Chronic back pain affects millions, and while causes like disc herniation or muscle strain are commonly recognized, the source of persistent discomfort can sometimes be elusive. Bands of internal scar tissue, known as adhesions, are a potential, though often overlooked, contributor to chronic back pain. These fibrous connections form as a natural part of the body’s healing process, but when they occur in specific locations, they create abnormal tension and restriction. The concept of adhesions acting as a pain generator is gaining recognition, particularly when conventional back treatments have not provided lasting relief.
Understanding Adhesion Formation and Location
Adhesions are bands of fibrous, scar-like tissue that develop between organs or tissues, causing them to stick together abnormally. This tissue is composed primarily of collagen, produced by the body in response to injury. The most common trigger for adhesion formation is prior surgical procedures, especially those involving the abdomen or pelvis, where they occur in up to 93% of cases following open abdominal surgery.
Adhesions can also form after internal trauma, infection, or chronic inflammation, such as endometriosis or inflammatory bowel disease. While many adhesions remain asymptomatic, they become relevant to back pain when they form in the abdominal or pelvic cavities, which are adjacent to the lumbar spine and sacrum. These internal scars can tether organs like the bowel, uterus, or bladder to the abdominal wall, creating a fixed anchor point that affects biomechanics far beyond the initial injury site.
The Mechanism: How Adhesions Cause Back Pain
Adhesions cause back pain through several biomechanical pathways that disrupt normal movement and nerve function. One primary mechanism is tension or traction. Adhesions pull on the surrounding fascial planes, muscles, and ligaments, creating a constant internal strain that manifests as pain in the posterior region. This fixed tension restricts the natural gliding motion of internal structures, forcing the spine and its supporting muscles to compensate during everyday movements.
Adhesions can also directly cause pain by entrapping nerves. If scar tissue forms near a peripheral nerve or a spinal nerve root, it can compress or tether the nerve, preventing its natural movement. This nerve entrapment leads to symptoms that radiate into the hips or legs, including burning sensations, numbness, or tingling, which may mimic conditions like sciatica. In the spine itself, a type of scar tissue called epidural fibrosis can form around the spinal cord and nerves, physically pulling on the nerve roots and causing persistent back and leg pain, especially following spinal surgery.
The restricted mobility forces the muscles of the back and core to work inefficiently, leading to chronic muscle strain. This constant compensatory effort results in fatigue and localized pain that often does not respond to treatments focused on the back muscles themselves. The pain felt in the back is often referred pain, meaning the source is the scar tissue in the anterior (front) cavity, but the sensation is experienced in the back due to shared nerve pathways and fascial connections.
Diagnosis and Management Strategies
Diagnosing adhesions as the source of back pain presents a challenge because they are often not detectable on standard imaging like X-rays, CT scans, or MRI. These non-invasive tests generally only visualize adhesions if they are causing a severe complication, such as a complete intestinal obstruction. Therefore, diagnosis relies heavily on a thorough clinical history, especially a detailed review of past surgeries, infections, or inflammatory episodes. Diagnosis often proceeds by exclusion, where other common causes of back pain are ruled out before adhesions are considered the primary culprit.
Once suspected, management begins with conservative approaches aimed at restoring mobility and reducing pain. This includes specialized physical therapy focusing on soft tissue mobilization and myofascial release techniques, which attempt to stretch and improve the pliability of the scar tissue and surrounding fascia. Pain management may involve medications or targeted nerve blocks to interrupt the pain signals.
Surgical treatment, known as adhesiolysis, involves cutting or removing the scar tissue to free the tethered structures. Due to the inherent risks and high potential for recurrence, adhesiolysis is considered a last resort. The body’s healing response to the surgery itself can lead to the formation of new adhesions, requiring a careful risk-benefit assessment before proceeding. For spinal adhesions, a minimally invasive procedure called epidural lysis of adhesions can be performed to target scar tissue near the nerve roots.