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

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Table 2.1The extracellular matrix (ECM)• *Ground substance (GS)• *Ionized water• Glycosaminoglycans (GAGs, e.g. chondroitin, *hyaluronan) and proteoglycans(PGs)• Polysaccharides play a role in energy, storage and ECM structure.Non-collagenous/cross-link proteinsNon-collagenous/cross-link proteins, where normal, healthy cross-link proteinsbind collagen fibers to the cell membrane, creating the pathway for mechanicalstrain/tensional loading information to transfer from the tissues to the cell.Additionally, normal cross-link proteins augment collagen fiber stability.
Clinical ConsiderationVitamin C has been identified as an important component in the formationof healthy cross-links. Here we can see the importance of adequate intakeduring tissue remodeling following exercise and trauma (Boyera et al.1998).
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Traumatic Scar Tissue ManagementMas
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Letter to NKS - from Camp Amigo cam
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Important noticeNeither the publish
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FOREWORDEveryone has scars: visible
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stories about how basic massage the
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to the events that resulted in the
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PREFACEMore people are surviving tr
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and
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ACKNOWLEDGEMENTSA thank you to the
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Lastly, thank you, the reader; the
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GLOSSARY AND KEY CONCEPTSAll the wo
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AdhesionsScar-like tissue that form
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Alphabet techniquesCs, Js, and Ss -
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AngiogenesisGrowth of new blood ves
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AponeurosesDense, sheet-like fascia
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Autonomic balanceHomeostatic and co
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BarrierIs defined as the point wher
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Best research evidenceThe best avai
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Body AwarenessConscious, attentiona
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BradykininInflammatory mediator - a
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Capsular contractureEnvelopment of
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ChemokinesSmall molecules released
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CicatrixAnother term for scar - the
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Collagen crimpThe wavy formation se
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Compassion fatigueThe profound emot
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Compression techniqueA therapeutic
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Consolidated edemaChronic stage ede
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CortisolHormone released in respons
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CreepA time-dependent response of v
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DebridementRemoval of foreign mater
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Degloving injuryA form of avulsion
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DermatomeAreas of skin supplied by
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Direct release techniqueCommonly us
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Dry needlingA procedure involving i
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Empathy strainA healthcare provider
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EndoneuriumFascia surrounding indiv
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Endothelial cellsSimple squamous ce
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EndoscopeAn instrument that is used
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EpidermisThe tough, outermost layer
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EpineuriumOutermost covering of fas
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Epithelial cellsCells that line the
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FasciaFibrocollagenous CT, its morp
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FibrinFibrous protein involved bloo
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FibroblastsSynthesize the component
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FibrosisA process culminating in th
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Fluid techniquesTechniques employed
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Gentle circles techniqueCircular mo
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Gross stretch techniqueCombination
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HomeostasisState of physiological e
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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
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Indirect release techniqueMechanica
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Informed consentProcess involving t
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Intense versus invasiveAn important
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InteroceptionIncludes a wide range
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KeratinA structural protein that pr
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KininsPeptides (e.g. bradykinin) pr
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Linking fasciaPlays a role in augme
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Lymph nodesFilter and clean the lym
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LymphangiogenesisFormation of new l
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Lymphatic drainageThe movement of f
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Lymphatic returnVolume of lymph ret
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Lymphatic transportThe movement of
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Lymphatic vesselsTri-laminar vessel
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LymphocyteThe main cell type found
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MacrophageA type of phagocytic whit
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MastectomySurgical removal of all b
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MechanotransductionThe mechanism by
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MucopolysaccharidesSee GAGs.Myofasc
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Nerve receptorsNerve terminations t
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NeurofasciaTri-laminar, continuous
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Neuropathic painPain due to damage
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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
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ParesthesiaAltered sensations; e.g.
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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
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Provisional matrixDuring the early
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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: General HistologyExtracellular Matr
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
Page 259 and 260: 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
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SeparatingSeparating fascia provide
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Clinical ConsiderationFascia suppor
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Andrade C-K (2013) Outcome-based ma
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Ingber D (2008) Tensegrity and mech
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tendons: organisation in vivo and r
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Zorn A, Hodeck K (2011) Walk with e
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Discovery of the Lymphatic SystemTh
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Hematic SystemThe heart, blood vess
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Lymphatic System Structure and Func
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Clinical ConsiderationNerves, blood
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Figure 3.1Lymph tissue structure.In
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Lymphoid OrgansThe lymphoid organs
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ThymusThe thymus is a lymphoid glan
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Lymphatic Drainage and TransportIn
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SuperficialThe superficial layer is
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Primary upper lymphatic structuresT
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Primary lower lymphatic structuresT
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Left side lymphatic drainageThe lef
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Lymphatic System FunctionsA brief o
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Fig 3.5Brain lymphatic vessels.Give
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ImmunityLymph nodes play an importa
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Wound HealingAs with the blood vasc
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Clinical ConsiderationFour continuo
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Lymphatic InadequacyInadequacy in t
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EdemaEdema - the medical term for s
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Lymphatic treatment protocols will
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CHAPTER 4NeurologyEach human nervou
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NS StructureThe human NS comprises
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Figure 4.1B Functional composition
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Pathophysiological ConsiderationWhe
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Figure 4.2Dorsal and ventral compon
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Figure 4.3Neuron anatomy: most neur
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Figure 4.4Classic axon to dendrite
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Figure 4.6PNS efferent (motor) and
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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
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Clinical ConsiderationThere is an e
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Clinical ConsiderationDiane Jacobs
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Clinical ConsiderationIt appears th
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Clinical ConsiderationAlthough musc
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Clinical ConsiderationThe form of s
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Example 2Ruffini stimulation result
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Table 4.1Summary of receptor typolo
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• Therapeutic outcome include enh
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NS FunctionThe primary functions of
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Clinical ConsiderationMechanorecept
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Clinical ConsiderationIn addition t
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Clinical ConsiderationManual techni
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large enough, a voltage spike is pr
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PathophysiologicalconsiderationUnde
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Table 4.2Important pain terms. Vari
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Clinical ConsiderationAccording to
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disorders (diabetes mellitus), drug
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forms of negative plasticity includ
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Central and peripheral sensitizatio
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Clinical ConsiderationFollowing per
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ExampleHypersensitive nerves (assoc
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Example 1Hypersensitized nerve fibe
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Clinical ConsiderationIt is suggest
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Clinical ConsiderationNeuropathic p
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Wound HealingThe NS plays an import
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Clinical ConsiderationNeural and ci
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Compression SyndromesAlthough perip
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Pathophysiological ConsiderationIf
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Pathophysiological ConsiderationUni
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Clinical ConsiderationAs is the cas
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Pathophysiological ConsiderationFas
Page 426 and 427:
Damasio AR, Grabowski TJ, Bechara A
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Magee DJ (2008) Orthopedic physical
Page 430 and 431:
Stecco C, Porzionato A, Macchi V et
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CHAPTER 5Wound healing and scarsNev
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Wound HealingWound healing, a compl
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Table 5.1Stages of wound healing
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Clinical ConsiderationBecause thera
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fibroblast growth factor (FGF), epi
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Clinical ConsiderationDuring wound
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Clinical ConsiderationAlthough the
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Pathophysiological ScarsPathophysio
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Figure 5.3Adapted from Huang et al.
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Pathophysiological considerationFib
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Table 5.2Important pathophysiologic
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According to Klingler (2012):… pa
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Table 5.3Scar types and related ter
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unyielding or pliable and mobile. R
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Prolonged InflammationInflammation
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ImmobilizationThe impact of immobil
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Figure 5.4The fall-out associated w
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Clinical ConsiderationHere we see t
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Pathophysiological ConsiderationAcc
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Pathophysiological ConsiderationNeu
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The diverse biological effects of N
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Clinical ConsiderationCareful appli
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Clinical ConsiderationSome patholog
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Pathophysiological ConsiderationSom
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compressive effect in the keloidal
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alterations in the mechanical envir
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Clinical ConsiderationMechanical fo
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Table 5.4Role of neuropeptides (NP)
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Fitch P (2005) Scars of life. Journ
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Langevin HM (2006) Connective tissu
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active scars. Journal of Bodywork a
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trauma.
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Clinical ConsiderationPostsurgical
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following burn injury,bacterial col
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Table 6.1Comparison of scars (Ogawa
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BurnsA burn injury to the skin or o
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Figure 6.1Depth of burn trauma and
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• Stimulate ECM formation• Regu
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Clinical ConsiderationIt has been i
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Clinical ConsiderationMT may be a v
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ThermoregulationThermoregulation (t
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from the tissues and taken up by th
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treatment strategies are difficult
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Clinical ConsiderationSkin rolling
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Sequelae and ComplicationsAdvances
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• Paresthesia - 47%• Arm/should
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breast or around the edge of the ar
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Radiation scarringScar tissue as a
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Implants and painPain of fluctuatin
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LymphedemaBreast cancer treatment o
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volume of fluid that accumulates or
Page 540 and 541:
OneTwoThreeCommonly referred to as
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myokinetic chain/myofascial meridia
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• Loss of touch sensation• Clum
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Figure 6.3Distribution of nerves in
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include preservation of as much of
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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
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Slemp AE, Kirschner RE (2006) Keloi
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scar tissue, while being mindful of
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Physiological ResponseAs discussed
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• The realization that one is abo
Page 568 and 569:
Stress Response and Stress Hormones
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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
Page 579 and 580:
Clinical ConsiderationProlonged str
Page 581 and 582:
Psychological Stress and Wound Heal
Page 583 and 584:
Pathophysiological ConsiderationNor
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Pathophysiological ConsiderationStr
Page 587 and 588:
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
Page 601 and 602:
ASD symptoms include (DSM-V 2013):
Page 603 and 604:
Box 7.1Why do medical events potent
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Rehabilitation and reintegrationThi
Page 607 and 608:
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
Page 617 and 618:
Page 619 and 620:
Somatoemotional ResponseDuring trea
Page 621 and 622:
• 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
Page 653 and 654:
Box 8.2Eight principles that guide
Page 655 and 656:
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
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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
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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
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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
Page 767 and 768:
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/
Page 777 and 778:
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
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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
Page 820 and 821:
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
Page 943 and 944:
TT cells 37technology 2, 242-3tempe
Page 945 and 946:
safety see safetysee also post-trea
Page 947 and 948:
Vvagus nerve 124polyvagal theory 14
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