Fascia Adhesions: Treatment Options for Chronic Pain Relief

Regarding extensive fascial degeneration, adhesion, or fibrosis?

Hello Doctor, I have been experiencing unexplained hip joint pain for over ten years.
After ten years of examinations, no issues were found until recently when abnormal nerve conduction signals were detected.
The doctor diagnosed that the report indicated no signs of nerve compression in the short term, leading to the conclusion that my nerves may have been damaged in the past and have healed improperly, resulting in abnormal signals.
Due to the nature of the pain resembling nerve compression, treatments have primarily focused on the neurological aspect.
However, as time has progressed, the original pain has gradually transformed into myofascial pain, with significant muscle strength imbalances observed during dynamic assessments.
There is noticeable asymmetry in the appearance of the hip and abdomen, with multiple muscles on the left side being non-functional.
The adhesions and friction in the fascia have become increasingly severe and widespread, severely impacting my daily life (I cannot walk without thinking, I sit crooked, and I experience sharp pain in the abdominal muscles and fascia, making it impossible to work for the past three to four years).
My previous profession was similar to that of an athlete, and most doctors assess that the cause is due to long-term poor posture and improper muscle use, with significant adhesions noted around the hip and iliac region.
The sliding ability of the fascia from the lower abdomen to the lower rib cage has deteriorated, and any movement feels like sandpaper rubbing against my body.
Both hospital doctors and therapists at private physical therapy clinics have suggested the presence of fascial adhesions, but unfortunately, I have not found a better treatment method.
Adhesions in the fascia or muscles are not visible on imaging studies (I have undergone countless MRIs, CT scans, X-rays, EEGs, and spinal examinations over the past ten years, to the point where doctors are concerned about radiation exposure and have advised against further imaging).
Most doctors can only recommend traditional physical therapy, electrical stimulation, and heat therapy; however, certain adhesion sites, such as the groin and abdomen, cannot be treated with electrical stimulation.
I have also tried various invasive therapies (prolotherapy injections: glucose, PRP, steroids, electrical acupuncture, etc.), but none have been effective.
I continue to attempt exercise therapy, but many muscles on the left side (latissimus dorsi, quadratus lumborum, iliopsoas, gluteal and lower back muscle groups, etc.) are being pulled towards the left hip and groin due to the adhesions, and since the adhesion points cannot be released, many muscles are in incorrect positions (visible to the naked eye) and cannot exert normal force.
Therefore, exercise therapy has been unable to effectively train these muscles (I initially discovered that the left side could not even expand during breathing).
Stretching is also ineffective, as it feels like a layer of plastic wrap tightly binding these muscles.
To supplement, the issue of fascial adhesions has been confirmed by many doctors and therapists during treatment, indicating that my sensations are not due to nerve damage causing abnormal feelings (I believe the adhesions are causing nerve conduction issues, as earlier neurological examinations were normal).
Currently, I can use a massage ball to loosen some fascia, but after loosening, the elasticity and sliding ability of the fascia are poor, and pain persists.
Additionally, the adhesion points in the hip joint cannot be released, and large areas of fascia in the abdominal cavity still feel misaligned.
However, when these areas are loosened, some muscles become usable.
I understand that fascial issues are complex, and I have consulted many doctors.
I also realize that it may be difficult for you to assess my situation based solely on text.
However, I genuinely do not know what to do anymore.
I would like to ask you if there are any treatment methods you would recommend for this type of fascial and muscular degeneration and adhesion, aside from electrical stimulation and heat therapy (which cannot be applied to many areas due to the extensive range).
I am willing to try anything that can be attempted.
Thank you for taking the time to read this, and I look forward to your reply.
Thank you.

A Yuan, 30~39 year old female. Ask Date: 2022/07/17

Dr. Li Yanheng reply Rehabilitation

It is recommended that if there are issues with pain and joint mobility, one should first consult a physician to address the pain and joint mobility concerns.
If the pain and joint mobility issues are manageable, it is advisable to engage in multi-joint exercises under the supervision of a coach or therapist, such as squats, to enhance muscle tension and neural connections, and to combat issues related to adhesions and degeneration.

Reply Date: 2022/07/17

More Info

Fascia adhesions can be a significant source of chronic pain and dysfunction, particularly when they lead to muscle imbalances and restricted movement. Your situation, characterized by long-standing hip pain, muscle imbalances, and the development of fascial adhesions, is indeed complex and requires a multifaceted approach to treatment.

Understanding Fascia Adhesions
Fascia is a connective tissue that surrounds muscles, bones, and organs, providing support and structure. When fascia becomes tight or adheres to surrounding tissues, it can restrict movement and lead to pain. This condition can arise from various factors, including poor posture, repetitive strain, injury, or prolonged immobility. In your case, it seems that years of compensatory movement patterns due to pain have contributed to the development of these adhesions.

Treatment Options
1. Physical Therapy: While you have already tried traditional physical therapy, it may be beneficial to seek out a therapist who specializes in myofascial release or manual therapy techniques. These approaches focus on releasing tension in the fascia and restoring normal movement patterns. Techniques such as deep tissue massage, myofascial release, and trigger point therapy can be particularly effective in addressing fascial restrictions.

2. Active Release Techniques (ART): This is a specific type of manual therapy that targets adhesions in the fascia and muscles. ART practitioners use their hands to evaluate the texture, tightness, and movement of muscles, fascia, tendons, ligaments, and nerves. They then apply specific tension while the patient moves through a range of motion to release adhesions.

3. Dry Needling: This technique involves inserting thin needles into trigger points in the muscle to relieve pain and improve function. It can help release tight fascia and improve blood flow to the affected areas.

4. Cupping Therapy: This alternative therapy uses suction cups to create a vacuum effect on the skin, which can help to loosen fascia, increase blood flow, and promote healing in the underlying tissues.

5. Fascial Stretch Therapy (FST): This is a form of assisted stretching that targets the fascia and can help improve flexibility and reduce pain. FST practitioners work with you to stretch the fascia and muscles in a way that promotes relaxation and mobility.

6. Hydrotherapy: Utilizing water for therapeutic purposes can help relax muscles and fascia. Warm water can promote blood flow and relaxation, while cold water can reduce inflammation and pain.

7. Regenerative Medicine: If you have not found relief through conservative measures, you might consider consulting with a specialist in regenerative medicine. Treatments such as Platelet-Rich Plasma (PRP) therapy or stem cell therapy may help promote healing in the affected tissues.

8. Surgical Options: In severe cases where conservative treatments fail, surgical intervention may be considered to release adhesions or repair damaged tissues. However, this is typically a last resort after all other options have been exhausted.

Lifestyle Modifications
In addition to these treatment options, consider making lifestyle changes that can support your recovery:
- Posture Awareness: Being mindful of your posture throughout the day can help prevent further strain on your fascia and muscles.

- Regular Movement: Incorporating gentle movement and stretching into your daily routine can help maintain flexibility and prevent stiffness.

- Stress Management: Chronic pain can be exacerbated by stress. Techniques such as mindfulness, yoga, or meditation can help manage stress levels and improve your overall well-being.

Conclusion
Your situation is undoubtedly challenging, but with a comprehensive approach that includes specialized physical therapy, alternative therapies, and lifestyle modifications, there is potential for improvement. It may take time to find the right combination of treatments that work for you, but persistence is key. Continue to advocate for your health and seek out practitioners who understand the complexities of fascial adhesions and chronic pain.

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