, scar tissue begins affecting surrounding muscles, tendons, ligaments, fascia, and nerves.
How To Get Rid Of Scar Tissue
Firstly, you must keep active! Dont listen to anyone who tells you to do nothing. Most of the swelling and inflammation will have subsided after the first 48 to 72 hours and you are now ready to start light activity.
Light activity promotes blood circulation and also activates the lymphatic system. The lymphatic system is vital in clearing the body of waste products, which can accumulate in the body following a pulled muscle or muscle strain. Activity is the only way to activate the lymphatic system.
To complete your recovery and remove most of the unwanted scar tissue, you now need to start two vital treatments. The first is commonly used by physical therapists , and it primarily involves increasing the blood supply to the injured area. The aim is to increase the amount of oxygen and nutrients to the damaged tissues.
Physical Therapists accomplish this aim by using a number of treatments to stimulate the injured area. The most common methods used are ultrasound, TENS and heat.
Ultrasound uses high frequency sound waves to stimulate the affected area, while TENS uses a light electrical pulse to stimulate the injured area. And heat, in the form of a ray lamp or hot water bottle, is also very effective in stimulating blood flow to the damaged tissues.
Either find someone who can massage the affected area for you, or if the injury is accessible, massage the damaged tissues yourself. Self massage has the advantage of knowing just how hard and deep you need to massage.
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Internal Scar Tissue Symptoms
No internal scar tissue symptoms are usually expected unless the scar tissue has led to the development of a painful adhesion. An adhesion is in simple terms a band of scar tissue that binds together two tissues that are naturally separate. For instance, a healing scar tissue could cause an organ to bind with the abdominal cavity.
Abdominal and pelvic adhesions are frequently the problematic type and can lead to Adhesion Related Disorder which is characterized by the following symptoms:
- Chronic abdominal and pelvic pain
- Infertility
- Depression and other emotional disorders
- Constipation
The above symptoms can be confused for a whole lot of conditions including endometriosis, fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, anxiety, and depression.
What Conditions Can Adhesiolysis Help With
The presence of scar tissue, even from an old and healed injury, can irritate still-healthy nerves.
One of the most common causes of excessive scar tissue is prior back surgery. After spinal surgery, adhesions develop and may cause recurrent, intractable pain. These inflamed nerves can cause pain that radiates from your lower back into the legs.
Prolonged neck or back pain can also result in scarring in the epidural space, particularly if other interventions have been met with minimal success. The scarring caused by disc herniation can also cause pain, even after repairing the damage.
Further, patients who experience pain from adhesions may suffer twice, as scar tissue can also prevent other pain treatments from working effectively. Scar tissue can block the medication delivered in an epidural steroid injection to both the epidural space and to other tissues or affected areas.
Instead, adhesiolysis dissolves scar tissue to reduce pressure on irritated nerves. Essentially, any back pain condition that has become chronic, or the treatment of which has resulted in scarring that has aggravated the pain and inflammation, could benefit from lysis of adhesions.
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Scar Tissue In The Back Muscles
Muscular scar tissue can affect the back muscles themselves or the tendons, fascia and ligaments in the affected region. Muscular scarring is common from repetitive strain injury and can build-up over time. Scarring in the back muscles can cause a reduction in functionality and range of motion. Scar tissue might encourage future injury at the same site, but this is not always the case.
Scar tissue is often blamed for pain, but is rarely the culprit for serious dorsopathy symptoms. Proper back pain rehabilitation of any muscular injury will go a long way to prevent problematic scarring from occurring in damaged soft tissues.
Help for Scar Tissue in the Back
Scar tissue is another very common scapegoat condition blamed for a host of otherwise idiopathic pain complaints. While it is possible that scar tissue can cause pain and functional impairment, this is the gross exception to the rule, not an everyday event. The most common cases of troublesome scar tissue occur in patients with multiple serious injuries to a particular body part, including athletes and people with repetitive motion jobs.
If you suspect that scar tissue might be playing a role in your pain, consult with a physical therapist who might be able to assist you in working through the condition and returning to full functionality.
Ways To Treat Scarred Spinal Nerves
Scarring is part of the bodys natural healing process. At the same time, it can be a source of additional pain following spine surgery. This type of scarring is referred to as epidural fibrosis, or spinal nerve scarring. Some spine surgery patients have post-surgery scarring without even knowing it if nerves arent irritated by scar tissue, which is what often happens. But if spinal nerve scarring is producing noticeable discomfort, keep reading to learn what can be done about it.
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What Is Active Rehabilitation
Most people refer to this phase of the recovery process as the active rehabilitation phase, because during this phase you will be responsible for the rehabilitation process. You will be doing the exercises and activities required to speed up your full recovery.
This phase of the injury rehabilitation process should only be implemented after the initial healing process has been completed.
The aim of this phase of your rehabilitation will be to regain all the fitness components that were lost during the injury process. Regaining your flexibility, strength, power, muscular endurance, balance, and co-ordination will be the primary focus.
Without this phase of the rehabilitation, there is no hope of completely and permanently making a full recovery from your pulled muscle. A quote from a great book called Sporting injuries by Peter Dornan & Richard Dunn will help to reinforce the value of active rehabilitation.
The injury symptoms will permanently disappear only after the patient has undergone a very specific exercise program, deliberately designed to stretch and strengthen and regain all parameters of fitness of the damaged structure or structures. Further, it is suggested that when a specific stretching program is followed, thus more permanently reorganizing the scar fibers and allowing the circulation to become normal, the painful symptoms will disappear permanently.
1. Range of Motion Exercises
2. Strength Exercises
3. Stretching Exercises
4. Balance and Proprioception
Scar Tissue Removal Surgery
Percutaneous epidural adhesiololysis, also known as the removal of scar tissue, is used to treat patients with refractory low back pain caused by scarring. Epidural scarring can occur as the result of a previous tear in the disc which inflamed the nerves, the inflammation may resolve, but scarring may persist without prior surgery.
Blood clot formation may occur in the epidural space during to the post-op period. After spine surgery, scar tissue may adhere to the nerve roots. Scar tissue around the nerve can inhibit nutrients from reaching the nerves, causing hypersensitivity. Mechanical compression can also occur. The scar tissue is formed in the epidural space. The potential space located in between the spinal cord and spinal canal.
The procedure is performed under x-ray guidance. After local anesthesia is administered to the skin, a needle is advanced to the proper anatomical location. A specialized catheter is advanced through the needle. Contrast dye is administered to outline the scar tissue.
There have been numerous alternatives to the next sequences of the treatment forms. Initially hypertonic saline was infused daily for three days to break up the scar tissue. Initial studies were promising, but unfortunately could not be reproduced.
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