Adhesions in the Body: Presentation by Larry Wurn (Video)

Larry Wurn, LMT, co-founder of Clear Passage, presents an overview of 30 years of studying and treating adhesions. With images compiled from a presentation at a conference of physicians, the video provides an in-depth overview of the biomechanics of adhesion formation and the ways in which manual physical therapy can be an effective treatment. We thank endogyn.com for some of the remarkable images of adhesions they provided for this educational video.

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Click the video below to watch the presentation.

I’m Dr Richard King a board-certified obstetrician gynecologist of 40 years I regularly perform surgeries two days a week during my professional career. In addition, I had the opportunity to conduct Clinical Research in Gynecology and other fields of medicine. I met Larry and Belinda W about 20 years ago they told me they were having success treating block Fallopian tubes in their physical therapy practice using just their hands to clear adhesions and open the Fallopian tubes.

Naturally, I was quite skeptical. But after reviewing several of the charts from their physical therapy clinic I realized they were getting results that would be difficult to achieve in surgery and I’m considered a very good surgeon. I have followed the Wurns and their treatment of adhesions with absolutely no remuneration for the last 20 years for two reasons.

One, I’m fascinated with what they do and the results they achieve in several conditions normally treated with surgery or for which there is no effective medical treatment.

Two, I believe this work is important to medicine as a conservative therapy that could eliminate many surgeries. Belinda and Larry have each treated roughly 40,000 patient hours over their career they have published studies in scientific reports and in some of the most respected journals in the United States including Fertility and Sterility Gastroenterology, the Journal of Endometriosis, and Web MD’s Medscape General Medicine edited by George Lundberg, the former editor of the Journal of the American Medical Association.

I hope you’ll find this guided trip through three decades of their investigation of the manual treatment of adhesions to be as fascinating as I do. I give you a man I’m proud to call my friend and colleague Larry Wurn.

Hello, and thank you for that kind introduction. I am Larry Warren. My wife and I, physical therapists, have been treating adhesions and involved with adhesions for 30 years of our professional careers. Initially, we began treating adhesions and investigating them for very personal reasons through a nightmare we were undergoing then through hundreds and finally thousands of patients we started gathering data.

Gathering physicians, and biostatistician scientists, to design and publish studies on whether or not we could actually treat adhesions non-surgically manually using just our hands the data is pretty compelling we think. I’ll let you make your own decisions.

The upside of this is that if adhesions can be broken apart non-surgically and we’re not talking about just you can massage that and that’ll go away. No that’s kind of far-fetched but what is the actual structure of adhesions what can we do and what data do we actually have that has been published in peer-reviewed journals that show that adhesions can be broken down and decreased perhaps eliminated non-surgically?

The upside potential is huge for patients, for physicians, and for insurers. Certainly, patients because they don’t risk undergoing another surgery. Surgery is the normal treatment for adhesions when they get bad enough. A surgeon has to go in there and cut or burn adhesions problem is that no matter how brilliant and skilled the surgeon the body creates new adhesions to heal from the surgery so with each surgery you develop more and more adhesions, at least many of these patients do, and there’s good data on this. Other risks include the cost certainly for insurers this is a big deal for the surgeon the surgical attendants the anesthesiologists the renting of the surgical suite.

Those of you who have read the latest data on the effects of anesthesia and multiple anesthesia on the brain know the risks there and the information coming out is pretty compelling that there is significant risk with a lot to a lot of patients with anesthesia general anesthesia. The risk of inadvertent ostomy is when a surgeon goes in there and he or she is looking around trying to cut through adhesions and some of these patients are so adhered it’s really difficult to see what’s going on you can inadvertently cut the bowel of the intestines. A little bit leaks out and suddenly you’ve got contents of the bowel in a warm moist dark environment then you close that patient up and three days later they’re in excruciating pain.

They’re developing peritonitis you have to open them back up in many cases pour ad antibiotics in and allow that patient to heal from the inside side out creating a huge scarring situation of course and adhesions.

Being internal scars so certainly that is the case where you’re actually intentionally cutting the Bell to remove adhered or diseased or necrotic tissue and reclosing the bell.

We’ll look at that data. We’re not talking about simple massage here the idea that you could actually just go in and massage these is a little far-fetched but so we’re going to look more deeply at the structure of adhesions how they are composed and um how this can work so you can make your own determinations.

At the end of this, we will go through the 30 years pretty quickly now looking at where we started the structure of adhesions what data we have found, and where we’re going next.

In 1984 my dear wife went to a physical therapist from the University of Florida developed massive adhesions after 72 hours of internal radiation therapy and 40 external radiation treatments they put her in a lead-lined room with radioactive pellets inserted inside of her said you know it’s dangerous for any of us to be in this room for more than about five minutes but don’t worry we’ll keep you drugged you we really need to get rid of this tumor.

A year after that experience she began having debilitating pain whenever she walked moved or breathed she was in excruciating pain.

I saw my beautiful and brilliant wife just deteriorating before my eyes we talked to our doctors about it they said well you cured our cancer you know but you really don’t want us to operate there I mean this vaginal tissue and pelvic tissue is so delicate we’re just going to create more adhesion she’ll just have to learn to live with it.

We were not interested in following that prognosis. We know that she had a frozen pelvis where everything was stuck together all of the organs in her pelvis were just adhered together and stuck like in a straight massive straightjacket.

We could not accept the diagnosis that you’re just going to have to learn to live with the pain we began to investigate on our own ways that we could perhaps decrease adhesions without surgery we learned that adhesions form naturally in the body whenever and wherever the body heals they rush in to surround the area that’s been injured once they formed if they don’t dissipate within 7 to 10 days.

They’re with you for life. The problem is that adhesions are made of collagen and collagen covers virtually every structural cell in the body so the body has no way to dissolve or detach adhesions on their own once they are formed they stay there they either stay the same or they get worse over the course of life.

This is probably what my wife’s body looked like a year after her radiation therapy where everything was stuck together the adhesions forming ropey structures that glue or squeeze structures that should be able to move freely it causes dysfunction, infertility can stop literally organ function and can cause a tremendous amount of pain gram for gram.

We know that adhesions are actually stronger than steel they’ve been estimated at roughly 2,000 lb a square inch so you can lift a horse with a square inch of them when they attach to structures they can cause significant pain and the surgical answer up till now has always been well let’s cut those out let’s burn them. Certainly, you can cut or burn the ones that you can see you can’t cut or burn the ones that are inside of an organ without cutting into that organ causing more damage even when you just cut or burn the external adhesions.

The data shows that after surgery and this was a study from several hundred thousand patients a 50e study showed that 55 to 100% of pelvic surgeries and 90% of abdominal surgeries cause adhesions to form from digestive surgery and you have the reference there you can pull it off our website if you like

Looking a little deeper here are some adhesions as they form. They’re like tiny strands of collagen here depicted in a muscle forming from cell to cell within a muscle you can imagine that it’s really virtually impossible for a surgeon to get to those without injuring the muscle looking even closer we discover that these tiny strands themselves attach to each other and to the underlying structure with a molecular chemical bond.

That bond we found is susceptible to design resolving or detaching by using sustained pressure and some other techniques that we use certainly we have to be very sight-specific and understand the anatomy very well.

Understand where we are in the body and be able to understand what’s adhered but given that we find that we can be very successful with many of these patients it takes a bit of time but as those bonds dissolve that strand detaches and sure it’s probably still attached at the other side but there’s already collagen covering every cell on the body.

The important thing is that it detaches from the next one and the next one and the next one so it becomes like pulling out the run in a sweater in a three-dimensional sweater in very slow motion for us looking at other depictions we started after after we treated my wife we started treating other patients who came to us with pain and we were initially surprised when women with block Fallopian tubes started reporting they were becoming pregnant and their tubes were opening.

It was very easy to check that because there’s an HSG die test that is inserted into the uterus where we radiographically view that you can see it has not come out of this particular tube there’s a hydrosalpinx helping there swelling in that tube as well after therapy has come through one of the tubes there is still a hydrosalpinx in that particular tube.

But this is just one of them when we’ll talk about hydrosalpinx. If you like we wrote to the gynecologist in town and we said you know we’re seeing results in opening block Fallopian tubes the chief of staff of the hospital Richard King who you just met called us in a research gynecologist and surgeon of 30 years’s experience at that time he said what’s this about opening blocked fallopian tubes?

We handed him half a dozen charts and he looked at them and said, “Gosh you’re doing things with your hands I’m not sure I could do them surgically!” I said well is that okay and he said well yeah it’s actually it’s really great! It’s neat have you done any research no would you like to be sure let’s research this.

I’ll join you if you like. You need to have somebody that understands research and I’ll just chip in my time. I’m pretty fascinated.

So we began doing research on our patients and presented at the American Society of Reproductive Medicine a meeting of about 9,000 uh Physicians did a couple of posters and an oral presentation on decreasing adhesions for hydrous helpings in this particular poster improving um some other functions in women with endometriosis and followed up with a study we published which is now available at the US National Library of Medicine Pub Med and Alternative Therapies in health and medicine on opening block Fallopian tubes.

At the time we we just had a very small I think there were 28 patients in this study and our success rate for opening block tubes was 61% still pretty good we thought after just manual therapy. Just using our hands pulled these adhesions apart but it was a small number a a matter of fact in 2015 we published a 10-year study a retrospective of nearly 1,400 women interestingly in this case we had 235 women with totally blocked fallopian tubes either both tubes blocked or one removed and the other blocked so we had half the chance to open tubes we had a 61% success rate.

The same success rate here you can see the comparison of the therapy in blue versus surgery in green interesting sub-note is that the patients who had not undergone tubal surgery prior to our therapy had a 69% success rate for opening tubes those who had undergone a prior surgery had a 35% success rate so again it’s the adhesions that form after surgery that are problem IC for Physicians and patients functionally our success rates were quite a bit higher than the studies we could find for surgery where our pregnancy rate was 57%.

About double of what the surgical success rates were for pregnancies after surgery as an insert we’ve seen success with other hormone-based conditions.

We were surprised when FSH levels plummeted in many patients and we saw that 39% became pregnant even though their FSH was 10 or above indicating subfertile or infertile conditions when we treated women prior to their IVF transfer 56% became pregnant with their next IVF much higher than the national success rate.

Interestingly, some of our highest successes were in women over 40 the success rates were close to three to five times the pregnancy rates of IVF without a pre-transfer therapy some women started calling us and saying, “Gosh I’m having some unusual side effects anybody ever reported that to you and what are you talking about he said well well it’s a little embarrassing but I’m having orgasms like I’ve never had before and my wife said to them is that okay yeah it’s great actually but it’s just so remarkable that I wanted to report it to you.”

We started getting more and more reports like this and we started talking and we mentioned it to Dr King. He said that’s really important. We said, “Yes, it is he said there’s nothing really in medicine that increases orgasm and we can measure those responses what do you think we’re doing we said, “Well, we’re doing nothing but what we always do and we’re treating adhesions so sometimes they adhesion to the cervix and it feels fibrous just to no stiff and we’ll be working on that.

So the husbands running into that then they’re having pain with deep penetration otherwise on the vaginal walls we’re working on the vaginal walls maybe those adhesions there forming from bacterial infections vaginal infections or rush sex or just adhesions there are masking the nerve decreasing desire or lubrication and orgasm and I know those particular domains because we could actually measure those domains of sexual function in our patients.

We did publish a study in Medscape General Medicine the largest medical journal in the world owned by WebMD this is the one that George Lenberg edited after editing the Jamama for 17 years that showed the increases in sexual function and decreases in intercourse pain were very high and decrease in improvements in the other domains of sexual function are shown here.

Desire, arousal, orgasm, lubrication, and so forth women started coming to us saying, “Gosh you know I’ve been doubled over for two days of every month with endometriosis pain you since you treated me. My period came I never even knew it was coming it totally surprised me.

That was shocking to them and we really didn’t know that much about endometriosis at the time of course we were just treating adhesions what could we be doing with these women well we found that adhesions form wherever endometrial tissue lands on the body It’s frequently and often that we find adhesions forming we believe that what happens is again we’re not really treating the endometriosis.

We’re just treating the adhesions that as those tissues swell every month with a woman’s period it’s pulling on those adhesions creating a pull on the underlying structures creating pain in the underlying structures and as we break those adhesions or detach them.

The decrease in pain is significant again the only other thing that these women could do is either go on birth control pills if they didn’t want to have a child so the tissue wouldn’t swell or have surgery.

So this presented a nice alternative for people who did not want to have their IND demetrial implants burned off and didn’t want to undergo surgery. We published in the Journal of Endometriosis the founder of the Endometriosis Association joined our Board of advisors she was very impressed and started measuring that the study showed the improvements in endometriosis pain just from therapy alone lasted for over 12 months which is as long as surgery has ever been shown to last.

As far as function again in our recently published study or 2015 study success rates for pregnancy for women who were infertile due to endometriosis were about equal to surgery so that’s from 299 [Music] women has things progressed and meanwhile my wife by this time. She’s working full-time she’s she’s doing great she has no pain she’s gungho and really pretty fascinated.

We started realizing that there was another problem for a lot of our patients and that is people started calling us and saying I’m having bowel obstructions I’m going back and back to the hospital for another and another surgery. I’m in the hospital with an NG tube in my nose and IVs in my arms they’re cutting me open and the worst part is I don’t know when I’m going to have to go back.

Adhesions form in the bowel as they did with Belinda we saw in some of those early slides just as they form anywhere in the body they can form on the outer Loops of the bowel squeezing it like a garden hose they can form inside the bowel as they do in Fallopian tubes bowel adhesions can be massive and this is an image of some adhesions that you can see so you can see that it’s it can be a huge problem when structures like this form in delicate tissues that are supposed to be helping your food move through 21 ft of your small intestines down to your large intestine.

What do physicians do when the bowels become obstructed? Well, the cost of bowel adhesiolysis surgery, that is the surgery to decrease adhesions itself, is significant.

From 2010 the Department of Health and Human Services and the patients that just went in for adhesion surgery averaged a little over 8 days in the hospital and about one out of eight of them were re-admitted to the hospital within 30 days probably from some of these. Often from some of these complications I mentioned earlier in the bowel, it can be really serious as strictures of narrowing or total obstructions prevent food from going through the bowel life-threatening condition.

The average cost to insurers and to the US population is over $100,000 a piece and there were over 100,000 of them performed in 2010 the cost and quality of life are much huger.

So here you have an ordinary American citizen who suddenly can’t take food in and feel nauseous. There’s a tremendous pain when nothing’s coming out there. They go to the hospital. In the hospital, we do put an IV in them with some femoral or dilute something to help numb things and give them help to slow down.

It will actually stop mobility together but then when we’re going to give them liquid and nutrition IV nutrition, put an NG tube through their nose, and into their stomach to pump out the contents of their stomach so that we don’t build up pressure there and now we’re just going to wait. And we’re going to see Sir or Madam if this clears well.

What happens if it doesn’t clear well? If it doesn’t clear we’re going to we generally will cut you. We always cut you open. We’ll pull out usually all 21 ft and examine that bowel. Wherever it’s bad we will cut.

What’s bad we will throw it away sew back what’s still okay, and put it back into you and that’s what we’re looking at while you’re lying here. Okay, we can do a CAT scan to see if we can find out exactly where it is. Hopefully, we can do this laparoscopically, but it is a major surgery so the average wait in the hospital is over 2 weeks about one out of five is readmitted to the hospital within 30 days of their surgery from some of the complications I talked about earlier.

35% are readmitted, have another surgery, and within 10 years during their life 2/3 of those within the first year. This is from the Lancet a highly respected Journal as you all know from 30,000 patients and you see the data there just as I have extrapolated it.

The huge problem in medicine is that brilliant surgeons want to help their patients but in the end after the surgery they can look at their patients and say, “Here’s my card the chances are reasonable that you’re going to be back.

This is going to happen again for our patients. They tell us, “You know it used to be that every day I’d look in the mirror and say what do I want to do today? What do I have to do now? I look at the mirror every morning and I say is this the day I’m going to die? Is this the day I’m going to be put into the hospital and maybe cut open? I’m afraid to go on a trip with my spouse. I’m afraid to go to my sister’s house. I don’t know what I can eat. I’m afraid something’s going to clog it up because I know I’ve been compromised and I know that those adhesions are going to come back. My doctor told me well they’re pretty likely to come back and they do.”

A big problem in medicine is an expensive problem and one of the problem of huge human [Music] suffering surgery is the primary cause of bowel obstruction so it’s brilliant and it’s wonderful and as dedicated as your surgeon is, he or she cannot prevent adhesions from forming and the films that they’ve used the tissues and different things to prevent adhesions.

None of them have skewed these numbers significantly at all. What are we looking at? Remember, we’re still looking at tiny little strands. Yeah, the surgeon may see ropes or curtains or balls of adhesions but at its very core, these adhesions are made of tiny strands attached to each other with a small molecular bond.

What a concept to be able to go in there and like the run in the three-dimensional sweater pull those apart so that those little attachments that are susceptible to a sustained stretch begin to dissolve. It’s like pulling out the run in a sweater and without surgery without the risk of ostomy, without anesthesia, and for a fraction of the cost.

What a neat concept once we realized we could open and clear blocked fallopian tubes we started to look at adhesions in the bowel really this life-threatening condition we’ve been talking about was one of our early patients actually our first patient for bowel obstructions had undergone six bow obstruction surgeries. She called us up she said, “Yes my my last surgery was 12 weeks ago and they’re scheduling my seventh surgery now.

For those of you who are surgeons out there, you just know how serious and dramatic that surgery is. I’ve lost 18 pounds. I can only ingest liquids it’s getting worse and worse. You’ve got to help me. They’re trying to help but they’re killing me.

She came in and we treated her. We had by this time developed a 5-day program where patients start on Monday and they’re done on Friday afternoon four hours of therapy a day by Wednesday afternoon Wednesday evening Belinda and I took her out to dinner. We had fish, and some soft-cooked vegetables, she was able to cancel her surgery she has started eating again. She can eat now pretty much whatever she likes and it’s been nearly 8 years now and she’s not had another surgery on her bowel since.

Then we began doing more serious research before and after radiologic testing. In one case we have a radiologic report showing obstruction before therapy totally cleared of obstruction after therapy strictures which are tightening of course of the bowel. In this case, the intestines before therapy and after therapy had no stricture at all so we began to get excited about the science we were developing we hired a woman with two post-doctorates in PhD. An expert in disease modeling familiar with working at very small levels inside the body and at the chemical and molecular level to help us determine what we were doing and to help us publish studies.

Those radiologic reports are available in the Journal of Clinical Medicine published in Healthcare. We created a validated study to look at quality of life differences because for us as a physical therapy group quality of life is very important. It’s not just “Do you have pain?” or “Do you not have pain?” “Can you Eat?” or “You’re going to die.”

Yeah, those are very important but what’s your quality of life? Like, what can you actually do, when you look in the mirror do you feel like I got a life or my life is basically over? I’ll never have my life back again.

Using that, the validated scale was published uh in healthcare we created and published some of the first of our pilot cases presented to 15,000 gastroenterologists at Digestive Disease Week in Washington DC in 2015. Published that pilot study in gastroenterology as an investigation of treating bowel obstructions [Music].

Non-surgically as part of that poster presentation, we found that we improved and had a really tight P value 025. We had significant improvements in pain, quality of life, and range of motion because when you think about it as you get adhered it pulls you forward. For so many of these people they’ve had their ilal valve cut out you’re getting pulled forward into the right now you can’t stand up you can’t bend. You certainly can’t bend backward nearly as well so we started measuring range of motion as a measure of how well we were doing as well as pain.

We did not do as well on diet and medication because we were a little bit skewered by the numbers. Only about half of the patients that we treated had restricted diets or were on medications so although they showed significant improvements when we threw them in with the ones that had no problems beforehand and no problems afterward. It threw the P values off a bit, looking a little bit deeper at the poster that we presented and at the dark blue at the bottom presents normal so you can see the changes from in diet pain.

Gastrointestinal systems, symptoms, quality of life, and medication from before on the left and after therapy on the right for those of you who prefer numerical graphs you can see a consistent return to normal in those areas the range of motion changes with P values were pretty much off the chart as far as improvements in all ranges of motion.

When I asked our PhD what do you think the mechanism is? What exactly are we doing here? These are the areas that she suggested where we were showing improvements we did as scientists and all clinicians who are conducting clinical research. Measure the side effects and adverse events.

We did find that the adverse events, major ones, are shown at the bottom but they they were transient. They were temporary and they tended to go away within a few days. We do screen our patients for contraindications to therapy because we’re treating in an interstitial area we want to make sure that people do not have infections.

Sometimes we’ll ask for blood for CDCs with CBCS with different SHS so that we can see if there’s a skewing of the nutrifil. Certainly, we don’t treat anyone who’s had surgery in an area that we’re going to treat within the last 30 or 90 days. We began creating a Home maintenance program because we saw that in the beginning when we treat we treated one woman she was having the typical one. She was having bowel obstructions like clockwork every 3 weeks and after we treated her we thought she figured she was good to go.

We opened her tubes before we cleared her bowel obstruction and instead of having them every 3 weeks she went 19 months but then she had another obstruction and we had two or three of these that showed us two things one we were making really dramatic improvements too. It wasn’t everything that their guts and their intestines had been compromised really for Life by their surgery.

These people have bowel obstructions, so we’ve begun an educational program with each of our patients where we teach them about the structure of adhesions how they form, how they deform, how they can deform them themselves, how they can maintain, and perhaps even increase on the results.

When we get the need for repeat surgeries it is a huge concern for patients. Having been handed this card you’ll probably be back or you may be back we do know that within a short period of time 30% of patients will return to the hospital for a repeat surgery this is from the literature before we created our maintenance program we had a 7% return at the hospital since we’ve created and Institute this Home Maintenance program with all of our small bowel obstruction patients our return to the hospital is 3% not zero but better than 30%.

We’re now conducting a larger Phase 2 study on small bowel obstruction with 350 patients we’ve also recently started working with Physicians who treat SIBO which is small intestinal bacterial overgrowth. When the bacteria that normally reside in the large intestines gravitate up into the small intestines it can be inconvenient to totally debilitate those bacteria can actually start eating away at the nutrition so we’ve had patients that came to us that have lost a tremendous amount of weight like 80 to 85 pounds or that have had this bacteria actually eating on the feeding on the inside of their intestines.

When Physicians treat them with antibiotics, the antibiotics can really help decrease those bacteria. The problem is if there are adhesions in the gut those bacteria will come back and they don’t escape. They can’t get out so we started working with a lot of SIBO Physicians to coordinate care with their patients so the patients get antibiotic treatment whether it’s natural antibiotics or pharmaceutical and we treat and they may be back and get a little bit more antibiotic treatment.

We are the mechanics in the process we help clear the adhesion so the intestinal bacteria that get blocked up in the intestines can escape so that’s pretty much it. That’s where we are after 30 years of this investigation the question in the beginning was really can adhesions be treated non-surgically?

I’ll let you make your own determination keep in mind that in all of these conditions, all we’ve been doing is treating adhesions that’s what we know how to do whether it’s block fallopian tubes, infertility, sexual dysfunction, chronic pain, adhesive pain, bowel obstruction, or small intestinal bacterial overgrowth the common factor for us and the one that we have used in all of our published data is treating adhesions with our hands so to that question to us apparently the answer is [Music] [Applause] yes

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