[libribook.com] Traumatic Scar Tissue Management 1st Edition

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Catherine Ryan RMTTelkwa, British Columbia, CanadaJuly 2015
ACKNOWLEDGEMENTSA thank you to the extraordinary family I have – my husband, Forrest, daughterDaren and son Michael. Thank you for the eye rolling, the encouraging wordsand allowing me the space to always try something new.To Cathy Ryan – thanks, chica, for not letting on that I am a clinician and not awriter. You, my friend, are exceptional at both.Pam Fitch – see above.To Diana Thompson for suggesting a presentation in Boston; to the wonderfuland dedicated North Florida Children’s Burn Camp volunteers at Camp Amigofor giving a massage therapist a chance to prove massage therapy does make adifference; to Rose Dean for her pursuit of making sure everyone she came incontact with knew that massage therapy changed her scars and quality of life; toDiane Garrison, Dana Ruben, Dr Annie Morien and Raquel Torres – many greatmemories from Camp in holding my hand through research; heart felt thanks toJulie Speigel for her encouragement and compassion; hugs and muchappreciation to Paul Davenport, Director and mentor from the best darn schoolin the world, The Florida School of Massage.Much admiration to the entire staff at Handspring Publishing for thehandholding, encouragement and guidance.Thanks so much to all my wonderful clients that allowed me to ‘explore’ theirtreatment protocols and to the case managers and physicians that recognizedmassage therapy can be cost effective and beneficial to those with traumaticscarring.We’ve only just begun …
Page 2 and 3: Traumatic Scar Tissue ManagementMas
Page 4: Letter to NKS - from Camp Amigo cam
Page 7 and 8: Important noticeNeither the publish
Page 9 and 10: FOREWORDEveryone has scars: visible
Page 11 and 12: stories about how basic massage the
Page 13 and 14: to the events that resulted in the
Page 15 and 16: PREFACEMore people are surviving tr
Page 17: and
Page 21 and 22: Lastly, thank you, the reader; the
Page 23 and 24: GLOSSARY AND KEY CONCEPTSAll the wo
Page 25 and 26: AdhesionsScar-like tissue that form
Page 27 and 28: Alphabet techniquesCs, Js, and Ss -
Page 29 and 30: AngiogenesisGrowth of new blood ves
Page 31 and 32: AponeurosesDense, sheet-like fascia
Page 33 and 34: Autonomic balanceHomeostatic and co
Page 35 and 36: BarrierIs defined as the point wher
Page 37 and 38: Best research evidenceThe best avai
Page 39 and 40: Body AwarenessConscious, attentiona
Page 41 and 42: BradykininInflammatory mediator - a
Page 43 and 44: Capsular contractureEnvelopment of
Page 45 and 46: ChemokinesSmall molecules released
Page 47 and 48: CicatrixAnother term for scar - the
Page 49 and 50: Collagen crimpThe wavy formation se
Page 51 and 52: Compassion fatigueThe profound emot
Page 53 and 54: Compression techniqueA therapeutic
Page 55 and 56: Consolidated edemaChronic stage ede
Page 57 and 58: CortisolHormone released in respons
Page 59 and 60: CreepA time-dependent response of v
Page 61 and 62: DebridementRemoval of foreign mater
Page 63 and 64: Degloving injuryA form of avulsion
Page 65 and 66: DermatomeAreas of skin supplied by
Page 67 and 68: Direct release techniqueCommonly us
Page 69 and 70:
Dry needlingA procedure involving i
Page 71 and 72:
Empathy strainA healthcare provider
Page 73 and 74:
EndoneuriumFascia surrounding indiv
Page 75 and 76:
Endothelial cellsSimple squamous ce
Page 77 and 78:
EndoscopeAn instrument that is used
Page 79 and 80:
EpidermisThe tough, outermost layer
Page 81 and 82:
EpineuriumOutermost covering of fas
Page 83 and 84:
Epithelial cellsCells that line the
Page 85 and 86:
FasciaFibrocollagenous CT, its morp
Page 87 and 88:
FibrinFibrous protein involved bloo
Page 89 and 90:
FibroblastsSynthesize the component
Page 91 and 92:
FibrosisA process culminating in th
Page 93 and 94:
Fluid techniquesTechniques employed
Page 95 and 96:
Gentle circles techniqueCircular mo
Page 97 and 98:
Gross stretch techniqueCombination
Page 99 and 100:
HomeostasisState of physiological e
Page 101 and 102:
HyperalgesiaHeightened pain sensati
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HyperexcitationNeurons firing too e
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Hypertrophic scarA thickened, red a
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HysteresisA property of systems (ti
Page 109 and 110:
Indirect release techniqueMechanica
Page 111 and 112:
Informed consentProcess involving t
Page 113 and 114:
Intense versus invasiveAn important
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InteroceptionIncludes a wide range
Page 117 and 118:
KeratinA structural protein that pr
Page 119 and 120:
KininsPeptides (e.g. bradykinin) pr
Page 121 and 122:
Linking fasciaPlays a role in augme
Page 123 and 124:
Lymph nodesFilter and clean the lym
Page 125 and 126:
LymphangiogenesisFormation of new l
Page 127 and 128:
Lymphatic drainageThe movement of f
Page 129 and 130:
Lymphatic returnVolume of lymph ret
Page 131 and 132:
Lymphatic transportThe movement of
Page 133 and 134:
Lymphatic vesselsTri-laminar vessel
Page 135 and 136:
LymphocyteThe main cell type found
Page 137 and 138:
MacrophageA type of phagocytic whit
Page 139 and 140:
MastectomySurgical removal of all b
Page 141 and 142:
MechanotransductionThe mechanism by
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MucopolysaccharidesSee GAGs.Myofasc
Page 145 and 146:
Nerve receptorsNerve terminations t
Page 147 and 148:
NeurofasciaTri-laminar, continuous
Page 149 and 150:
Neuropathic painPain due to damage
Page 151 and 152:
NeuropeptidesSignaling molecules th
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NociceptionThreatening stimuli acti
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Nociceptive painPain that arises fr
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OxytocinHormone that plays role in
Page 159 and 160:
ParesthesiaAltered sensations; e.g.
Page 161 and 162:
Peripheral sensitizationIncreased r
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PerineuriumFascia surrounding/inves
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Pitting edemaAn edematous region wh
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Proprioceptive disinformationRecept
Page 169 and 170:
Provisional matrixDuring the early
Page 171 and 172:
Pumping techniqueA lymphatic techni
Page 173 and 174:
Referred painPain perceived at a lo
Page 175 and 176:
RetinaculaeDense fascial bands that
Page 177 and 178:
ScarMark left in various tissues or
Page 179 and 180:
Secondary lymphedemaOccurs as a res
Page 181 and 182:
Self careThose practices and activi
Page 183 and 184:
Selfcare managementResponse to sens
Page 185 and 186:
SensitizationChanges in the PNS or
Page 187 and 188:
SerotoninNeurotransmitter involved
Page 189 and 190:
Shear techniqueA therapeutic loadin
Page 191 and 192:
Skin graftMedical procedure where a
Page 193 and 194:
SomatizationA tendency to experienc
Page 195 and 196:
State anxietyThe experience of unpl
Page 197 and 198:
Stress response adaptationAny of th
Page 199 and 200:
Stress responseAny cognitive, physi
Page 201 and 202:
Substance PA neuropeptide acting as
Page 203 and 204:
Therapeutic environmentEncompasses
Page 205 and 206:
Therapeutic relationshipEncompasses
Page 207 and 208:
Trait anxietyA more intense degree
Page 209 and 210:
TraumaInsult or injury to the physi
Page 211 and 212:
Traumatic scarPathophysiological sc
Page 213 and 214:
ViscoelasticityThe ability of a med
Page 215 and 216:
Nowadays it is common to see massag
Page 217 and 218:
A Reasonable NexusPrecise etiologic
Page 219 and 220:
integration of art and science are
Page 221 and 222:
Diamond M (2012) Scars and adhesion
Page 223 and 224:
General HistologyExtracellular Matr
Page 225 and 226:
Clinical ConsiderationVitamin C has
Page 227 and 228:
Ground substanceGround substance (G
Page 229 and 230:
Pathophysiological ConsiderationIn
Page 231 and 232:
HyaluronanThis hydrophilic, viscous
Page 233 and 234:
Clinical ConsiderationHA and its fr
Page 236 and 237:
Figure 2.1Layers and components of
Page 238 and 239:
Skin HistologyThe skin comprises:
Page 241 and 242:
Figure 2.2The delicate, well-hydrat
Page 243 and 244:
DermisThe dermis is made up of laye
Page 245 and 246:
Fascia Structure and FunctionsIn th
Page 247 and 248:
fundamental characteristic is its c
Page 249 and 250:
tensional properties co-exist in bo
Page 251 and 252:
HistologyFascia comprises:• ECM (
Page 253 and 254:
Clinical ConsiderationManual therap
Page 255 and 256:
Clinical ConsiderationTransforming
Page 257 and 258:
CollagenCollagen is the most abunda
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Clinical ConsiderationSignificant c
Page 261 and 262:
Fascia Layers and FunctionsFascia t
Page 263 and 264:
Clinical ConsiderationSuperficial a
Page 265:
Clinical ConsiderationWhen thickene
Page 268 and 269:
LinkingLinking fascia is sub-divide
Page 270 and 271:
FascicularFascicular fascia augment
Page 272 and 273:
Clinical ConsiderationMuscle spindl
Page 274 and 275:
SeparatingSeparating fascia provide
Page 276 and 277:
Clinical ConsiderationFascia suppor
Page 278 and 279:
Andrade C-K (2013) Outcome-based ma
Page 280 and 281:
Ingber D (2008) Tensegrity and mech
Page 282 and 283:
tendons: organisation in vivo and r
Page 284 and 285:
Zorn A, Hodeck K (2011) Walk with e
Page 286 and 287:
Discovery of the Lymphatic SystemTh
Page 288 and 289:
Hematic SystemThe heart, blood vess
Page 290 and 291:
Lymphatic System Structure and Func
Page 292 and 293:
Clinical ConsiderationNerves, blood
Page 295:
Figure 3.1Lymph tissue structure.In
Page 298 and 299:
Lymphoid OrgansThe lymphoid organs
Page 300 and 301:
ThymusThe thymus is a lymphoid glan
Page 302 and 303:
Lymphatic Drainage and TransportIn
Page 304 and 305:
SuperficialThe superficial layer is
Page 306:
Primary upper lymphatic structuresT
Page 309 and 310:
Primary lower lymphatic structuresT
Page 311 and 312:
Left side lymphatic drainageThe lef
Page 313 and 314:
Lymphatic System FunctionsA brief o
Page 316 and 317:
Fig 3.5Brain lymphatic vessels.Give
Page 318:
ImmunityLymph nodes play an importa
Page 321 and 322:
Wound HealingAs with the blood vasc
Page 323 and 324:
Clinical ConsiderationFour continuo
Page 325 and 326:
Lymphatic InadequacyInadequacy in t
Page 327 and 328:
EdemaEdema - the medical term for s
Page 329 and 330:
Lymphatic treatment protocols will
Page 331 and 332:
CHAPTER 4NeurologyEach human nervou
Page 333:
NS StructureThe human NS comprises
Page 337 and 338:
Figure 4.1B Functional composition
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Pathophysiological ConsiderationWhe
Page 341 and 342:
Figure 4.2Dorsal and ventral compon
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Figure 4.3Neuron anatomy: most neur
Page 346 and 347:
Figure 4.4Classic axon to dendrite
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Figure 4.6PNS efferent (motor) and
Page 352 and 353:
Clinical ConsiderationPSNS afferent
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Clinical ConsiderationSNS activatio
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Figure 4.8Anterior and posterior di
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Figure 4.9Neurofascial envelopes.
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Pathophysiological ConsiderationA n
Page 364 and 365:
Clinical ConsiderationThere is an e
Page 366 and 367:
Clinical ConsiderationDiane Jacobs
Page 368 and 369:
Clinical ConsiderationIt appears th
Page 370 and 371:
Clinical ConsiderationAlthough musc
Page 372 and 373:
Clinical ConsiderationThe form of s
Page 374 and 375:
Example 2Ruffini stimulation result
Page 376 and 377:
Table 4.1Summary of receptor typolo
Page 378 and 379:
• Therapeutic outcome include enh
Page 380 and 381:
NS FunctionThe primary functions of
Page 382 and 383:
Clinical ConsiderationMechanorecept
Page 384 and 385:
Clinical ConsiderationIn addition t
Page 386 and 387:
Clinical ConsiderationManual techni
Page 388 and 389:
large enough, a voltage spike is pr
Page 390 and 391:
PathophysiologicalconsiderationUnde
Page 392 and 393:
Table 4.2Important pain terms. Vari
Page 394 and 395:
Clinical ConsiderationAccording to
Page 396 and 397:
disorders (diabetes mellitus), drug
Page 398 and 399:
forms of negative plasticity includ
Page 400 and 401:
Central and peripheral sensitizatio
Page 402 and 403:
Clinical ConsiderationFollowing per
Page 404 and 405:
ExampleHypersensitive nerves (assoc
Page 406 and 407:
Example 1Hypersensitized nerve fibe
Page 408 and 409:
Clinical ConsiderationIt is suggest
Page 410 and 411:
Clinical ConsiderationNeuropathic p
Page 412 and 413:
Wound HealingThe NS plays an import
Page 414 and 415:
Clinical ConsiderationNeural and ci
Page 416 and 417:
Compression SyndromesAlthough perip
Page 418 and 419:
Pathophysiological ConsiderationIf
Page 420 and 421:
Pathophysiological ConsiderationUni
Page 422 and 423:
Clinical ConsiderationAs is the cas
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Pathophysiological ConsiderationFas
Page 426 and 427:
Damasio AR, Grabowski TJ, Bechara A
Page 428 and 429:
Magee DJ (2008) Orthopedic physical
Page 430 and 431:
Stecco C, Porzionato A, Macchi V et
Page 432 and 433:
CHAPTER 5Wound healing and scarsNev
Page 434 and 435:
Wound HealingWound healing, a compl
Page 436 and 437:
Table 5.1Stages of wound healing
Page 438:
Clinical ConsiderationBecause thera
Page 441 and 442:
fibroblast growth factor (FGF), epi
Page 443 and 444:
Clinical ConsiderationDuring wound
Page 445 and 446:
Clinical ConsiderationAlthough the
Page 447 and 448:
Pathophysiological ScarsPathophysio
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Figure 5.3Adapted from Huang et al.
Page 452 and 453:
Pathophysiological considerationFib
Page 454 and 455:
Table 5.2Important pathophysiologic
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According to Klingler (2012):… pa
Page 458 and 459:
Table 5.3Scar types and related ter
Page 460 and 461:
unyielding or pliable and mobile. R
Page 462 and 463:
Prolonged InflammationInflammation
Page 464 and 465:
ImmobilizationThe impact of immobil
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Figure 5.4The fall-out associated w
Page 469 and 470:
Clinical ConsiderationHere we see t
Page 471 and 472:
Pathophysiological ConsiderationAcc
Page 473 and 474:
Pathophysiological ConsiderationNeu
Page 475 and 476:
The diverse biological effects of N
Page 477 and 478:
Clinical ConsiderationCareful appli
Page 479 and 480:
Clinical ConsiderationSome patholog
Page 481 and 482:
Pathophysiological ConsiderationSom
Page 483 and 484:
compressive effect in the keloidal
Page 485 and 486:
alterations in the mechanical envir
Page 487 and 488:
Clinical ConsiderationMechanical fo
Page 489 and 490:
Table 5.4Role of neuropeptides (NP)
Page 491 and 492:
Fitch P (2005) Scars of life. Journ
Page 493 and 494:
Langevin HM (2006) Connective tissu
Page 495 and 496:
active scars. Journal of Bodywork a
Page 497 and 498:
trauma.
Page 499 and 500:
Clinical ConsiderationPostsurgical
Page 501 and 502:
following burn injury,bacterial col
Page 503 and 504:
Table 6.1Comparison of scars (Ogawa
Page 505 and 506:
Page 507 and 508:
BurnsA burn injury to the skin or o
Page 510 and 511:
Figure 6.1Depth of burn trauma and
Page 512 and 513:
• Stimulate ECM formation• Regu
Page 514 and 515:
Clinical ConsiderationIt has been i
Page 516 and 517:
Clinical ConsiderationMT may be a v
Page 518 and 519:
ThermoregulationThermoregulation (t
Page 520 and 521:
from the tissues and taken up by th
Page 522 and 523:
treatment strategies are difficult
Page 524 and 525:
Clinical ConsiderationSkin rolling
Page 526 and 527:
Sequelae and ComplicationsAdvances
Page 528 and 529:
• Paresthesia - 47%• Arm/should
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breast or around the edge of the ar
Page 532 and 533:
Radiation scarringScar tissue as a
Page 534 and 535:
Implants and painPain of fluctuatin
Page 536 and 537:
LymphedemaBreast cancer treatment o
Page 538 and 539:
volume of fluid that accumulates or
Page 540 and 541:
OneTwoThreeCommonly referred to as
Page 542 and 543:
myokinetic chain/myofascial meridia
Page 544:
• Loss of touch sensation• Clum
Page 548 and 549:
Figure 6.3Distribution of nerves in
Page 550 and 551:
include preservation of as much of
Page 552 and 553:
complication is present there is de
Page 554 and 555:
Clinical ConsiderationScar complica
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BreastCancer.org (2015c) Side Effec
Page 558 and 559:
323-9.Kania A (2012) Scars. In: Dry
Page 560 and 561:
Slemp AE, Kirschner RE (2006) Keloi
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scar tissue, while being mindful of
Page 564 and 565:
Physiological ResponseAs discussed
Page 566 and 567:
• The realization that one is abo
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Stress Response and Stress Hormones
Page 570 and 571:
dissociation and inner shakiness) (
Page 572:
Figure 7.1(A) Summary of the HPA me
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Chronic Stress ResponseChronic stre
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Pathophysiological ConsiderationChr
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Clinical ConsiderationProlonged str
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Psychological Stress and Wound Heal
Page 583 and 584:
Pathophysiological ConsiderationNor
Page 585 and 586:
Pathophysiological ConsiderationStr
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Page 589 and 590:
Clinical ConsiderationEvidence sugg
Page 591 and 592:
Page 593 and 594:
Clinical ConsiderationThe effects o
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Stress DisordersFollowing a traumat
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Clinical ConsiderationThe Task Forc
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Clinical ConsiderationCertainly it
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ASD symptoms include (DSM-V 2013):
Page 603 and 604:
Box 7.1Why do medical events potent
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Rehabilitation and reintegrationThi
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Page 609 and 610:
Page 611 and 612:
DissociationDissociation is describ
Page 613 and 614:
Page 615 and 616:
not only does the brain carry memor
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Page 619 and 620:
Somatoemotional ResponseDuring trea
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• If the client asks what happene
Page 623 and 624:
Clinical ConsiderationWorking with
Page 625 and 626:
Given the impact of trauma on the b
Page 627 and 628:
Page 629 and 630:
The Massage Therapist and TraumaThe
Page 631 and 632:
Bordoni B, Zanier E (2014) Skin, fa
Page 633 and 634:
Foex (2013) Surgical Tutor UK Avail
Page 635 and 636:
Kutner JS, Smith MC, Corbin L et al
Page 637 and 638:
Schmidt NB, Richey JA, Zvolensky MJ
Page 639 and 640:
CHAPTER 8Communication and the ther
Page 641 and 642:
The Therapeutic RelationshipThe the
Page 643 and 644:
Needs assessment, treatment plannin
Page 645 and 646:
Clinical ConsiderationIt is importa
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Therapeutic Closeness and Vulnerabi
Page 649 and 650:
BoundariesOver the course of our li
Page 651 and 652:
Box 8.1Aside from obvious sexually
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Box 8.2Eight principles that guide
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Effective Listening and Empathetic
Page 657 and 658:
Clinical ConsiderationNever underst
Page 659 and 660:
Clinical ConsiderationAs manual the
Page 661 and 662:
Interview exampleMary is a client w
Page 663 and 664:
SummarySeveral pieces of informatio
Page 665 and 666:
with traumatic scar tissue clients.
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‘Physicians’ perspective of mas
Page 669 and 670:
Referral exampleTonya, a 21-year-ol
Page 671 and 672:
Referral exampleJane experienced me
Page 673 and 674:
CHAPTER 9Assessment and treatmentHe
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MT. Additionally, sometimes people
Page 677 and 678:
Traumatic Scars and Associated Impa
Page 679 and 680:
Clinical ConsiderationReduction of
Page 681 and 682:
Clinical ConsiderationMT has been f
Page 683 and 684:
Clinical ConsiderationMassage can h
Page 685 and 686:
Health History and InterviewA stand
Page 687 and 688:
surrounding muscle structures that
Page 689 and 690:
we are gathering information about
Page 691 and 692:
Keep in mind that the therapist’s
Page 693 and 694:
Continuous evaluation during the se
Page 695 and 696:
Pre-treatment assessment/evaluation
Page 697 and 698:
Scar scalesScar scales can be used
Page 699 and 700:
response to negative pressure. It h
Page 701 and 702:
• Client self-management strategi
Page 703 and 704:
BindOnce barrier is reached or surp
Page 705 and 706:
Table 9.1Comparative of normal and
Page 707 and 708:
2-3 times a year effectively addres
Page 709 and 710:
Myofascial meridian exampleSuperfic
Page 711:
Clinical ConsiderationKnee and back
Page 715 and 716:
Clinical ConsiderationApplication t
Page 717 and 718:
Pathophysiological ConsiderationMec
Page 719 and 720:
Clinical ConsiderationStecco and co
Page 721 and 722:
Safety FirstMT appears to have few
Page 723 and 724:
Deep workThe deep techniques noted
Page 725 and 726:
Psychological considerationsIt is w
Page 727 and 728:
Clinical ConsiderationMT dosage and
Page 729 and 730:
Developing a sound treatment strate
Page 731 and 732:
Treatment outcomesEssentially, earl
Page 733 and 734:
Dosage considerationsThe presence o
Page 735 and 736:
Clinical ConsiderationNumerous syst
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Clinical ConsiderationHeat in the t
Page 739 and 740:
Clinical ConsiderationBest and co-w
Page 741 and 742:
Pathophysiological considerationCom
Page 743 and 744:
Clinical ConsiderationTiming is eve
Page 745 and 746:
Clinical ConsiderationEvidence sugg
Page 747 and 748:
Clinical ConsiderationSeveral studi
Page 749 and 750:
Clinical ConsiderationPreventive me
Page 751 and 752:
Pathophysiological ConsiderationWit
Page 753 and 754:
TechniquesCommonly employed techniq
Page 755 and 756:
Treatment outcomesThe later stages
Page 757 and 758:
Clinical ConsiderationsNon-threaten
Page 759 and 760:
Clinical ConsiderationsIt has been
Page 761 and 762:
Clinical ConsiderationsMT may be a
Page 763 and 764:
Pathophysiological ConsiderationUnd
Page 765 and 766:
Clinical ConsiderationsIn the early
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Clinical ConsiderationsAs the remod
Page 769 and 770:
Treatment outcomesEssentially, the
Page 771 and 772:
Dosage considerationsThe presence o
Page 773 and 774:
TechniquesAny carpenter will tell y
Page 775 and 776:
Pressure Level 4 - Strong pressure/
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Grade 7 and 8• Firm, deep• Trig
Page 779 and 780:
Neutralize pHFacilitate healing pro
Page 781 and 782:
Manual Lymphatic TechniquesEarly ma
Page 783 and 784:
Table 9.4Treatment guideline summar
Page 785 and 786:
Clinical ConsiderationEdema, excess
Page 788 and 789:
Figure 9.2Half-moon/circles: cleari
Page 791 and 792:
Figure 9.3Pumping: clearing the ext
Page 793:
RotaryThe rotary technique is commo
Page 797:
Figure 9.5Rotary (thorax). Half-moo
Page 800 and 801:
One of the most obvious differences
Page 802 and 803:
Clinical ConsiderationVarious forms
Page 804:
Box 9.10Sensory amnesia and proprio
Page 808 and 809:
Clinical ConsiderationAs all of the
Page 810 and 811:
Compression techniqueCompression te
Page 812 and 813:
Figure 9.8Tension. The lower leg is
Page 814:
Figure 9.9Approximation-compression
Page 818 and 819:
Figure 9.11(A) Shear: begin by enga
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Clinical ConsiderationIt is common
Page 823 and 824:
Figure 9.12Torsion/rotation. Begin
Page 826 and 827:
Figure 9.13Lifting. Begin by graspi
Page 828 and 829:
Gross stretchGross stretch techniqu
Page 830 and 831:
Figure 9.15‘Cs’. Begin as noted
Page 833 and 834:
Figure 9.17J-stroke. Begin at one e
Page 835 and 836:
Clinical ConsiderationIrritated ner
Page 837 and 838:
Pathophysiological ConsiderationCha
Page 839 and 840:
Clinical ConsiderationAs the mechan
Page 841 and 842:
Clinical ConsiderationIn various st
Page 843 and 844:
Chaudhry H, Schleip R, Ji Z et al (
Page 845 and 846:
principles and methods. Philadelphi
Page 847 and 848:
Pilat A (2003) Myofascial therapies
Page 849 and 850:
Yang G, Im HJ, Wang JHC (2005) Repe
Page 851 and 852:
Medial thigh 4th degree skin grafts
Page 853:
Figure B.2 Post-treatmentSurgical s
Page 857 and 858:
Figure C.2 Post-treatment2 December
Page 859 and 860:
and to be consistent with any selfc
Page 861 and 862:
ability to resume social responsibi
Page 863 and 864:
Clinical ConsiderationTrauma can be
Page 865 and 866:
MaintenanceSelfcare maintenance is
Page 867 and 868:
ManagementSelfcare management is de
Page 869 and 870:
Client and Therapist PartnershipTo
Page 871 and 872:
Box 10.1Factors affecting, effectiv
Page 873 and 874:
Strategies to Facilitate Engagement
Page 875 and 876:
Clinical ConsiderationThe authors u
Page 877 and 878:
instances. Make your clients aware
Page 879 and 880:
Relaxation MeasuresVarious relaxati
Page 881 and 882:
scope of practice, such as relaxati
Page 883 and 884:
Silicone gel and silicone sheetingS
Page 885 and 886:
Medicinal honeyThe use of honey for
Page 887 and 888:
Wise Use of Your BodyIt is not esse
Page 889 and 890:
Empathy Strain and BurnoutEmpathy,
Page 891 and 892:
Box 10.3A reflection on reasons for
Page 893 and 894:
Clinical ConsiderationIn the author
Page 895 and 896:
trauma are the therapist’s person
Page 897 and 898:
Care for the care providerIt is imp
Page 899 and 900:
body. Edinburgh: Churchill Livingst
Page 901 and 902:
Salvo SG (2015) Body mechanics, cli
Page 903 and 904:
Research databases and repositories
Page 905 and 906:
Funding for massage therapy researc
Page 907 and 908:
Journals and magazinesInternational
Page 909 and 910:
INDEX
Page 911 and 912:
see also parasympathetic nervous sy
Page 913 and 914:
breathing exercises 245burning sens
Page 915 and 916:
CGRP (calcitonin gene-related pepti
Page 917 and 918:
Ddanger (perceived) 135, 150fight-o
Page 919 and 920:
Eedema 40-1, 69burns-related 112-13
Page 921 and 922:
Ffascia 11-22assessment 186client-r
Page 923 and 924:
Gglia 48glucocorticoids 137, 138, 1
Page 925 and 926:
see also dehydrationhyperalgesia 63
Page 927 and 928:
JJ-stroke 221joint instability 190
Page 929 and 930:
Llarge Pacini and paciniform corpus
Page 931 and 932:
Mmacrophages 13, 63, 80, 81, 89lymp
Page 933 and 934:
Nnecrosisbreast implant-related 119
Page 935 and 936:
Oobservation 180-2occupational inju
Page 937 and 938:
peripheral nervous system 45, 49-50
Page 939 and 940:
Rradiation therapy 193breast cancer
Page 941 and 942:
interviewing 169-71skin 5-11fascia
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TT cells 37technology 2, 242-3tempe
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safety see safetysee also post-trea
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Vvagus nerve 124polyvagal theory 14
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[libribook.com] Traumatic Scar Tissue Management 1st Edition

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