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.
Condition-Specific FAQs
What is an adhesion?
An adhesion is an the internal scar; adhesions tend to form in all of us wherever our bodies heal as the first step in healing. Adhesions may occur on the surface of our bodily structures or deep within them. They can join any structure in the body to its neighbor or to distant structures, causing confusing symptoms of 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. They may grow so large that they stretch down the front of the torso from neck to waist, bending a person forward so that s/he literally cannot stand erect.
What causes adhesions?
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.
What is infertility?
This depends on who you ask. The U.S. Centers for Disease Control and Prevention defines infertility as the inability to “get pregnant (conceive) after one year of unprotected sex.” In women over the age of 35, it is defined as inability to conceive after sixth months of unprotected intercourse. The World Health Organization defines infertility as the inability to become pregnant after two years of unprotected sex.
What causes infertility?
A number of factors can cause female infertility. Some women have hormonal causes (e.g. high FSH, PCOS, ovulation problems), while others have mechanical causes such as scarring and adhesions.
Adhesions can block fallopian tubes, decrease function of the fimbriae or ovaries and restrict the cervix, making a difficult passage for sperm. In addition, tiny adhesions within the walls of the uterine body may cause spasm, inflammation or otherwise decrease the chance for implantation, or cause a miscarriage after fertilization. Ovarian adhesions 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 when performed within 15 months before embryo transfer.
What is chronic pain?
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 thought to be a common cause or contributor to unexplained 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.
What is a small bowel obstruction?
A small bowel obstruction is a life-threatening event which occurs when the small intestine becomes partially or fully blocked, preventing food, liquids and gas from moving through the intestines.
Symptoms include severe pain around or just below the belly button, nausea or vomiting, swelling or bloating of the stomach (distention), constipation and the inability to pass gas with a complete obstruction. Total small bowel obstructions are 100% fatal unless the adhesions are cleared. If you experience severe abdominal pain or other bowel obstruction symptoms, you should seek immediate medical attention.
What causes bowel obstruction?
Adhesions (internal scar tissue) from prior surgery are most common cause of small bowel. Other causes include hernias and Crohn’s disease, which can twist or narrow the intestine, and tumors that block the intestine.
In the large intestine, cancer is a common cause of a blockage. Other causes may include severe constipation from a hard mass of stool or narrowing of the intestine called a stricture. Adhesions can also occur as a result of:
- diverticulitis (pouches called diverticula form in the wall of the large intestine and become inflamed or infected)
- inflammatory bowel disease (ongoing inflammation of the intestines that may recur many times in a person’s life)
- Bipolar disorder patients often do not do well with this therapy
- Blood clotting disorder, abnormal bleeding or blood thinning medication
- Both fallopian tubes have been removed or surgically closed; you may qualify for our pre-IVF therapy, but not natural infertility reversal. Call for more information.
- Cancer in the last 18 months (Requires a more extensive evaluation)
- Cardiac conditions, including DVT, PE, or CVA in the last 12 months
- Congestive heart failure (need your details)
- Connective tissue disorder (EDS, Marfan)
- Deep Vein Thrombosis, PE or CVA within 12 weeks of scheduled therapy
- Endometrioma; other non-follicular cyst(s)
- Fistula present within 6 weeks of therapy of scheduled therapy
- Gall stones or kidney stones (Requires more extensive evaluation)
- Heart, liver or kidney dysfunction (Requires a more extensive evaluation)
- Hernia (we need to know the location and approximate size)
- HIV
- IUD or Essure must be removed before receiving therapy
- Lymphedema (wear compression garments during therapy and traveling)
- Seizures – may require MD clearance letter and/or be accompanied by a caregiver
- SIBO – we have suggested protocols to share with you and your physician
- Sickle cell disease
- Some cardiac or kidney dysfunctions
- Stents (note location, approx. date inserted)
- Surgery (no surgery within 90 days before therapy, some exceptions apply)
Can I receive treatment while I am in the hospital?
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.
How do I know whether this therapy may help me?
You should either complete our online Request Consultation form, and Medical History Form. After thorough review, we can provide information that is specific to your situation.
Who can perform this treatment?
The Wurn Technique®️ is unique. It is 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 for over 25 years, with results published in peer-reviewed medical journals.
Where and how can I get this treatment?
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.
How can my doctor or I learn more about your work?
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 via 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 with a similar history.
How does Clear Passage® therapy compare with myofascial release and visceral mobilization?
All three of these techniques have their histories, merits and individual traits.
Myofascial release (MFR) 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 case studies that report MFR for treating musculoskeletal pain (e.g., low back and ankle pain); none examined its use for abdominal or pelvic conditions.While many people claim to do myofascial release, we are most comfortable recommending a Barnes trained therapist for chronic muscle problems.
Visceral manipulation (VM)) 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 one 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 revealed very few studies that examine the use of VM in humans. One examines its use for neck pain, another examined its use among stroke survivors.
Clear Passage® (CP) is a therapy developed over 30+ years as a method developed specifically to decrease internal scars called adhesions wherever they form in the body. A PubMed (NIH) literature search shows numerous published citations and studies examine the safety and effectiveness of CP in respected medical journals. Among others, published data on CP is found in Fertility and Sterility, the Journal of Endometriosis, Contemporary Ob/Gynand in WebMD’s Medscape General Medicinefor women’s health. Studies appear inGastroenterology, the World Journal of Gastroenterology, the Journal of Clinical Medicine, Pediatric Reports, the Journal of Palliative Medicineand others for treating bowel obstructions.
CP was initially developed by Belinda Wurn, PT and Larry Wurn, LMT as a treatment for chronic pain and dysfunction in patients with pain due to adhesions. This pain was often labeled ‘unexplained’ because adhesions do not appear on diagnostic tests.
When the therapy started opening blocked fallopian tubes, they were joined by physicians and researchers, fascinated with surprising positive results the therapists were witnessing – without surgery. When studies showed CP could open fallopian tubes in most patients, their practice expanded to test, then treat adhesions affecting the intestines of people with life-threatening small bowel obstructions. To date, over a thousand babies have been born to women diagnosed infertile. The therapy has saved countless lives for people with recurring bowel obstructions. Over a dozen citations and studies have reported on the safety and effectiveness of CP therapy.
Understanding that adhesions are the primary cause of life-threatening small bowel obstructions (SBO), CP therapists and researchers began testing the effectiveness of CP therapy to clear SBO. They felt this was important because SBO is the 2nd most common emergency surgery in the USA, carries the highest complication rate (47%), andoften recurs due to the post-surgical adhesions that formed after bowel repair surgery. In a large, controlled study authored by doctors from Harvard, Stanford, Washington and U of Florida medical schools, CP therapy was shown to decrease repeat SBO by 15 times the norm (p=0.0003).
CP is often quite deep, sometimes lighter but always focused on decreasing adhesions – which are a significant problem for many patients and their doctors.
Whatsets CP apart from other forms of bodywork?
- CPonly trains therapists with many years’ experience in bodywork. As of this writing (May 2022), CP therapists average 30 years of experience.
- CP only certifies therapists they have trained one-on-one and found to be highly effective.
- 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.
- 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 are indexed by Google Scholar, and PubMed (National Institutes of Health), and housed in the US National Library of Medicine.
How do I know that Clear Passage®️ is legitimate and that your data is credible?
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, George Washington, 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.
- Physio/physical therapy (PT) is a highly-respected form 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.
Does the medical community accept this work?
Roughly 40% of our patients are healthcare providers (doctors, nurses, therapists, etc.) or their spouses. 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. Patients should be screened by their physician for conditions that would prevent treatment, such as active infection, active cancer or abnormal cysts. We are glad to consult with your physician to explain our work or discuss your case.
Will my health insurance cover treatment? (U.S. Patients)
While you will pay us directly for our services, your insurer may reimburse you for part or all of your therapy. Please note that Medicare and Medicaid do not cover our level of service.
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. This document can also help you get insurance reimbursement. If you are coming for the five-day program, s/he can add “20 hours of manual physical therapy over five days.” Your doctor note “medically necessary, no substitution”, then should sign, date, include their NPI number and give you the referral slip.
Twenty hours of physical therapy per year falls within the parameters of most insurers but some limit therapy to one hour per day. If you speak with your insurer, explain that you have to travel for therapy for services they do not provide; this is one of the only clinics in the country that treats adhesions non-surgically. 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. Learn more about insurance and reimbursement.
Condition-Specific FAQs
What is an adhesion?
An adhesion is an the internal scar; adhesions tend to form in all of us wherever our bodies heal as the first step in healing. Adhesions may occur on the surface of our bodily structures or deep within them. They can join any structure in the body to its neighbor or to distant structures, causing confusing symptoms of 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. They may grow so large that they stretch down the front of the torso from neck to waist, bending a person forward so that s/he literally cannot stand erect.
What causes adhesions?
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.
What is infertility?
This depends on who you ask. The U.S. Centers for Disease Control and Prevention defines infertility as the inability to “get pregnant (conceive) after one year of unprotected sex.” In women over the age of 35, it is defined as inability to conceive after sixth months of unprotected intercourse. The World Health Organization defines infertility as the inability to become pregnant after two years of unprotected sex.
What causes infertility?
A number of factors can cause female infertility. Some women have hormonal causes (e.g. high FSH, PCOS, ovulation problems), while others have mechanical causes such as scarring and adhesions.
Adhesions can block fallopian tubes, decrease function of the fimbriae or ovaries and restrict the cervix, making a difficult passage for sperm. In addition, tiny adhesions within the walls of the uterine body may cause spasm, inflammation or otherwise decrease the chance for implantation, or cause a miscarriage after fertilization. Ovarian adhesions 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 when performed within 15 months before embryo transfer.
What is chronic pain?
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 thought to be a common cause or contributor to unexplained 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.
What is a small bowel obstruction?
A small bowel obstruction is a life-threatening event which occurs when the small intestine becomes partially or fully blocked, preventing food, liquids and gas from moving through the intestines.
Symptoms include severe pain around or just below the belly button, nausea or vomiting, swelling or bloating of the stomach (distention), constipation and the inability to pass gas with a complete obstruction. Total small bowel obstructions are 100% fatal unless the adhesions are cleared. If you experience severe abdominal pain or other bowel obstruction symptoms, you should seek immediate medical attention.
What causes bowel obstruction?
Adhesions (internal scar tissue) from prior surgery are most common cause of small bowel. Other causes include hernias and Crohn’s disease, which can twist or narrow the intestine, and tumors that block the intestine.
In the large intestine, cancer is a common cause of a blockage. Other causes may include severe constipation from a hard mass of stool or narrowing of the intestine called a stricture. Adhesions can also occur as a result of:
- diverticulitis (pouches called diverticula form in the wall of the large intestine and become inflamed or infected)
- inflammatory bowel disease (ongoing inflammation of the intestines that may recur many times in a person’s life)
What does therapy feel like?
Sometimes, therapy can feel like a deep stretch; other times, the work can be very light, as it follows the subtle rhythm within the connective tissue sheath that surrounds the spinal cord and brain. Depending on the diagnosis and treatment area, your therapist may work to improve motility – subtle organ movements. During therapy, we may ask you to flex large muscles or move in certain ways to improve the body’s symmetry and function. We continuously communicate with patients throughout treatment to ensure they understand our intent and findings, and maintain their comfort level. We educate our patients in self-help techniques to prevent reinjury and to maximize the results of therapy.
What is internal treatment like?
The closer we can get to adhesions, the more effective our work. Thus, we have found that combining internal and external assessment and treatment can be much more effective than external assessment and treatment alone in order to resolve some abdominal and pelvic conditions. Physical therapists in the U.S. have been treating patients internally for urinary incontinence and pelvic pain since 1975. The Women’s Health section of the American Physical Therapy Association (APTA) regularly teaches and endorses courses in internal assessment and treatment of pelvic floor dysfunctions.
While most of our therapy is external, your evaluating therapist may suggest some vaginal or rectal assessment to locate tissues that are tender, tight, inflamed, irritated or restricted. As with any part of your evaluation or therapy, we will communicate the basis for suggesting this option and you may accept or decline this component of your care.
With your approval, using non-latex gloves and “environment-friendly” lubricant, we treat any adhered or restricted tissues and structures within the vagina or rectum, as indicated. You can expect to feel some pressure with internal treatment; tenderness will generally improve as we restore mobility to these tissues. Your therapist will always remain within your tolerance level during therapy and, upon your request, will stop at any point in the treatment.
Does therapy hurt?
We work within each patient’s comfort or tolerance level. At all times, the patient is in total control of the depth at which we work. Some invite us to work quite deeply and describe what they call a “good hurt”; others say “you are exactly on the area I have been telling my doctor about for years but that s/he cannot find.”
Our therapists’ touch can be very light when they treat delicate or painful areas, such as on the vaginal wall of a woman suffering from intercourse pain. At other times (and within the patient’s tolerance), we may use deeper pressure to slowly pull through thick muscles in areas such as the back, buttock or leg.
We maintain communication with patients at all times to ensure their comfort level and understanding of our findings. We educate many of our patients in techniques to maximize results and prevent reinjury. Learn more about what to expect during therapy.
Who may benefit from this therapy?
The best candidates have any of the conditions listed on our website or histories indicating possible adhesion formation. These histories include:
- surgery in the abdomen, pelvis, back, hip or neck
- An injury or repetitive trauma, chronic poor posture, physical or sexual abuse
- infection or inflammatory process (e.g. endometriosis, appendicitis, PID)
We treat adults and children of all ages. Minor patients must be accompanied by an adult at all therapy sessions.
Who may not be a good candidate for this therapy
We want you to do well; we don’t want to injure you. Thus, you must report accurately about your body and medical history. Some applicants with the conditions below may need to obtain physician clearance prior to scheduling therapy; some may not be appropriate for therapy. We are cautious about treating patients with the following conditions:
- Aneurysm
- Active infection
- Autoimmune disorders must be under control. We may need to delay, or to spread therapy over two weeks if applicant has elevated inflammatory markers for these conditions:
- Crohn’s
- Fibromyalgia
- Celiac Disease
- Grave’s disease
- Ulcerative Colitis
- Rheumatoid Arthritis
- Systemic Lupus Erythematosus
- Bipolar disorder patients often do not do well with this therapy
- Blood clotting disorder, abnormal bleeding or blood thinning medication
- Both fallopian tubes have been removed or surgically closed; you may qualify for our pre-IVF therapy, but not natural infertility reversal. Call for more information.
- Cancer in the last 18 months (Requires a more extensive evaluation)
- Cardiac conditions, including DVT, PE, or CVA in the last 12 months
- Congestive heart failure (need your details)
- Connective tissue disorder (EDS, Marfan)
- Deep Vein Thrombosis, PE or CVA within 12 weeks of scheduled therapy
- Endometrioma; other non-follicular cyst(s)
- Fistula present within 6 weeks of therapy of scheduled therapy
- Gall stones or kidney stones (Requires more extensive evaluation)
- Heart, liver or kidney dysfunction (Requires a more extensive evaluation)
- Hernia (we need to know the location and approximate size)
- HIV
- IUD or Essure must be removed before receiving therapy
- Lymphedema (wear compression garments during therapy and traveling)
- Seizures – may require MD clearance letter and/or be accompanied by a caregiver
- SIBO – we have suggested protocols to share with you and your physician
- Sickle cell disease
- Some cardiac or kidney dysfunctions
- Stents (note location, approx. date inserted)
- Surgery (no surgery within 90 days before therapy, some exceptions apply)
Can I receive treatment while I am in the hospital?
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.
How do I know whether this therapy may help me?
You should either complete our online Request Consultation form, and Medical History Form. After thorough review, we can provide information that is specific to your situation.
Who can perform this treatment?
The Wurn Technique®️ is unique. It is 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 for over 25 years, with results published in peer-reviewed medical journals.
Where and how can I get this treatment?
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.
How can my doctor or I learn more about your work?
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 via 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 with a similar history.
How do I know that Clear Passage®️ is legitimate and that your data is credible?
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, George Washington, 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.
- Physio/physical therapy (PT) is a highly-respected form 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.
Does the medical community accept this work?
Roughly 40% of our patients are healthcare providers (doctors, nurses, therapists, etc.) or their spouses. 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. Patients should be screened by their physician for conditions that would prevent treatment, such as active infection, active cancer or abnormal cysts. We are glad to consult with your physician to explain our work or discuss your case.
Will my health insurance cover treatment? (U.S. Patients)
While you will pay us directly for our services, your insurer may reimburse you for part or all of your therapy. Please note that Medicare and Medicaid do not cover our level of service.
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. This document can also help you get insurance reimbursement. If you are coming for the five-day program, s/he can add “20 hours of manual physical therapy over five days.” Your doctor note “medically necessary, no substitution”, then should sign, date, include their NPI number and give you the referral slip.
Twenty hours of physical therapy per year falls within the parameters of most insurers but some limit therapy to one hour per day. If you speak with your insurer, explain that you have to travel for therapy for services they do not provide; this is one of the only clinics in the country that treats adhesions non-surgically. 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. Learn more about insurance and reimbursement.
Condition-Specific FAQs
What is an adhesion?
An adhesion is an the internal scar; adhesions tend to form in all of us wherever our bodies heal as the first step in healing. Adhesions may occur on the surface of our bodily structures or deep within them. They can join any structure in the body to its neighbor or to distant structures, causing confusing symptoms of 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. They may grow so large that they stretch down the front of the torso from neck to waist, bending a person forward so that s/he literally cannot stand erect.
What causes adhesions?
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.
What is infertility?
This depends on who you ask. The U.S. Centers for Disease Control and Prevention defines infertility as the inability to “get pregnant (conceive) after one year of unprotected sex.” In women over the age of 35, it is defined as inability to conceive after sixth months of unprotected intercourse. The World Health Organization defines infertility as the inability to become pregnant after two years of unprotected sex.
What causes infertility?
A number of factors can cause female infertility. Some women have hormonal causes (e.g. high FSH, PCOS, ovulation problems), while others have mechanical causes such as scarring and adhesions.
Adhesions can block fallopian tubes, decrease function of the fimbriae or ovaries and restrict the cervix, making a difficult passage for sperm. In addition, tiny adhesions within the walls of the uterine body may cause spasm, inflammation or otherwise decrease the chance for implantation, or cause a miscarriage after fertilization. Ovarian adhesions 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 when performed within 15 months before embryo transfer.
What is chronic pain?
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 thought to be a common cause or contributor to unexplained 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.
What is a small bowel obstruction?
A small bowel obstruction is a life-threatening event which occurs when the small intestine becomes partially or fully blocked, preventing food, liquids and gas from moving through the intestines.
Symptoms include severe pain around or just below the belly button, nausea or vomiting, swelling or bloating of the stomach (distention), constipation and the inability to pass gas with a complete obstruction. Total small bowel obstructions are 100% fatal unless the adhesions are cleared. If you experience severe abdominal pain or other bowel obstruction symptoms, you should seek immediate medical attention.
What causes bowel obstruction?
Adhesions (internal scar tissue) from prior surgery are most common cause of small bowel. Other causes include hernias and Crohn’s disease, which can twist or narrow the intestine, and tumors that block the intestine.
In the large intestine, cancer is a common cause of a blockage. Other causes may include severe constipation from a hard mass of stool or narrowing of the intestine called a stricture. Adhesions can also occur as a result of:
- diverticulitis (pouches called diverticula form in the wall of the large intestine and become inflamed or infected)
- inflammatory bowel disease (ongoing inflammation of the intestines that may recur many times in a person’s life)
What is Clear Passage®️?
We are a network of physical therapy (called physiotherapy in outside the U.S.A.) clinics. We provide a unique manual therapy protocol (the Clear Passage® Approach) to treat chronic pain and dysfunction, including post-surgical pain, small bowel obstruction and female infertility. Our therapists receive exclusive training, certification and licensing to provide our work. None of our treatments involve drugs or surgery.
Patients come to Clear Passage®️ locations from around the world and from all walks of life. Many have conditions that have not resolved after traditional therapy, medications or surgery; some want to avoid future surgery. About 35% of our patients are health care professionals, or their spouses. Our therapy has shown positive results in numerous peer-reviewed, PubMed indexed studies, housed in the US National Library of Medicine.
What is the Clear Passage® Approach?
The Clear Passage® Approach is a unique hands-on therapy protocol, developed over 25+ years of study and clinical research by Belinda Wurn, PT and Larry Wurn, LMT. Our focus is to deform, detach and seperate the bonds that attach collagenous cross-links, the building blocks of adhesions. The protocol includes over 200 individual techniques designed to reduce and eliminate adhesions that form wherever the body heals. As a manual therapy, it works without the risks or side effects of surgery or drugs. Studies on the effectiveness of this work, published in peer-reviewed medical journals, show success treating conditions not previously treated via outpatient therapy.
Why is this therapy unique?
Every body heals differently after injury, surgery, infection or inflammation. Physical therapists certified in the Clear Passage®️ Approach are trained to evaluate and treat the entire body. Coupled with extensive patient history and feedback, this holistic view helps us understand the physical forces preventing patients from leading the life they envision. Our focus is to decrease the powerful adhesive pulls that cause pain or dysfunction – no matter where they occur in the body.
Our therapy is different from other manual therapies for several reasons:
- We have lived the experience. Our work was born in 1986 from the need to find a non-surgical answer to treat debilitating pain in our co-founder and Therapist Director, Belinda Wurn, PT.
- Focused on decreasing adhesions, our background is broad; our focus is logical and methodical. We studied rigorously with top manual physicians and physical therapists in the U.S. and abroad. From that strong foundation, we worked hard to develop a therapy to effectively treat the adhesions causing Belinda’s pain and dysfunction. After Belinda was able to return to work, we continued to refine our work to treat others with pain and dysfunction.
- We test our work and publish our results. Independent physicians and scientists design studies that measure the results of our therapy. We regularly present our findings and results at medical conferences. Studies on the effectiveness of the Wurn Technique®️ and Clear Passage®️ have been published in peer-reviewed medical journals and accepted into the U.S. National Library of Medicine. Citations about this work appear in WebMD’s Medscape General Medicine, Fertility and Sterility, Gastroenterology, Healthcare, Contemporary Ob-Gyn, Alternative Therapies in Health and Medicine, the Journal of Endometriosis, and the World Journal of Gastroenterology, among others.
- We rigorously test and train our therapists for knowledge and clinical skills. We base their certification on strong manual and palpatory skills, and on test results after weeks of study and training. Each must pass tests that demonstrate a thorough understanding of the material in our 600-page Therapist Training Manual written by Belinda Wurn, PT and her training staff.
What does therapy feel like?
Sometimes, therapy can feel like a deep stretch; other times, the work can be very light, as it follows the subtle rhythm within the connective tissue sheath that surrounds the spinal cord and brain. Depending on the diagnosis and treatment area, your therapist may work to improve motility – subtle organ movements. During therapy, we may ask you to flex large muscles or move in certain ways to improve the body’s symmetry and function. We continuously communicate with patients throughout treatment to ensure they understand our intent and findings, and maintain their comfort level. We educate our patients in self-help techniques to prevent reinjury and to maximize the results of therapy.
What is internal treatment like?
The closer we can get to adhesions, the more effective our work. Thus, we have found that combining internal and external assessment and treatment can be much more effective than external assessment and treatment alone in order to resolve some abdominal and pelvic conditions. Physical therapists in the U.S. have been treating patients internally for urinary incontinence and pelvic pain since 1975. The Women’s Health section of the American Physical Therapy Association (APTA) regularly teaches and endorses courses in internal assessment and treatment of pelvic floor dysfunctions.
While most of our therapy is external, your evaluating therapist may suggest some vaginal or rectal assessment to locate tissues that are tender, tight, inflamed, irritated or restricted. As with any part of your evaluation or therapy, we will communicate the basis for suggesting this option and you may accept or decline this component of your care.
With your approval, using non-latex gloves and “environment-friendly” lubricant, we treat any adhered or restricted tissues and structures within the vagina or rectum, as indicated. You can expect to feel some pressure with internal treatment; tenderness will generally improve as we restore mobility to these tissues. Your therapist will always remain within your tolerance level during therapy and, upon your request, will stop at any point in the treatment.
Does therapy hurt?
We work within each patient’s comfort or tolerance level. At all times, the patient is in total control of the depth at which we work. Some invite us to work quite deeply and describe what they call a “good hurt”; others say “you are exactly on the area I have been telling my doctor about for years but that s/he cannot find.”
Our therapists’ touch can be very light when they treat delicate or painful areas, such as on the vaginal wall of a woman suffering from intercourse pain. At other times (and within the patient’s tolerance), we may use deeper pressure to slowly pull through thick muscles in areas such as the back, buttock or leg.
We maintain communication with patients at all times to ensure their comfort level and understanding of our findings. We educate many of our patients in techniques to maximize results and prevent reinjury. Learn more about what to expect during therapy.
Who may benefit from this therapy?
The best candidates have any of the conditions listed on our website or histories indicating possible adhesion formation. These histories include:
- surgery in the abdomen, pelvis, back, hip or neck
- An injury or repetitive trauma, chronic poor posture, physical or sexual abuse
- infection or inflammatory process (e.g. endometriosis, appendicitis, PID)
We treat adults and children of all ages. Minor patients must be accompanied by an adult at all therapy sessions.
Who may not be a good candidate for this therapy
We want you to do well; we don’t want to injure you. Thus, you must report accurately about your body and medical history. Some applicants with the conditions below may need to obtain physician clearance prior to scheduling therapy; some may not be appropriate for therapy. We are cautious about treating patients with the following conditions:
- Aneurysm
- Active infection
- Autoimmune disorders must be under control. We may need to delay, or to spread therapy over two weeks if applicant has elevated inflammatory markers for these conditions:
- Crohn’s
- Fibromyalgia
- Celiac Disease
- Grave’s disease
- Ulcerative Colitis
- Rheumatoid Arthritis
- Systemic Lupus Erythematosus
- Bipolar disorder patients often do not do well with this therapy
- Blood clotting disorder, abnormal bleeding or blood thinning medication
- Both fallopian tubes have been removed or surgically closed; you may qualify for our pre-IVF therapy, but not natural infertility reversal. Call for more information.
- Cancer in the last 18 months (Requires a more extensive evaluation)
- Cardiac conditions, including DVT, PE, or CVA in the last 12 months
- Congestive heart failure (need your details)
- Connective tissue disorder (EDS, Marfan)
- Deep Vein Thrombosis, PE or CVA within 12 weeks of scheduled therapy
- Endometrioma; other non-follicular cyst(s)
- Fistula present within 6 weeks of therapy of scheduled therapy
- Gall stones or kidney stones (Requires more extensive evaluation)
- Heart, liver or kidney dysfunction (Requires a more extensive evaluation)
- Hernia (we need to know the location and approximate size)
- HIV
- IUD or Essure must be removed before receiving therapy
- Lymphedema (wear compression garments during therapy and traveling)
- Seizures – may require MD clearance letter and/or be accompanied by a caregiver
- SIBO – we have suggested protocols to share with you and your physician
- Sickle cell disease
- Some cardiac or kidney dysfunctions
- Stents (note location, approx. date inserted)
- Surgery (no surgery within 90 days before therapy, some exceptions apply)
Can I receive treatment while I am in the hospital?
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.
How do I know whether this therapy may help me?
You should either complete our online Request Consultation form, and Medical History Form. After thorough review, we can provide information that is specific to your situation.
Who can perform this treatment?
The Wurn Technique®️ is unique. It is 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 for over 25 years, with results published in peer-reviewed medical journals.
Where and how can I get this treatment?
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.
How can my doctor or I learn more about your work?
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 via 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 with a similar history.
How do I know that Clear Passage®️ is legitimate and that your data is credible?
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, George Washington, 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.
- Physio/physical therapy (PT) is a highly-respected form 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.
Does the medical community accept this work?
Roughly 40% of our patients are healthcare providers (doctors, nurses, therapists, etc.) or their spouses. 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. Patients should be screened by their physician for conditions that would prevent treatment, such as active infection, active cancer or abnormal cysts. We are glad to consult with your physician to explain our work or discuss your case.
Will my health insurance cover treatment? (U.S. Patients)
While you will pay us directly for our services, your insurer may reimburse you for part or all of your therapy. Please note that Medicare and Medicaid do not cover our level of service.
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. This document can also help you get insurance reimbursement. If you are coming for the five-day program, s/he can add “20 hours of manual physical therapy over five days.” Your doctor note “medically necessary, no substitution”, then should sign, date, include their NPI number and give you the referral slip.
Twenty hours of physical therapy per year falls within the parameters of most insurers but some limit therapy to one hour per day. If you speak with your insurer, explain that you have to travel for therapy for services they do not provide; this is one of the only clinics in the country that treats adhesions non-surgically. 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. Learn more about insurance and reimbursement.
Condition-Specific FAQs
What is an adhesion?
An adhesion is an the internal scar; adhesions tend to form in all of us wherever our bodies heal as the first step in healing. Adhesions may occur on the surface of our bodily structures or deep within them. They can join any structure in the body to its neighbor or to distant structures, causing confusing symptoms of 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. They may grow so large that they stretch down the front of the torso from neck to waist, bending a person forward so that s/he literally cannot stand erect.
What causes adhesions?
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.
What is infertility?
This depends on who you ask. The U.S. Centers for Disease Control and Prevention defines infertility as the inability to “get pregnant (conceive) after one year of unprotected sex.” In women over the age of 35, it is defined as inability to conceive after sixth months of unprotected intercourse. The World Health Organization defines infertility as the inability to become pregnant after two years of unprotected sex.
What causes infertility?
A number of factors can cause female infertility. Some women have hormonal causes (e.g. high FSH, PCOS, ovulation problems), while others have mechanical causes such as scarring and adhesions.
Adhesions can block fallopian tubes, decrease function of the fimbriae or ovaries and restrict the cervix, making a difficult passage for sperm. In addition, tiny adhesions within the walls of the uterine body may cause spasm, inflammation or otherwise decrease the chance for implantation, or cause a miscarriage after fertilization. Ovarian adhesions 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 when performed within 15 months before embryo transfer.
What is chronic pain?
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 thought to be a common cause or contributor to unexplained 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.
What is a small bowel obstruction?
A small bowel obstruction is a life-threatening event which occurs when the small intestine becomes partially or fully blocked, preventing food, liquids and gas from moving through the intestines.
Symptoms include severe pain around or just below the belly button, nausea or vomiting, swelling or bloating of the stomach (distention), constipation and the inability to pass gas with a complete obstruction. Total small bowel obstructions are 100% fatal unless the adhesions are cleared. If you experience severe abdominal pain or other bowel obstruction symptoms, you should seek immediate medical attention.
What causes bowel obstruction?
Adhesions (internal scar tissue) from prior surgery are most common cause of small bowel. Other causes include hernias and Crohn’s disease, which can twist or narrow the intestine, and tumors that block the intestine.
In the large intestine, cancer is a common cause of a blockage. Other causes may include severe constipation from a hard mass of stool or narrowing of the intestine called a stricture. Adhesions can also occur as a result of:
- diverticulitis (pouches called diverticula form in the wall of the large intestine and become inflamed or infected)
- inflammatory bowel disease (ongoing inflammation of the intestines that may recur many times in a person’s life)
If you’d like a free consult, please take 20 minutes and fill out this form and we can determine if therapy would be a good fit for you.
