I had a great discussion today with one of our therapists about the difference between fibrosis and adhesions. Both adhesions and fibrosis are the result of injury and inflammation in tissue causing fibrous deposits. The main difference is where these deposits occur. Fibrosis occurs within a muscle or organ, where adhesions bind two separate tissues or organs together. This technical jargon really matters most to us therapists. The feeling the client experiences may not be any different, but to the therapist when palpating, an adhesion will feel like a little piece of extra-crunchy tissue and fibrosis will make the muscle itself feel bunched up. In my personal experience adhesions break up much easier than fibrosis unless the adhesions are imbedded deep within a joint like in frozen shoulders.
One big reason for this discussion is how therapists can communicate expectations to clients regarding frequency of visits and healing time. For example, someone with adhesions between their IT band and Vastus Lateralus muscles may – and let me emphasize may – experience relief from pain, and increased range of motion immediately after the therapist breaks them up. And someone with fibrosis in their upper trap may need multiple sessions before they experience any significant amount of pain relief or increased range of motion. Of course, there is much to consider when discussing time required to experience relief from pain, such as daily routine (i.e. time spent exercising and stretching, and activities that may aggravate the tissues involved), how acute or chronic the injury may be, the tolerance level of your client to possibly uncomfortable treatment, and the potential for other tissues to be involved.
Remember client/therapist communication is the key to any successful results. It is up to us therapists to set realistic expectations of our work and to encourage our clients to explore and understand the nature of their discomforts so that we can develop an attainable plan. Our plans should also be evaluated and shifted as needed to accommodate the results our clients are experiencing.
Be well, Gina Tibbs