Back Pain After Abdominal Surgery—Why Does It Happen?

During the peak of the COVID-19 crisis, many elective surgeries were delayed by weeks or months. Now in the clinic, we’re seeing a large number of clients coming in with severe post surgery back pain.

Some have had cysts removed, caesareans, or appendectomies, while others have had hernia repaired. Some had large incisions, and some had multiple small incisions. While these are not long-term complications of abdominal surgery, they can still be associated with certain risks and considerations during recovery.

But why, a few weeks later, did their backs start playing up?

The first reason is that they had underlying issues and pathology that they may or may not have been aware of. Some clients had previously had multiple episodes of back pain—some severe—that had ‘resolved’ after a few days or a few weeks. This sort of story is really common.

When people come to see us, they come in because they’ve heard from someone that we’re different and that our physios are awesome—which is true. Usually, by the time we see them, they’ve already seen multiple other chiros, physios or massage therapists without really getting much change. They have stories where they have experienced multiple flare-ups with their back every 6-12 months that they just put up with. When you put up with this sort of situation, a muscle in your back called the multifidus gets switched off at the level in your spine where the problem is. The trouble is that this muscle does not switch back on unless someone intervenes.

Assessment and treatment of the multifidus is not part of physio for back pain, so standard physios don’t address it. But it’s a super important part of your core, and the multifidus supports the vertebrae and contributes towards maintaining the health of your discs.  

The longer it is left to its own devices and switched off, the more the muscles waste away, and the more fat starts infiltrating and replacing once healthy muscle. This is so common that really significant fat infiltration of the multifidus isn’t even mentioned in MRI reports, even though it’s a big problem. 

So the first reason people get back pain after abdominal surgeries is that things were already problematic. 

Then you have your abdominal surgery, and the surgeon has to cut through the muscles of the stomach and the fascia and connective tissue to get to the area they need to do their highly specialised and important work. Then, as the wound heals, scar tissue forms. Some people have more issues with scar tissue than others. Some get big, lumpy red scars. Others are luckier, but everyone gets some scar tissue after surgery.

The trouble is that scar tissue can impact how your muscles and connective tissue (fascia) can glide and slide. It’s like there’s a new sticky point. The muscle 

surrounding the incision site often switches off due to pain and the incision itself. If you’re lucky, it switches on (even if only partially). If you’re not lucky, it doesn’t unless you deliberately do some work to get it to switch back on. The bigger the incision, the bigger the impact. 

Hopefully, you’re starting to see a bit of a problematic picture forming: 

1. There are underlying problems in the spine.

2. Those problems have led to the multifidus switching off or not functioning well. This means you’re missing an important ‘core’ muscle that helps stabilise the spine at that level.

3. The abdominal wound has switched off or reduced the function of part of your abdominal muscles—another important aspect of your ‘core’.

In this situation, it becomes harder for your body to hold it all together without getting pain. Sometimes you start using other muscles to do work they’re not supposed to do or overload other joints to try and keep things going, but that won’t work well for very long. And soon enough, things start to break down, discs and joints get irritated, and suddenly, you’ve walked into the perfect storm—really commonly after doing a few things in the garden or just lifting something up.

Managing scar tissue after any surgery is really important. Physios can help reduce the ‘sticky-ness’ of scar tissue, minimise what it adheres to, and help free up the scar so that the tissue can glide and slide as you move.

We have an ultrasound machine in the clinic. This lets us have a look at your core muscles when you try to turn them on. We can look at different areas in the muscle to see if it’s working well. Our physios use ultrasound to help you find the best way to get your core muscles back on so your back is supported and as protected as possible.

If you’ve had abdominal surgery, we would strongly encourage you to come in and get your scar and abdominal muscles checked. If you have a history of back pain – surgery or no surgery—we cannot emphasise enough how important it is that someone checks your multifidus, looks for any deficits, and teaches you how to address them sooner rather than later.

Early assessment of multifidus muscles and tailored physiotherapy for back pain can be immensely beneficial in addressing any deficits and promoting recovery. Taking proactive steps through back pain physiotherapy can contribute to a smoother and more effective rehabilitation process.