Scars and adhesions are not inert remnants of injury—they are dynamic, neuroimmune-active contributors to pain, dysfunction, and altered interoception. This intensive 3-day course bridges emerging science with hands-on practice, exploring how inflammation, neuroplasticity, and manual therapy interact in the context of persistent pain and post-surgical recovery.
Led by published researcher and manual therapist Susan Chapelle, participants will learn how to apply neurobiological reasoning to the assessment and treatment of scars and adhesions. Through interactive labs, clinical discussion, and case-based application, therapists will deepen their understanding of how touch can modulate the nervous system, restore mobility, and support tissue health in complex cases of chronic and acute pain.
Learning Objectives:
Participants will:
- Understand mechanisms of adhesion formation, tissue restriction, and pain modulation
- Understand the diDerences between adhesion formation and scars
- Apply research-informed manual therapy techniques to scars and deep tissue restrictions
- Identify signs of neuroinflammation and central sensitization in clinical presentations
- Build trauma-informed, functionally driven treatment plans
- Improve palpation, clinical reasoning, and outcome evaluation in post-surgical or chronic pain care
Three-Day Course Outline
DAY 1 – The Science of Scars and Adhesions
Morning: The Biology of Healing and Adhesion Formation
- Welcome and orientation
- Tissue injury and wound healing overview
- Scar vs. adhesion: mechanical and biological distinctions
- Role of fibroblasts, myofibroblasts, and extracellular matrix
- Formation of dense connective tissue and peritoneal adhesions
- Review of research:
- o Chapelle & Bove (2012): Visceral mobilization in preventing adhesions
- o Chapelle & Bove (2013): Manual therapy and postoperative inflammation
- o Chapelle S.L. (2017), Chapter 51: Understanding and approach to treatment of scars and adhesions, in Fascia in the Osteopathic Field, edited by Liem, Tozzi & Chila (link below to PDF)
Afternoon: Clinical Implications and Palpation
- How adhesions alter function: movement restriction, inflammation, and organ-tissue interface
- Adhesion presentation in diDerent anatomical regions (breast, abdomen, thorax, pelvis)
- Hands-on lab: palpating scars and identifying mobility loss
- Manual tissue engagement: force, direction, and therapeutic goals **Evening (Optional): Focused Case Session – C-Section & Breast Cancer Recovery
- Case studies: Breast cancer post-surgical adhesions, C-section scars, musculoskeletal overlays
- Critical inquiry: Translating research into practice
- Group discussion of trauma-informed dialogue and consent
DAY 2 – Manual Therapy for Adhesions: Treatment in Practice
Morning: Manual Application Strategy
- Evidence-informed principles: load, frequency, and dose
- Structuring treatment sessions: decision-making at tissue level
- Tissue responsiveness and change over time
- Hands-on lab: working with superficial and deep scars (anterior torso, surgical sites)
- Tissue lengthening and ongoing patient compliance techniques
Afternoon: Refining Technique and Patient Integration
- Partner work: technique precision and palpatory feedback
- Scar interventions by region (abdomen, thorax, orthopedic incisions)
- Managing dense adhesions and tissue sensitivity
- Facilitating change in tissue and movement with direct contact
- Therapist ergonomics, boundaries, and sensitivity to patient cues
DAY 3 – Neurobiology of Pain, Sensitization, and Integration
Morning: The Nervous System and Pain Science
- Introduction to persistent pain, inflammation, and sensitization
- Central sensitization, hyperalgesia, and cortical changes
- Interoception and the lived experience of adhesions
- Pain memory and long-term eDects of trauma on sensitization
- Linking tissue change to nervous system modulation and change.
Afternoon: Clinical Reasoning and Wrap-Up
- Building neurobiologically informed treatment plans
- Case-based problem solving: functional goals and tissue strategy
- Group lab: applying all components (science + hands-on + pain framework)
- Evaluating progress in patient outcomes
- Final Q&A, reflection, and certification
Required Pre-Course Reading
- Chapelle, S. L., & Bove, G. M. (2012). Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model.
Journal of Bodywork and Movement Therapies, 16(1), 76–82. https://doi.org/10.1016/j.jbmt.2011.01.002
- Chapelle, S. L., & Bove, G. M. (2013). Visceral massage reduces postoperative ileus in a rat model.
- Journal of Bodywork and Movement Therapies, 17(1), 83–88. https://doi.org/10.1016/j.jbmt.2012.08.002
Chapelle S.L. (2017), Chapter 51: Understanding and approach to treatment of scars and adhesions, in Fascia in the Osteopathic Field, edited by Liem, Tozzi & Chila PDF available here.
BC Participant Prep Checklist
- Read research papers before Day 1
- Bring loose, comfortable clothing for hands-on lab work
- Notebook or device for clinical reflection
- Optionally bring a de-identified case scenario to apply to practice
- Be prepared to engage with curiosity, care, and a commitment to evidence-informed practice!
Apparaat
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Outlook (online)