Physical Therapy for Abdominal Adhesions

Abdominal adhesions arise when soft tissues form scar tissue in the abdomen, making them dense and sticky, and causing them to adhere to the abdominal wall, or to visceral organs — a condition sometimes referred to as “frozen abdomen.” While many patients with abdominal adhesions remain symptom-free, some may develop abdominal pain and other serious symptoms that require aggressive intervention.

Learn about abdominal adhesions, the complications they can cause, and alternative methodologies and regenerative technologies that help to release adhesions and restore tissue integrity.

What Causes Abdominal Adhesions?

Healthy soft tissues — muscles, fat, connective tissues, blood vessels, nerves and fascia — are designed to glide freely among one another, and among visceral organs and bony structures throughout the body. Most soft tissues are slippery and elastic, stretching and gliding as you move. But certain factors can cause soft tissues to become sticky and inelastic, inhibiting their movement and causing them to adhere to other structures.

Causes of abdominal adhesions include:

  • Cesarean section (C-section) during childbirth
  • Abortion and miscarriage
  • Cosmetic surgery
  • Gynecological procedures
  • Other types of abdominal surgery
  • Endometriosis
  • Inflammatory infections
  • Bowel disorders
  • Certain digestive disorders

Abdominal surgery is the number one cause of abdominal adhesions, with more than 90 percent of patients developing adhesions post-surgery.

Certain factors can increase the risk and severity of post-surgical and other types of abdominal adhesions, including:

  • Surgery complexity
  • Extent of trauma to the peritoneum — the membrane lining the abdominal cavity
  • Metabolic disorders like diabetes
  • Poor nutritional status
  • Chronic dehydration
  • Medical implants
  • Bacterial infections
  • Laparoscopic surgery

Complications of Abdominal Adhesions

Surgery-related adhesions are more likely to develop complications compared to other causes, some of them life-threatening. Adhesion-related complications and symptoms can arise months or even decades after surgery.

Complications of intra-abdominal adhesions include:

  • Chronic abdominal pain
  • Accumulation of gas in the GI tract (meteorism)
  • Irregular bowel movements with variable stool consistency
  • Digestive disorders
  • Intestinal obstruction
  • Pelvic pain
  • Painful intercourse
  • Female infertility

According to one source, abdominal adhesions cause 65% to 75% of small bowel occlusions, and 15-20% of female infertility. In some cases, abdominal adhesions can cause back pain and pelvic disorders due to their restrictive effect on biomechanics in the lumbopelvic region. They may also cause gait deficits and postural issues.

Adhesions can also cause intestinal obstructions that can be life-threatening and require immediate medical intervention. Adhesions and scar tissue can create a difficult environment for future surgeries, prolonging the length and complexity of procedures, and extending recovery time for the patient.

Diagnosis of Abdominal Adhesions

Abdominal pain alone is not enough to assume that a patient has abdominal adhesions. Imaging modalities like CT scan, MRI and diagnostic ultrasonography are used to identify adhesions and their related complications. Of the three modalities, MRI and ultrasound have the best track records, with overall accuracy ranging from 79-90% for MRI, and 76 to 100% for ultrasound.

Ultrasonography has distinct advantages over MRI for adhesion treatment:

  • Ultrasound renders real-time images — patients can be assessed on-site, with no waiting for lab results.
  • Ultrasound can scan the length of long structures like muscles, bones and nerves in a single session.
  • Ultrasound can render dynamic images with the patient in motion, to assess how adhesions and scar tissues affect the mobility and function of visceral organs and other structures.
  • Ultrasound can be used to guide surgical procedures, to help prevent the formation of adhesions post-surgery.
adhesion treatment 1 adhesion treatment 2 adhesion treatment 3

Ultrasound equipment is relatively inexpensive compared to MRI, and takes up minimal space. The equipment is agile and mobile, and ultrasound does not emit damaging radiation, making it safe for anyone. Compared to MRI, ultrasonography is far more comfortable and convenient for patients, and it empowers them to participate in the diagnostic process.

Abdominal Adhesion Treatment Options

Some medical doctors attempt to release adhesions via laparoscopic or open abdominal surgery, but surgery to treat adhesions can actually cause new adhesions to form. Physical therapy for abdominal adhesions uses non-invasive alternative approaches to break up scar tissue and release adhesions while enhancing the integrity of associated tissues.

Alternative approaches for safe and effective adhesion therapy include:


Stecco Fascia Manipulation Therapy
The Stecco method of fascia manipulation involves deep friction that heats up tissues and stimulates mechanical action. When performed by a trained professional, Stecco fascia manipulation is a fantastic and evidence-based methodology for breaking up scar tissue and releasing adhesions. Regenerative technologies are often used in conjunction with Stecco myofascial release of abdominal adhesions. Patients often report immediate pain relief after a single Stecco session.

INDIBA Radiofrequency Therapy
INDIBA therapy is an extracorporeal (outside the body) adhesion treatment approach that helps to restore the ionic charge of damaged cells. When used in conjunction with Stecco adhesion therapy and shockwave therapy, INDIBA helps to accelerate tissue healing at the cellular level.

Stecco Fascia Manipulation Therapy INDIBA Radiofrequency Therapy

Radial Extracorporeal Shockwave Therapy (ESWT)
Radial ESWT is an FDA-approved technology that is highly effective for adhesion treatment. It uses ballistic sound waves that penetrate soft tissues to trigger the body’s natural healing mechanisms. Shockwaves cause the targeted cells to release bio-chemicals that stimulate the growth of new microscopic blood vessels in the tissue.

Barral Visceral Manipulation
Manual visceral manipulation therapy focuses on the internal organs and dysfunctional tissues in their environment. A well-trained and experienced practitioner learns to “listen” to tissues with their hands, to feel where the tissues are pulling toward areas of restriction.

Radial Extracorporeal Shockwave Therapy (ESWT) Barral Visceral Manipulation

Preventing Abdominal Adhesions

Abdominal adhesions from previous surgeries can make new procedures more complicated to perform, significantly increasing the patient’s risk of injury and infection, and prolonging the recovery period. Adhesions can complicate or even prohibit procedures like diagnostic ultrasonography, in-vitro fertilization, chemotherapy and kidney dialysis.

Recent research has shifted focus from treatment to prevention, to find effective ways to avoid future complications related to existing adhesions. Measures like optimizing patient health and nutrition status prior to surgery, and using ultrasonography to guide surgical procedures are steps in the right direction. Precise and meticulous surgical technique is key to preventing adhesion formation.

Abdominal Adhesion Specialists in NYC

Successful abdominal adhesion treatment begins with a thorough and accurate diagnosis. The clinic at NYDNRehab features the most advanced high-resolution diagnostic ultrasound equipment available. Dr. Kalika is a recognized expert in diagnostic ultrasonography, with multiple scientific publications to his credit.

Our clinic also features an array of regenerative technologies for treating scar tissue and adhesions. Our expertise in myofascial release techniques and visceral manipulation therapy is second to none.

Contact NYDNRehab today for accurate diagnosis and state-of-the-art adhesion therapy

Request an appointment » map Our location: 11 West 25th Street 5th floor, New York, NY 10010

If you have had abdominal surgery recently or in the past, there is a high likelihood that you have developed abdominal adhesions. Contact NYDNRehab today for accurate diagnosis and state-of-the-art adhesion therapy in NYC.


  • Brüggmann, Dörthe, et al. “Intra-abdominal adhesions: definition, origin, significance in surgical practice, and treatment options.” Deutsches ärzteblatt international 107.44 (2010): 769.
  • Carmichael II, Samuel P., et al. “Regenerative medicine therapies for prevention of abdominal adhesions: A scoping review.” Journal of Surgical Research 275 (2022): 252-264.
  • Gerner-Rasmussen, Jonas, Anders Meller Donatsky, and Flemming Bjerrum. “The role of non-invasive imaging techniques in detecting intra-abdominal adhesions: a systematic review.” Langenbeck’s Archives of Surgery 404 (2019): 653-661.
  • Gumán-Valdivia-Gómez, G., E. Tena-Betancourt, and P. M. de Alva-Coria. “Postoperative abdominal adhesions: pathogenesis and current preventive techniques.” World J Surg Surgical Res. 2018; 1 1008 (2019).
  • Yasemin, Altıntas, Bayrak Mehmet, and Alabaz Omer. “Assessment of the diagnostic efficacy of abdominal ultrasonography and cine magnetic resonance imaging in detecting abdominal adhesions: A double-blind research study.” European journal of radiology 126 (2020): 108922.

In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

Buy now 3D Gait
Payment Success
Request Telehealth Request Telehealth Request in office visit Book now