Generally, abdominal surgeries can lead to all sorts of pain and problems, but abdominal surgeries from infancy can really wreak a whole new level of havoc with functional movement patterns. The extent can be dramatic and, in some cases, cause lifelong chronic pain, postural issues, and functional deficiencies and disabilities.
I’ve been seeing one client to treat the effects of an infant abdominal surgery as well as many other issues, weekly, for a while. We have made huge leaps forward in many areas, increasing strength and stability, and reducing pain. However, one issue has been eluding us. My client’s right hip often slips forward in its socket, especially when walking, making it unstable and painful.
We’ve known for a long time that the abdominal scar tissue, which is primarily on the right side, was causing this problem. The scar tissue in the front of the right abdomen pulls aggressively all the way down the front of the thigh and a downregulation of the rectus femoris is one of the results. Activation of the rectus femoris helps the head of the femur glide backwards, and when it isn’t doing its job the glutes and hamstrings will unhappily push the head of the femur too far forwards when walking.
I have highly developed skills in releasing scar tissue and can work precisely and subtly to get results. And I’ve tried to release this tissue on the table a few times, but I haven’t been successful. One of the scar tissue release techniques that I use frequently is to ask clients to activate certain lines of pull while I pin the tissue in place. This can work on the table, but it hasn’t in this case. I just couldn’t seem to target the exact right tissues.
There are two important reasons I kept missing the mark:
This client has never organized their core muscles optimally to support them in standing or walking because these scars grew when those functions were not yet required by their infant body.
Firstly, I identified the tissues affected and the lines of pull and dysfunction in standing, and while the client was trying to lift the right leg.
I did some releases in standing and while we made some progress with this, I wasn’t satisfied. We had to take it a step further.
The second step was to train the abdominal muscles meant to stabilize the left side of the abdomen and hip when standing on the left leg to coordinate with the right hip flexors. This is particularly difficult for this client, who had never managed to stabilize their core with their core muscles because the abdominal surgery happened just after they were born.
To train this I explained the mechanics, cued the client, offered supports and demonstrated while the client palpated my hip, back, and abdomen.
Eventually, while holding a chair for extra support, the client was able to do this task with difficulty and huge levels of concentration for a minute or so at a time. The range of motion was very small, but the correct muscles were activating while the core was stable.
The last thing to do was the actual release. The client did this focused and precise activation WHILE I pinned the scar tissue in place with a fair amount of force. With each lift of the rectus femoris, it pulled the exact right scar tissue apart and the movement got easier and easier. BINGO!
The results were excellent. My client has been able to stop visiting the physio regularly just to have her hip ‘put back in’ and we are both happy.
All Integrative Movement Therapy services are provided under the scope of practice of Registered Massage Therapy in Ontario as per the regulations of the CMTO, and are thus eligible for insurance coverage for massage therapy.