19 Oct Osteopathic approach after an appendectomy
Osteopathic approach after an appendectomy
The procedure and necessity of appendectomies is without question brilliant. In many cases it is a vital procedure. However there are, in some cases, consequences of an appendectomy. Let’s look at an Osteopathic approach after an appendectomy.
Procedure of an appendectomy
When the appendix is removed, 3 small incisions are made. One for the camera, one for the cutter and one for the burner. The appendix is then gradually sliced or burned away from its various attachments. It is then taken out and the 3 slices are stitched up. An appendectomy is typically completed within 20-30 minutes.
You are given pain killers, maybe some antibiotics (although that is less common now) and then most likely released from hospital on that day. Rarely are you followed up and to be honest I can kind of understand this since an appendectomy is a relatively straight forward surgery.
Here is a great video of an appendectomy. I would like to thank Carolina Surgical for this video.
Principles of scar tissue
Why is it then that a small percentage of people develop complications after their appendectomy? The most common symptoms people can get are back pain, groin pain, constipation, abdominal pain, gas/painful cramps, knee and leg pain.
To explore this it is very important to consider the affect of scar tissue during any surgery. I have written a separate article about scar tissue. It is really good and goes hand in hand with this article.
Principles of Fixation
The appendix is located at the end of the cecum (the name given to the beginning of the large intestine). Due to the nature of scar tissue this area around the cecum, including the cecum itself, can become fixated to the back wall of the abdomen.
When the inherent movement of the cecum has stopped it creates what I call drag. This is a principle resulting from scar tissue. This drag almost acts like a gravity field. Not only is the inflexibility of the scar tissue causing tension to spread through the structure, it also causes other nearby structures associated with it to get pulled towards the scar tissue or fixation. Read the scar tissue article.
The back wall, in this case, would be the transverse abdominis and iliacus muscle. The cecum is also the junction where the small and large intestine meet. In some woman the cecum can actually connect to the right ovary via the ligament of Cleyet.
Osteopathic approach after an appendectomy
What is the relevance of this? Why can complications of an Appendectomy occur?
Any organ that becomes fixated or stuck creates two offending scenarios. One it restricts the surrounding musculoskeletal or organ system that it attaches too. Two, the function of that organ becomes dysfunctional.
So in this case the cecum becomes fixed. This is the beginning of the large intestine which is responsible for absorbing water and certain vitamins. This job becomes impeded leading to possible constipation, diarrhoea, cramping, gas and mild dehydration. Also its ability to absorb nutrients will undoubtably reduce too.
Remember it is important to consider the body wide affect that each of these symptoms cause. Constipation is not just difficultly pooing. It is stagnant waste sitting in your intestines. It is a build up of toxins. It is increased pressure (in many cases this can be extremely painful). It is poor nutrient absorption. Etc etc.
Since it attaches to the posterior abdominal wall then those structures it attaches too will also struggle.
Complications of an Appendectomy further afield
Higher up as part of the ascending colon, the cecum attaches to the duodenum (the beginning of the small intestines), the right kidney, liver, gallbladder and finishing up fixing into the diaphragm. I highlight all these attachments because these can become potential areas of compensation, irritation and/or sites of ‘injury’/symptoms.
Hip, knee and ankle complications can develop
The cecum attaches to the iliacus muscle of the pelvis, which works to produce flexion and internal rotation of the hip. If the cecum becomes stuck it can cause the iliacus muscle to pull towards the area of fixation. It is almost like the two structures start to act as a single structure.
Ultimately this causes the muscle to become chronically contracted and the hip to become more and more internally rotated and flexed. This will lead to internal rotation of the femur and then internal rotation of the knee joint. The knee joint will also remain in further flexion.
Both these actions result in the tibia shifting further forward on the ankle joint and inwards towards the medial arch of the foot. This can predispose to stress on the medial arch, which over time can lead to collapsing of that arch known as over pronation.
Conditions like plantar fascitis and heel spurs can develop. So with just this simple chain we can see the potential of knee, ankle and foot complications occurring just from an appendectomy.
Remember these are just potential causes and NOT definite compensations that will happen to everyone that has had an appendectomy.
Neck complications can develop
So going back to the other structures mentioned above. I’m going to leave out the duodenal and kidney attachments here otherwise I’ll end up writing a book rather than an article. But let’s focus on the liver and diaphragm attachments.
Through fixation of the cecum, the ascending colon is gradually being drawn down towards the cecum area via the drag and this directly pulls on the liver and diaphragm. The liver is having to move with an unnatural force pulling it constantly downwards towards the hip.
The liver has massive attachments to the diaphragm and then with the direct attachments of the ascending colon as well, we suddenly find the diaphragm is struggling too.
Now on the upper surface of the diaphragm you have the pleura of the lungs (the membrane that covers the lungs) which blends directly into the diaphragm. At the apex of the lungs, the pleura attaches to the vertebral bones of the neck via Sibson’s fascia.
With the pull of the diaphragm down, you also get a pull of the pleura, which pulls on the neck. Neck pain, stiffness and tension can occur.
I think it is important to clarify here that although I’m talking about one structure pulling on another structure and then that other structure pulling still further on another structure; it is slightly different within the body.
We have to remember the body is living and everything is connected, even if it is not physical, it is still connected by blood, nerves, emotions, hormones and gravity. It is very difficult to highlight how this represents in the body via words.
In the medical world when we learn anatomy we cut everything down and separate everything to its basic level, so we can learn. But to grasp how the body truly works we need to build up that anatomy again and see a whole living body once more. It is very easy to think,
“How is it possible for the Cecum, which is all the way down near the hip to affect the neck – the two structures are so far away?”
In the body these structures are in fact touching, but perhaps not in a direct way.
Low back pain is common
Here I am going to talk about a structure called ‘toldt’s fascia’. This structure is a membrane type structure or for understandings sake let’s just say it acts like a piece of ‘cling film’ or ‘shrink wrap’. This membrane starts from the spine, spreads out and wraps around the ascending colon to then travel back to the spine again.
So when the colon becomes fixed, this can lead to stress and tightness spreading through Toldt’s fascia, resulting in a pull on the spine. Over a prolonged period of time it puts a greater demand on the spine and it gradually stiffens up.
The exact same principle applies to the transverse abdominis. This is a major component of your core muscles. The core muscles are so important for lower back strength and stability.