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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 for some of the remarkable images of adhesions they provided for this educational video.

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 for 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 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 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 otomy 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 um so and certainly that is the a case with B rection 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 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 um looking at the where we started the structure of adhesions and what data we have found and where we’re going next 19 84 my dear wife sumacom loud 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 wife and Brilliant wife just just deteriorating before my eyes we talked to our doctors about it they said well you cured our cancer you know but we we 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 um we know that she had a frozen pelvis where everything was stuck together all of her organs in her pelvis were just adhered together stuck like in a straight massive straight Jack in 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 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 looks like 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 can cause cause 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 c those out let’s burn them and 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 th000 patients a 50e study showed that 55 to 100% of pelvic surgeries and 90% of abdominal surgeries cause adhesions to form it’s 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 shown 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 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 olving or detaching by using sustained pressure and some other techniques that we use certainly we have to be very sight specific 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 a die test where D inserted into the uterus we radiographically view that you can see it has not come out of this particular tube there’s a hydr helpings there a swelling in that tube as well after therapy has come through one of the tubes there is still a hydro salpin in that particular tube but this is just one of them when we’ll talk about Hydro Sal penes 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 yd years’s experience at that time he said what’s this about opening black Philippian tubes handed him a half a dozen charts and he looked at them and he said gosh you’re doing things with your hands I’m not sure I could do surgically and I said well is that okay and he said well yeah it’s actually it’s really great it’s it’s neat have you done any research no would you like to sure let’s research this I’ll I’ll join you if you like you you need to have somebody that understands research and I’ll just chip in my time I’m I’m pretty fascinated so we began doing research on our patients 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 hydris 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 the US National Library of Medicine Pub Med and alternative Therapies in health and medicine on opening block Fallopian tubes and at the time we we just had a very small in 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 um just manual therapy just just using our hands pulling these adhesions apart but it was a small number as a a matter of fact in 2015 we published a 10-year study a retrospective of nearly 1,400 women interestingly and in 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 uh the same success rate the here you can see the comparison of of the therapy in blue versus surgery in green interesting subnote in that is that the patients who had not undergone tubal surgery prior to 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 it’s the adhesions that form after surgery that 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 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 it’s just so remarkable that I wanted to report it to you we 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 is we it is we said yes it is he said there’s nothing really in medicine that increases orgasm and we can measure those those responses what do you think we’re doing and we said well we’re doing nothing but what we always do we’re treating adhesions so sometimes they adhesion to the cervix and it feels fibros 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 um otherwise on the vaginal walls we’re working on the vaginal walls maybe those adhesions there forming from bacterial infections vaginal infections or or Rush sex or just adhesions there are masking the nerve vings decreasing desire orous 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 uh medical journal in the world owned by WebMD this is the one that George lenberg edited after editing the jamama for 17 years um that showed the increases in sexual function decreases of intercourse pain were very high and decrease in improvements in the other domains of sexual function are shown here desire arousal orgasm lubrication 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 since you since you treated me my my period came I never even knew it was coming it totally surprised me that that it was shocking to them and 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 in the body it’s frequent and often that we find adhesions forming we believe that what happen 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 of 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 that 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 our Board of advisors she was very impressed and uh started measuring that 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 to last um as far as function again in our recently published study or 2015 study we are success rates for pregnancy for women who were infertile due to endometriosis were about 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 um we gungho and really pretty fascinated we 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 um 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 blinda 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 Val 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 do Physicians do when the bows become obstructed well cost of bow of adhesiolysis surgery that is the surgery to decrease adhesions itself is significant this is from 2010 from 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 bow life-threatening condition the average cost to insurers and to the US population is over $100,000 a piece um for and there were over 100,000 of them performed in 2010 the cost and quality of life is much Huger so here you have an ordinary American citizen who suddenly they can’t take food in they feel nauseous there’s a tremendous pain they nothing’s coming out there no sounds they go to the hospital in the hospital hospital we do put an IV in them with some demol or deloted something to help numb things and give them help slow slow down it will actually can stop motility alog together but then when we’re going to give them liquid to and nutrition IV nutrition put an NG tube through their nose 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 all always cut you open we’ll pull out usually all 21 ft examine that bowel wherever it’s bad will cut what’s bad throw it away sew back what’s what’s still okay put it back into you and um that’s so that’s what we’re looking at while while you’re Ling here okay we can do a cab scan 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 weight 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 within within 10 years during their life 2third of those within the first year this is from 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 huge problem in medicine brilliant surgeons wanting to help their patients but at the end after the surgery they can look at their patient and say Here’s my card the chances are reason reasonable that you’re going to be back that 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 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 CU my doctor told me well they’re pretty likely to come back and they do big big problem in medicine expensive problem and one 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 curtain of 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 as 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 otomy without anesthesia how 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 one of our early patients actually our first patient for bow 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 a Whipple and for those of you who are surgeons out there you just know how serious and uh 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 blinda and I took her out to dinner we had fish uh 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 valve since then we began doing more serious research with 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 after therapy 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 help us publish studies those radiologic reports are available in the journal of clinical medicine published in healthc care 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 but what’s your quality of life like can you actually do you 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 validated scale was published uh in healthcare we created and published some the first of our pilot cases presented to 15,000 gastroenterologist at Digestive Disease week in Washington DC in 2015 published that um pilot study in gastroenterology as an investigation of treating P 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 rain of motion because when you think about it as you get adhere 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 backwards 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 afterwards it threw the P values off a bit looking a little bit deeper at the poster that we presented there the dark blue at the bottom presents normal so you can see the changes from in diet pain gas 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 what all are we doing here these are the areas that she suggested we were where we were showing improvements we did as scientists and all clinicians should do 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 they tended to go away within a few days we do screen our patients for contraindications to therapy we because we’re treating in an interstitial area we want to make sure that people do not have infections sometimes we’ll ask for um blood for cdc’s with cbcs with differenti 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 um within the last 30 uh 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 um the typical one she was having B obstructions like clockwork every 3 weeks and after we treated her we thought she figured she was good to go we just like we opened her tubes before we cleared her Val 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 two it wasn’t everything that their guts their intestines had been compromised really for Life by their surgery these people that have gone B 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 um on the results that we that we get so the need for repeat surgeries is a huge con 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 Val obstruction patients our return to the hospital is 3% not zero but better than 30 we’re now conducting a larger Phase 2 uh study on small bow obstruction with 350 patients we’ve also recently started working with Physicians who treat sio which is small intestinal bacterial overgrowth when the the bacteria that normally reside in the large intestines gravitate up into the small intestines it can be inconvenient to totally debilitating 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 they we 80 85 pounds um or that have had the this bacteria actually eating on the feeding on the inside of their intestines when Physicians treat them with antibiotics the antibiotics can really help those decrease those uh bacteria the problem is if there are adhesions in the gut those bacteria will come back 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 get antibiotic treatment whether it’s natural antibiotics or pharmaceutical um and we treat and they may C 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 um 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 so whether it’s block foping tubes infertility sexual dysfunction chronic pain adhesive pain bow obstruction orous small intestinal bacterial overgrowth the common factor for us and the one that we have used in all of our publish data is treating adhesions with our hands so to that question to us apparently the answer is [Music] [Applause] yes

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