Sciatic pain caused by an old abdominal scar from years ago.

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She said that over the past couple of years, her leg pain which began on one side was now in both legs Getting out of a chair was painful and difficult. She was now experiencing knee pain as well and thought the stiffness in her upper body and neck was a normal part of aging, since it developed over many years. Her medical doctors suggested the sciatic pain problem was due to spinal stenosis after reading her MRI report. Spinal stenosis is a condition that will reduce  the space for the nerves in her spine and cause sciatic pain.   Her doctors first recommended physical therapy which was unhelpful and then recommended epidural injections to the lower back which did not offer long term improvement of her symptoms. Upon further questioning, she did mention that she had two abdominal surgeries, one for gall bladder and another for a hysterectomy years ago. Our evaluation showed that she was built asymmetrically, with low arches, although extension of the lower back did not exacerbate her back pain or aggravate her leg symptoms.  Spinal stenosis is usually aggravated by extension of the lower back and can cause stenosis related leg pain to worsen. While performing the evaluation while standing, she had notable restrictions of movement to the right when standing which caused pain in her opposite leg.   It was also noted when feeling around the area of her lower abdominal scar that the scar itself was restricting movement in both lateral bending and extension when she was standing.  These type of scars are known as active scars, and unless a thorough evaluation of the patient is performed combined with a thorough history, it cs often missed. The patient noted an improvement of mobility and pain after the scar was treated in two different positions during her first visit to our office.

Understanding active scars

An active scar develops after surgery when a scar underneath the surface is restricting the movement of the body causing symptoms after it heals. The most common types of active scars are in the abdomen and are usually caused by;  
  • C-sections.
  • Hernia repairs
  • Hysterectomies done through the abdominal musculature.
  • Other open abdominal surgeries.
Less common are scars caused by arthroscopic procedures, since they are less traumatic. Differential diagnosis of an active scar from other sources of back pain requires the healthcare provider to palpate or feel for restrictions.  While an MRI in the case of sciatic pain may be valid, not evaluating or considering a potentially active scar can result in costly and risky treatments and tests that were avoidable by treating the scar first. The data on active scars has been growing over the years, with many of these papers being presented at the International Fascia Research Congress. The percentage of how many scars are active has never been reported, however, your risk increases if there were an infection during the healing process.

Treatment of active scars

Treatment consists of myofascial techniques to the scar, and to adhesions that reside underneath the scar in the abdominal area.  A skilled therapist may use their hands with the patient in different positions to free adhesions that are restricting motion and causing symptoms. Usually, when an adhesion that affects motion has been cleared, the patient will experience dramatic symptomatic relief immediately.  They may also notice that activities that were aggravating it such as walking, yoga moves or other types of activities were now possible without the pain they were experiencing before. Active scar treatment is also enhanced by treating the skeletal and extremity components of tight tissues, and well as by using manipulation of the joints in those regions. A chiropractor who performs myofascial therapy such as myofascial release, Graston Technique for surface scars and then uses manipulation to improve the movement of the area with exercises is your most efficient and effective type of provider to treat these types of conditions.  Combined with the holistic approach chiropractors use for evaluation and treatment without drugs or invasive procedures, they can help you resolve or markedly improve the condition. Chiropractors are primary care for musculoskeletal conditions and are often referred to as being primary spine physicians. Who you see first can make a big difference in proper diagnosis, cost, and responsiveness to care.   All roads lead to the chiropractor.