Adhesions And Pain
An adhesion is an internal scar. Adhesions tend to form in all peopleat the site of tissue damage wheneverand wherever the body heals. Adhesions consist largely of tiny but powerful strands of collagen that bind to each other and to underlying surfaces, isolating injured areas to set up the process of healing. These collagen fibers can form in random patterns to form a patch or in parallel patternslike the strands of a nylon rope. Adhesions occur on the surface of our bodily structures or deep within them.
Adhesions can be formidable, with a strength estimated at over 2,000 pounds per square inch (140K/cm2). Responding to inflammation, they can squeeze muscles, organsor nerves like a straitjacket, or spread to join any bodily structure to nearby, or even distant structures. When this occurs, the internal squeeze or pull can cause confusing symptoms of pain or dysfunction.
Because adhesions are virtually invisible to diagnostic tests, doctors sometimes fail to consider the profound effect these internal scars can cause. Physicians may truthfully say “I don’t see anything” or “all tests are coming back as normal.” The mistake comes if they say “there’s nothing there” when powerful bonds are squeezing or joining areas that are designed to be free and mobile. Thus, the patient is confused by the diagnosisof “unexplained pain or dysfunction.”
Adhesions may be filmy or coarse, thick or thin. They may be small enough to join individual muscle cells deep within a structure, or large enough to stretch down the front of the torso from neck to waist, bending a person forward so that s/he literally cannot stand erect. (We frequently see this in people as they age.)
To us, adhesions appear to take four forms.
- Microscopic bonds: Tiny adhesions can form as individual bonds within the structure of a muscle, organ or joint as a response to infection, injury, or damage. When this occurs, they tend to decrease the natural mobility and function of that structure.
- Curtains: Collagen fibers can join to form curtains or sheets that can cover a bodily structure or join it to another like a sheet of stretched glue. We feel these are fairly easy for us to decrease, as we shred the curtain-like adhesion apart, like pulling out the run in a sweater.
- Rope-like strands: Collagen fibers can join together like the strands of a nylon rope, creating bonds powerful enough to pull the body forward, drawing the shoulders and neck down toward the pelvis. These are among the most challenging of the adhesions we treat as we focus on detaching the fibers of the rope from one another, shredding the rope-like formation back to individual strands, then detaching the strands from the internal structures to which they are bound.
- Clumps or balls: In some areas, collagen fibers join together in masses or clumps, similar to a ball of rubber bands one might see on someone’s desk. To us, these can feel like an oddly shaped ball beneath the surface. We address these similarly to the way we address the ropes, slowly detaching the balls from structures to which they are attached, then working to detach the individual strands that comprise the ball from each other.
Adhesions form as part of the body’s natural healing process after tissue damage due to an infection, inflammation, surgery, trauma, or radiation therapy. Once formed adhesions can remain in the body for a lifetime. Due to their pull on internal structures, adhesions can cause ongoing inflammation, causing more adhesions to form. Surgery is a primary cause of adhesion formation.
According to the American Academy of Family Physicians, pain is categorized into two types – acute and chronic. Acute pain tells you that your body is injured and typically does not last long. It tends to resolve as your body heals from injury. Chronic pain can last for months or even years, interfere with your daily activities and significantly impact quality of life. It can lead to low self-esteem, depression and anger. Because adhesions are a common natural occurrence in the body and they are undetectable by most diagnostic tests, they are a common cause or contributor to chronic pain. We find unexplained chronic pain is often caused by adhesions that form after a surgery, injury or infection. Our clinic started as a place to relieve chronic pain and that remains a central focus of our work. Studies and patient testimonials address this throughout this website.
Female Infertility
Numerous factors can cause female infertility. Perhaps the largest two groups are hormonal causes such as high FSH, PCOS, and problems with ovulation, and mechanical causes such as scarring and adhesions that can block fallopian tubes, or attach to reproductive structures such as the uterus, tubes or ovaries. When adhesive crosslinking forms at the pituitary gland (the master gland of female reproduction, deep in the cranium), the line between hormonal and mechanical cause becomes blurred.
Adhesions can block fallopian tubes, decrease function of the fimbriae or ovaries and restrict the cervix, causing spasm or making a difficult passage for sperm to enter the uterus. Tiny adhesions within the walls of the uterine body may cause spasm, inflammation or coat the inner lining, decreasing the chance for implantation or cause a miscarriage after fertilization. Adhesions on the ovaries can decrease hormonal function or block eggs from leaving the ovary.
Published studies on our work have shown measurable results in all of the above causes. While most of our successes have been by natural conception, Our therapy has been shown to statistically increase pregnancy rates for IVF by roughly 50% when performed within 15 months before embryo transfer.
Adhesions are frequently found in the female reproductive system. While men can also develop adhesions, we have no data that shows we can help reverse fertility problems in males. We are willing to discuss possible treatment on a case by case basis, but all of our infertility data centers around treating women.
We first started treating female infertility in 1989. After several surprise pregnancies in women diagnosed totally infertile due to blocked fallopian tubes, we began researching the phenomenon of reversing female infertility from various causes in 1996.
Yes, significant data published in peer-reviewed medical journals cite our safety and success rates treating causes of female infertility related to:
- Blocked fallopian tubes
- Endometriosis
- Advanced age (high FSH)
- Polycystic Ovarian Syndrome (PCOS)
- Secondary infertility
- Unexplained infertility
- Increasing IVF success rates
Bowel Obstructions
All people and animals require food to survive. Simply put, if we cannot eat, we die. A small bowel obstruction is a life-threatening event that occurs when the small intestine becomes partially or fully blocked, preventing food, liquids and gas from moving through the intestines. A total bowel obstruction is fatal in 100% of cases unless the obstruction is cleared – by surgery, by Clear Passage. It is rare for a total obstruction to resolve on its own. If an obstruction happens to clear on its own (perhaps by something shifting within), little has changed in the actual structure of the bowel. The likelihood of obstruction recurrence is considered high by most physicians.
Symptoms include severe pain that can occur around or below the umbilicus (belly button) and be accompanied by nausea, vomiting, abdominal swelling or bloating (distention), constipation and the inability to pass gas. If you experience severe abdominal pain accompanied by any of these symptoms, you should seek immediate medical attention.
Post-surgical adhesions are widely regarded as the primary cause of small bowel obstructions (SBO). Adhesions form as a response to infection, inflammation, surgery, injury or radiation therapy, and account for 65% to 75% of all obstructions.
Other causes include:
- hernia or Crohn’s disease
- malignant tumors that can block the intestine.
- inflammation from diverticulitis
- inflammatory bowel disease
- endometriosis
Clear Passage treatment focuses on decreasing internal scars called adhesions, the most common cause of small bowel obstruction (SBO).
We regret that we cannot treat you at the hospital. We can treat patients in our clinics at any time, provided they have not had surgery within the prior 12 weeks. We can sometimes make exceptions to the ‘time since surgery’ rule, e.g., if you had hand surgery and we will be treating your abdomen. Please contact us if you have any questions.
Treatment
You can get some indication by completing our online Request Consultation form, To get the most definitive answer, you should complete our Medical History Form. We will review this at no charge, then provide information specific to your history, present condition and goals.
Clear Passage® therapy and its core focus, the Wurn Technique®️ are unique in the field of rehabilitation. These modalities are only performed by staff trained and licensed by Clear Passage®️ to perform our work. These designations ensure you receive the specialized therapy that has been developed and researched for30+ years, with results published in respected peer-reviewed medical journals.
We have locations in North America and the United Kingdom. While local patients may choose to spread therapy over several weeks, most patients visit Clear Passage® locations from out of town or other countries, and receive our full 20-hour therapy program over five days (e.g., Monday-Friday). Patients with extensive history of surgery or adhesions may benefit from additional therapy. We try to save a few hours the following week to accommodate patients who want or need to book additional hours.
From the initial evaluation through therapy, discharge and follow-up, every aspect of treatment is thorough, private, respectful and focused on each patient’s individual needs and goals. Please call our Headquarters in the U.S. at 1-352-336-1433 to learn about our clinic locations.
Doctors, Insurance
Information about our work is readily available in public settings, both on- and offline. These include:
- Download our Guide for Physicians
- Published studies in mainstream medical journals are available at our website or viaPubMed, the National Institutes of Health (NIH) database, housed in the U.S. National Library of Medicine
- Physical Therapy for Adhesions video on YouTube
- TV and published news stories
- Citations and recommendations from physicians, scientists and healthcare leaders in mainstream books, magazines and websites;
- Written and video testimonials from patients about the care and results they received at Clear Passage®️ clinics;
After we review your medical records, we may be able to have you speak with a former Clear Passage®️ patient who had a similar history or goals.
Roughly 40% of our patients are healthcare providers (doctors, nurses, therapists, etc.), their spouses or children. Due to published studies on our therapy, physician acceptance of our work is growing steadily. Authors, Advisors and Researchers include doctors from major medical schools, and the Founder of the Endometriosis Association.
Physicians recognize that physical therapy is a conservative approach. Since there is such a low risk of complications, most physicians encourage patients to attend or to make their own decisions regarding therapy. We suggest you download and print two documents for your doctor:
- Our Guide for Physicians booklet will help inform your doctor about our work and studies,
- Our Physician Referral Sheet will help you with insurance reimbursement and will alert your doctor to any conditions that would delay or prevent treatment, such as active infection, active cancer or abnormal cysts.
We are glad to consult with your physician directly to explain our work or discuss your case.
In a word, the answer is: Maybe. While you will pay us directly for our services, your insurer may reimburse you for part or all of your therapy. WhileMedicare Primary does not cover our level of service, many patients report reimbursement by their secondary Medicare coverage. Patients are not covered by Medicaid.
You may wish to contact your insurer to clarify your benefits before you schedule treatment. Ask them about your “out-of-network, outpatient physical therapy benefits for adhesions and/or pain.” We provide you with copies of your initial evaluation, daily notes, progress report and a statement noting all charges, payments, provider information, diagnosis and procedure codes to support your claim for reimbursement.
Our procedure codes are defined and approved by the American Medical Association and include the following common PT codes:
- 97161 – Initial Evaluation (Low Complexity)
- 97162 – Initial Evaluation (Moderate Complexity)
- 97163 – Initial Evaluation (High Complexity)
- 97164 – Re-Evaluation
- 97110 – therapeutic procedure
- 97112 – neuromuscular reeducation
- 97140 – manual therapy
- 97530 – therapeutic activities to increase function
- 97535 – self care instruction
Ask your insurer if you need pre-authorization and a physician’s written referral (available by clicking here.)This referral sheet states that your therapy is “medically necessary” – a requirement of many insurers. Signed by your doctor, this document can also help you get insurance reimbursement. If you are coming for the five-day program, your doctor can add “20 hours of manual physical therapy over five days,” then sign, date, include their NPI number and give you the referral slip.
Remind your insurer that twenty hours of physical therapy per year falls well within the parameters of most insurers. However, some want to limit therapy reimbursement to one hour per day. If you speak with your insurer, explain that you have to travel for therapy for services that are not provided in their network. Clear Passage® is the only facility in the country that has been shown to decrease adhesions without surgery. Advise them of the tremendous cost-savings for their company of having you attend therapy in place of surgery. Ask to speak with a supervisor, if necessary. Record the name, time and date of every person with whom you speak and what they tell you.
Upon request, we are happy to provide you with a letter that you may forward to your insurance company. This document provides advice regarding our specialized therapy program and notes your pre-treatment diagnosis codes, based on your reported medical history.
We encourage all patients to consult their physician and to obtain a referral for our therapy for two reasons:
- We want to keep you safe. We’d like you to hand your physician our Referral Form so s/he can clear you for any cautions and contraindications to therapy.
- A referral signed by your doctor can help you to get reimbursement from your insurer.
Our Guide for Physiciansis designed to inform your doctor about our work; the back cover doubles as a Referral Form s/he can complete, sign, and give to you or send to us.
The total amount of information in the world is constantly increasing. In 1900, human knowledge was estimated to double every 100 years. By 1945, that estimate shortened to 25 years. By 1989, that number was revised to 10 years. With the growth of the Internet, new estimates are that the amount of information available to us is doubling every 12 hours. Nowhere has this explosive growth become more obvious than in medical literature. While 30 years ago, virtually all medical journals were provided in print form, most journals today are available online, with many being available ONLY online.
In essence, the passing of clinical knowledge to healthcare providers has grown at logarithmic speeds for the last two decades and continues to do so. As such, it is virtually impossible for any physician to remain current with all the studies available to them. We encourage your doctor to search PubMed for “Wurn” where s/he will find studies about our work that have been archived in the US National Library of Medicine.
You may want to print a copy of our Guide for Physicians that explains our work, and hand it to your doctor. There, s/he may scan the QR codes in our Guide for Physicians.
Technique
People who are looking for relief from chronic pain or dysfunction associated with adhesions often do not know where to turn for answers, especially if they are trying to avoid surgery and medications and achieve a natural solution with physical therapy. Here, we hope to clear away misconceptions and confusion about three types of techniques: Myofascial release (MFR), visceral manipulation (VM), and Clear Passage® (CP). Although each technique has its own history, merits, and individual traits, the specific methods, standards, and outcomes of Clear Passage® set it apart as the preferred technique for treating adhesions wherever they form in the body, especially when it comes to certain women’s health conditions, female infertility, and life-threatening small bowel obstructions. Here are the details as of this writing (May 2022).
Myofascial release is generally a deep structural manual therapy developed by John F. Barnes, PT as a method to treat restrictions in the muscles (myo) and fascia (fascial) of the human body. A PubMed (NIH) literature search found several case studies that report MFR for treating musculoskeletal pain (notably low back and ankle pain). None examined its use for patients with abdominal or pelvic conditions. Many providers claim to perform myofascial release. We are most comfortable recommending an expert-level Barnes trained therapist for chronic musculoskeletal pain.
Visceral manipulation is generally a very light manual therapy initially developed to treat viscera (organs) in the body. Its founder, Jean Pierre Barral, D.O. often suggests conducting a single 60-minute VM session every three weeks. He feels that a site-specific application of VM can be “the pebble that starts the avalanche” in healing the body of physical restrictions. A PubMed (NIH) literature search conducted in May 2022 revealed five studies of VM, most for neck and back pain. Despite its name, no study exists that examines VM for treating organs in humans.
Clear Passage® is a therapy developed over 30+ years as a method to decrease specific internal scars called adhesions wherever they form in the body. CP was initially developed by Belinda Wurn, PT and Larry Wurn, LMT as a treatment for chronic pain and dysfunction in patients with problems caused or exacerbated by adhesions. This pain was often labeled ‘unexplained’ because adhesions do not appear on diagnostic tests. Over time, the therapy has expanded with peer-reviewed studies examining its effectiveness treating several women’s health conditions, female infertility, and life-threatening small bowel obstructions.
CP is a very site-specific soft tissue therapy. It is often quite deep and sometimes lighter, but CP is always focused on decreasing adhesions – a significant problem for many patients and their doctors. An aspect of the therapy considered pioneering by some physicians is its ability to replace a planned surgery. In doing so, CP helps decrease the risks of anesthesia, surgery and post-surgical adhesions.
- CP has a strict certification process; they require many years’ experience in bodywork before a therapist is considered to undergo training. As of this writing, CP has certified 17 therapists worldwide to perform their work: therapists average 30 years of experience.
- CP monitors results from each therapist they have trained on an ongoing basis.
- Realizing the complexity of processes involved in reproductive and digestive organs, CP screens every patient for “cautions and contraindications” before accepting them for therapy to assure safety and assess likely outcomes.
- CP is dedicated to clinical research to validate results. Numerous studies in respected medical journals examine the safety and effectiveness of CP therapy to decrease adhesions in the abdomen and pelvis. Studies on CP therapy are indexed by Google Scholar, and PubMed (National Institutes of Health), and housed in the US National Library of Medicine.
Published studies: A search of PubMed (NIH – National Library of Medicine) reveals numerous studies that examine the safety and efficacy of CP in respected medical journals. Published data on CP treating women’s health conditions are found in Fertility and Sterility, the Journal of Endometriosis, Contemporary Ob/Gyn and in WebMD’s Medscape General Medicine, among others. Studies reporting CP treatment of digestive, post-surgical and trauma-induced adhesions appear in Gastroenterology, the World Journal of Gastroenterology, the Journal of Clinical Medicine, Pediatric Reports, the Journal of Palliative Medicine, and others.
Women’s health: While treating pelvic pain in women in 1990, the Wurns learned they were opening totally blocked fallopian tubes – a procedure previously thought impossible without surgery. The group was joined by physicians and researchers interested in examining the surprising results the therapists were witnessing. Guided by physicians and scientists from a major medical school (Univ. of Florida), they followed the ‘scientific method’ to investigate the reasons for their success. Thus, they progressed from case studies to pilot studies, and recently completed a 10-year retrospective of 1,392 women diagnosed infertile from various causes. Based on results they found in women’s health, studies were published about CP’s ability to decrease period, endometriosis and intercourse pain, to improve sexual function and to increase IVF pregnancy success rates. To date, over 1,000 babies have been born to women diagnosed infertile, treated at CP, with the great majority being due to natural pregnancy.
Small bowel obstruction: Adhesions are the primary cause of life-threatening small bowel obstruction (SBO), a condition that tends to recur during a lifetime. After showing success clearing tiny fallopian tubes of adhesions, in 2009 researchers began documenting and publishing studies on the use of CP to decrease adhesions and open much larger tubes: the intestine. Several remarkable pilot studies noted significant patient improvement, including the use of CP to replace a planned surgery, or surgical series. An important point of focus in the studies was its ability to decrease or stop repeat obstructions.
As a non-surgical treatment, CP is considered lifesaving by some physicians for several reasons. JAMA Surgery journal reports SBO is the 2ndmost common emergency surgery in the USA and carries the highest complication rate (47%). Nearly one in five (18%) of patients are re-hospitalized within the month after SBO surgery. Because surgery is regarded as the primary cause of SBO, the treatment that saves a person’s life can become the cause of their next obstruction, leaving patients in a repeating cycle of adhesions-obstruction-surgery, with no end in sight. In a large, controlled study authored by doctors from Harvard, Stanford, Washington (St. Louis) and the University of Florida medical schools, CP therapy was shown to decrease repeat SBO by 15 times the norm (p=0.0003).
Of the three physical therapy techniques mentioned here, Clear Passage® has a proven track record of treating chronic pain or dysfunction associated with adhesions.
We suggest taking the following factors into account when considering our legitimacy and credibility:
- View dozens of reviews of Clear Passage®️ at Google, or the Better Business Bureau
- We conduct and publish scientific research to quantify our results. View published studies about us in peer-reviewed medical journals, and in the U.S. National Library of Medicine by doing a PubMed search for “Wurn.” On our website, visit the Published Studies section for links to all published studies of our work.
- We work with respected independent physicians and scientists. Learn about the physicians and scientists who work with us by visiting our “Authors, Advisors and Researchers” page. This group includes doctors from Harvard, Stanford, Washington (St. Louis), U.C. Irvine, Columbia, Northwestern and the Universities of Florida and Arizona Medical Schools. They also include the former Chief of Staff of North Florida Regional Medical Center and the Founder/Director of the Endometriosis Association.
Physiotherapy (worldwide) and physical therapy (USA) are highlyrespected fields of mainstream medicine. It is a licensed and highly regulated profession, requiring a five (plus) year university degree. In order to be accepted into a physical therapy program, a candidate must have an academic history and background similar to that required for medical school.