Tuesday, July 10, 2007

How Scars influence your posture

(You can find a French translation of this article Here)

Surgeries are not always useful or needed but they do save millions of lives every year.

While allopathic medecine "saves" your life, it brings little attention to the consequence of such a procedure. I don't talk here about the risk inherent to a surgery but about the "post traumatic adaptation" of your body.

My first clinical experience with such a case was when I was an Osteopathic student at the ESO teaching clinic. I was treating Mr G., 67yrs old, for some chronic low back pain. Mr G. couldn't stand for more than 30 minutes without experiencing pain in both thighs. This was a good excuse to avoid the boring food shopping with his wife. He was playing golf twice a week, while the walking and the swing were more supportable than standing still, at the end of the game and for the following few days his back was particularly stiff.
The treatment that I was providing were mostly based on deep massages, mobilisation of the spine, hips, knees... Mr G. was feeling some relief from it and was coming back every 3 weeks for a maintenance treatment.
One day, my Osteopathic tutor (Miss Celine Meneteau) entered the treatment room and asked me : "What is the scar your patient does have on the front ? Did you ever stretch it ?" Effectively the patient had a peritonitis 20 years ago and a subsequent 20 cm scar on his abdominal wall, and "no" I never worked on it, and never thought that it could be of any significance regarding my patient symptoms.
I did indeed stretch this scar as well as providing the usual treatment.
3 weeks later, Mr G. reported that he could not escape any more the shopping with his wife because he could stand more than 2hrs and half without any pain. His swing improved of 60 yards (obviously with the same club !).

"Post traumatic adaptation" :
Obviously an open wound is an experience a bit painful. The following weeks after the surgery, the patients will tend to protect their scar adopting an antalgic posture. The aim of this antalgic posture is to decrease the tension around the painful area.
In the case of a Csection, for example, the patient will bend forward and avoid to straighten up or to arch backward. Slowly the patient recovers from her surgery and can sraighten up a bit more, but compare to her initial posture she is now leaning forward. Why is this ? because there are some scar adhesions !
When an abdomen is cut open, you cut different layers of skin, muscles, fasciae... when the healing process takes place, scarring tissues create adherences between these different layers. What was once upon the time smooth, sliding, elastic healthy tissues are now fix, congested, non-elastic ones. This is the beginning of a long chain of problems...

Let's continue with our new mother who just had a Csection :
The first symptoms will be a sensation of heavyness on the lower abdomen, increase frequency of urination, bloating sensation.
Few months later low back pain starts being an issue and can be associated with pain/cramps in the calves. Of course carrying a child is not helping, but the tension of the scar obliges the mother to constantly lean forward. To compensate this imbalance, the extensors muscles of the spine constantly contract to prevent her from falling forward. At the same time when she leans forward, her gravity centre moves forward as well. This increases the pressure at the distal end of her feet. More tension by the calves muscles is needed to bring back the gravity centre. Guess what ! it gives pain/cramp/stiffness in the calves !

Exercise Time, let's have a try :
Please stand up, flat feet on the floor, bend forward a bit then grab an inch of skin underneath your belly button. Now straighten up (gently) stop as soon as you feel uncomfortable in your lower abdomen. As you cannot straighten up completely, you should be able to feel some contraction in your low back muscles. Slowly you will feel your posture shifting forward, and an urge to push down with your toes, now you feel more tension in your calves . Well done ! if you are a man you just discover the post traumatic adaptation of a Csection!
If you continue this little exercise, You will notice that if you want to look straight you have to extend a bit more your neck. On the long term it increases the compression on the facets of the cervical spine which leads to neck pain, spondylosis, headaches...

In this case, if you just manipulate the spine or massage the back you cannot expect any improvement but a symptomatic short term relief. As soon as you will start working on this scar as well as opening the anterior fascial chain, the change in the posture will be tremendous and this will lead to a great improvement of the symtoms.

Patients who had a masectomy and suffer from shoulder pain on the same side few years later, Patients who had an appendicectomy as a child and now you suffer from some sacro-iliac pain on the right side, patients who had a Csection or a hysteretomy and complain from low back pain or neck pain, did you ever think it could come from this old scar ? If it sounds familiar don't hesitate to contact your nearest osteopath or another competent therapist.


Anonymous said...


I think that it is a good idea to do some exercises with scars and may be it will be good to suggest some for the internal adherences after operations.
By the way, how you suggest to grasp the skin horizontally or vertically?
Then, how to improve adherences after the peritonitis? With time they can lead to the intestinal block and this is the problem for many operated people.
Thanks for your answer,

Pierre de Lasteyrie du Saillant said...

Hi G. !
Sorry been a bit late to answer to your question.
Well I definitely think that it would be needed after most surgeries.
Concerning the grasping bit, well you need to stretch it against the resistance if you want to work with a direct technique otherwise in the direction of the tension if you work inderectly.
You can work on it through more than 8 dimensions if you want to !
horizontally, vertically, deeply, more or less time, temperature, with some "healing" oilments, magnetiquely, psychologically...
For any serious surgery such as Csection for example wait a few months after the intervention before gently getting there.

If you want to know more about any visceral techniques I strongly recommend "visceral manipulation" from J.P. Barral