Adhesions are bands of fibrous tissue that form inside the body as a natural part of the healing process following injury or inflammation. They connect organs or tissues that are normally separate from one another. While most adhesions remain asymptomatic, they can sometimes become a source of chronic discomfort or pain. When they restrict movement or irritate nerves, they can manifest as pain distant from their origin, including persistent or recurring back pain.
Understanding Adhesions
Adhesions are fibrous connections composed of collagen, the main protein in scar tissue. They range from thin, sheet-like structures to thick, rigid cords. These structures form when the body responds to trauma, most commonly during surgical procedures, particularly in the abdomen or pelvis.
The body’s repair mechanism involves laying down a temporary mesh of fibrin to seal the damaged area. Normally, enzymes dissolve this mesh once the tissue is healed. However, if the healing response is excessive, the fibrin persists and turns into permanent, dense scar tissue. While surgery is the most frequent cause, adhesions can also develop from infections like peritonitis, inflammatory conditions such as endometriosis, or physical trauma.
How Adhesions Generate Back Pain
Adhesions generate back pain through two primary pathways: biomechanical restriction and neurological irritation. Adhesions, often post-surgical in the abdominal or pelvic cavities, create tension that pulls on surrounding fascial layers and connective tissue. This tension restricts the normal, fluid movement of the trunk and pelvis.
This restriction forces the body to adopt compensatory movement patterns, placing unnatural stress on the muscles, ligaments, and joints of the lumbar spine. This chronic strain leads to muscle imbalances and persistent stiffness, manifesting as chronic, non-specific back pain. The non-elastic nature of the adhesion inhibits the subtle internal movement necessary for full spinal range of motion.
Neurologically, an adhesion can directly compress or irritate somatic nerves as they exit the spine or pass through the pelvic region. This nerve irritation causes referred pain, felt not at the site of the adhesion, but in the lower back, hips, or legs. Furthermore, when adhesions form in the epidural space surrounding the spinal cord, often after previous spine surgery, they can tether or entrap nerve roots. This entrapment causes radiating, burning, or shooting pain that mimics conditions like a recurrent disc herniation.
Diagnosing Adhesion-Related Pain
Diagnosing adhesions as the source of chronic back pain is challenging because the fibrous bands are difficult to visualize with standard diagnostic tools. Conventional imaging, such as X-rays, CT scans, and standard MRI, typically do not provide clear images of the thin, non-calcified adhesions in the abdominal and pelvic cavities. Therefore, the diagnosis of referred back pain from abdominal adhesions is largely a process of exclusion.
A detailed review of the patient’s medical history, especially prior surgeries, infections, or inflammatory conditions, is a paramount diagnostic tool. The pattern of pain is also a crucial indicator: adhesion-related pain is often chronic, worsens with specific movements that stretch the scar tissue, and is unresponsive to typical musculoskeletal treatments. For suspected spinal adhesions, specialized MRI techniques using contrast dye can help differentiate scar tissue from other causes like a recurrent disc.
Managing Pain Caused by Adhesions
The initial approach to managing back pain caused by adhesions is typically conservative, focusing on restoring mobility and reducing pain sensitivity. Specialized physical therapy employs manual techniques like myofascial release and visceral manipulation. These techniques aim to gently stretch and loosen the restrictive scar tissue, improving the movement between internal structures and relieving tension on the spine.
For more localized or severe pain, interventional options include targeted pain injections to calm irritated nerves. For spinal adhesions, a minimally invasive procedure known as epidural lysis of adhesions may be performed to break down the scar tissue around nerve roots. Surgical intervention, called adhesiolysis, is reserved as a last resort because cutting the existing scar tissue carries a significant risk of triggering the body’s healing response and forming new adhesions.