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

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Primary upper lymphatic structuresThe thoracic duct is the largest lymphatic structure in the body and constitutesthe terminal end of the lymphatic transport system. The thoracic duct ispositioned between the 11th thoracic and the 2nd lumbar vertebrae just anteriorto the vertebral column. The thoracic duct is between 10 and 18 inches (25 and45 cm) long and contains a large number of valves. It perforates the diaphragmand continues to run upward to connect with the left venous angle.
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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
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Referred painPain perceived at a lo
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RetinaculaeDense fascial bands that
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ScarMark left in various tissues or
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Secondary lymphedemaOccurs as a res
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Self careThose practices and activi
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Selfcare managementResponse to sens
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SensitizationChanges in the PNS or
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SerotoninNeurotransmitter involved
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Shear techniqueA therapeutic loadin
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Skin graftMedical procedure where a
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SomatizationA tendency to experienc
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State anxietyThe experience of unpl
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Stress response adaptationAny of th
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Stress responseAny cognitive, physi
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Substance PA neuropeptide acting as
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Therapeutic environmentEncompasses
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Therapeutic relationshipEncompasses
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Trait anxietyA more intense degree
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TraumaInsult or injury to the physi
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Traumatic scarPathophysiological sc
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ViscoelasticityThe ability of a med
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Nowadays it is common to see massag
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A Reasonable NexusPrecise etiologic
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integration of art and science are
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Diamond M (2012) Scars and adhesion
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General HistologyExtracellular Matr
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Clinical ConsiderationVitamin C has
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Ground substanceGround substance (G
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Pathophysiological ConsiderationIn
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HyaluronanThis hydrophilic, viscous
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Clinical ConsiderationHA and its fr
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Figure 2.1Layers and components of
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Skin HistologyThe skin comprises:
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Figure 2.2The delicate, well-hydrat
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DermisThe dermis is made up of laye
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Fascia Structure and FunctionsIn th
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fundamental characteristic is its c
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tensional properties co-exist in bo
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HistologyFascia comprises:• ECM (
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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
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 308 and 309: Figure 3.3Torso and pelvic anatomy.
Page 310 and 311: Right side lymphatic drainageThe ri
Page 312 and 313: Figure 3.4Lymphatic drainage areas.
Page 314: Clinical ConsiderationLymph is the
Page 317 and 318: Clinical ConsiderationManual lympha
Page 320 and 321: Figure 3.6Bloodvascular circulation
Page 322 and 323: lymph (Zuther 2011)• Traumatic sc
Page 324 and 325: Pathophysiological ConsiderationAbd
Page 326 and 327: Clinical ConsiderationCompression b
Page 328 and 329: LymphedemaLymphedema is an abnormal
Page 330 and 331: Marieb EN (2003) Human anatomy and
Page 332 and 333: foundation for understanding the wo
Page 335: Figure 4.1A Major anatomical compon
Page 338 and 339: CNSThe primary structures of the CN
Page 340 and 341: Meninges and CSFThe meninges, a tri
Page 342: Neurons• Excitable nerve cells an
Page 345 and 346: PNSThe primary structures of the PN
Page 347: Figure 4.5PNS: organization and fun
Page 351 and 352: Figure 4.7PSNS and SNS control.
Page 353 and 354: Clinical ConsiderationStress and th
Page 355: • Areas of skin supplied by a sin
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• A loose collagenous matrix that
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Clinical ConsiderationThe space bet
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Innervation of Skin and FasciaNerve
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Clinical ConsiderationHigher nerve
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MechanoreceptorsMechanoreceptors ar
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Figure 4.10Mechanoreceptor mediated
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Clinical ConsiderationRetinaculae i
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Example 1According to Cottingham (1
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Example 3IRs, found in abundance th
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Clinical ConsiderationSignificant n
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NociceptorsA nociceptor is a recept
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Clinical ConsiderationAccording to
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Pathophysiological ConsiderationTra
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Clinical ConsiderationIn addition t
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Clinical ConsiderationMassage immun
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Pathophysiological considerationEle
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Referred painSensitizationPain perc
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Figure 4.11Lowered threshold outcom
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Clinical ConsiderationAcute and chr
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heightened nociceptive responses an
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Clinical ConsiderationA key princip
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changes often lead to strong and ch
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Clinical ConsiderationA hypersensit
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Clinical ConsiderationHypersensitiv
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Example 2Hypersensitized nerves are
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Pathophysiological ConsiderationPai
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Clinical ConsiderationMT has been f
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release inflammatory substances tha
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Pathophysiological ConsiderationCom
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Pathophysiological ConsiderationEnd
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Clinical ConsiderationWith double-c
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Proprioceptive DisinformationDensif
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Bogduk N (2009) On the definitions
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axons: a physiological basis for th
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immunoreactive nerve endings in rat
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Wilkie DJ et al (2001) Nociceptive
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A massage therapist can play an act
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formation - granulation tissue. Thi
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Pathophysiological ConsiderationUnd
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Figure 5.1Hypertrophic scar example
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This continues what began in Stage
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yield an innocuous scar that exhibi
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Scar ChronologyThe wound healing pr
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Types of Pathophysiological ScarsIn
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Pathophysiological considerationIt
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Clinical considerationMechanical di
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Figure 5.2Keloid scar example.Patho
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Clinical ConsiderationAs discussed
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Box 5.1Factors that drive excessive
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Pathophysiological ConsiderationIn
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Clinical ConsiderationDrainage of e
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Clinical ConsiderationFascia hydrod
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Clinical ConsiderationImmobilizatio
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NeuropeptidesUnder physiological an
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Pathophysiological ConsiderationNeu
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Clinical ConsiderationExcessive neu
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Clinical ConsiderationAs noted abov
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Nerve density in pathophysiological
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alleviates patient discomfort but a
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Clinical ConsiderationMassage thera
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Clinical ConsiderationIn the treatm
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Clinical ConsiderationOff-loading w
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are covered in greater detail in Ch
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Carano A, Siciliani G (1996) Effect
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rehabilitation and injury preventio
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Ramos ML, Gragnani A, Ferreira LM (
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CHAPTER 6Burns, mastectomies and ot
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Excessive ScarringExcessive scarrin
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size/depth, anatomic region, and lo
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Clinical presentationExpanded dermi
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Keloids are typically pink to purpl
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Clinical ConsiderationThe margins o
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Degree of InjuryBurn injuries are c
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Sequelae and ComplicationsA critica
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Pathophysiological ConsiderationApo
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Clinical ConsiderationHypertrophy t
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Skin GraftsAs previously noted, the
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vasoconstrictor pathways. The same
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As noted in Chapter 4, neuropathic
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Clinical ConsiderationBurn rehabili
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Breast CancerThe breast is made up
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Early detectionBreast cancer is typ
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effectively prevent or reduce unnec
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Table 6.2Types of mastectomiesAs ma
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Capsular contractureCapsular contra
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Implants and necrosisNecrosis - the
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Table 6.3Baker scaleCancer treatmen
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Clinical ConsiderationEarly detecti
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Table 6.4Stages of lymphedema: 0-3A
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Clinical ConsiderationIt has been d
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Figure 6.2Nerves plexuses in the ch
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Degloving InjuryDegloving - named f
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LiposuctionBrief consideration is g
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Neurological SequelaeHypoesthesia i
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Traumatic Scars and MTWhen working
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207-227.Derderian CA, Bastidas N, L
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Monocryl vs. Vicryl-rapide. Annals
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CHAPTER 7TraumaThe quality of outco
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Traumatic Events and Traumatic Resp
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Psychological ResponsePsychological
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StressDay in and day out, our hands
Page 569 and 570:
Stress Adaptation ResponseA vast ar
Page 571 and 572:
Stress Response PhysiologyStress pl
Page 574 and 575:
Figure 7.2Summay of the normal stre
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Pathophysiological ConsiderationA s
Page 578 and 579:
Pathophysiological ConsiderationVar
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Clinical ConsiderationStress and th
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Silverstein 1992, Leproult et al. 1
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Pathophysiological ConsiderationEle
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Pathophysiological ConsiderationTho
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Clinical ConsiderationMultiple stud
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Clinical ConsiderationListing and c
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Clinical ConsiderationRapid develop
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Clinical ConsiderationData demonstr
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physical impairments that fall with
Page 598 and 599:
Page 600 and 601:
Clinical ConsiderationMainstream tr
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ASD can occur as a result of medica
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The critical care phaseA patient ma
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physical sensations). The inability
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Clinical Considerationvan der Kolk
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Clinical ConsiderationMT is commonl
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amygdala that is primed to go into
Page 614 and 615:
Scope of Practice ConsiderationsWe
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may feel unsettled or distressed an
Page 618 and 619:
Clinical ConsiderationFollowing an
Page 620 and 621:
Box 7.2Basic strategies for navigat
Page 622 and 623:
Clinical ConsiderationFor some who
Page 624 and 625:
InteroceptionDamasio (2003) and Cra
Page 626 and 627:
Clinical ConsiderationA number of s
Page 628 and 629:
psychotherapy and psychotherapy is
Page 630 and 631:
order to complete tasks that once w
Page 632 and 633:
0248-y.Crane JD, Ogborn DI, Cupido
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Interlandi J (2014) A revolutionary
Page 636 and 637:
without massage. Neuroscience Lette
Page 638 and 639:
Van Der Kolk B (2014) The Body Keep
Page 640 and 641:
Pamela Fitch’s book, Talking Body
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Informed Consent and IntakeInformed
Page 644 and 645:
Providing a Safe Therapeutic Enviro
Page 646 and 647:
There is no hierarchy in a client-c
Page 648 and 649:
be detrimental to the therapeutic p
Page 650 and 651:
countertransference, which can dimi
Page 652 and 653:
Professional EthicsThe purpose of p
Page 654 and 655:
CommunicationEthical and profession
Page 656 and 657:
enhance follow-up questions during
Page 658 and 659:
gather information for the session.
Page 660 and 661:
changed since the last session; med
Page 662 and 663:
would like to work on the chest wal
Page 664 and 665:
Box 8.4According to Broas (2008), M
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Interprofessional CollaborationInte
Page 668 and 669:
ReferralsFor MTs, knowing when to r
Page 670 and 671:
Referral exampleA common example of
Page 672 and 673:
Barker K, Oandasan I (2005) Interpr
Page 674 and 675:
direct change. Minimization of the
Page 676 and 677:
Box 9.1Evidence-based and evidence-
Page 678 and 679:
Clinical ConsiderationOne important
Page 680 and 681:
Clinical ConsiderationIn a cancer p
Page 682 and 683:
Clinical ConsiderationIt is hypothe
Page 684 and 685:
Clinical ReasoningOver the life-spa
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Clinical ConsiderationAnything that
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Assessment and EvaluationIt is impo
Page 690 and 691:
ObservationThere are many layers to
Page 692 and 693:
Box 9.2The MT’s ability to use th
Page 694 and 695:
PalpationPalpation assessment ought
Page 696 and 697:
Scar assessment toolsAs with other
Page 698 and 699:
• 10 reflects the ‘worst imagin
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understanding of the body’s adapt
Page 702 and 703:
Soft tissue mobility and barriersIn
Page 704 and 705:
Is gradualWhen engaged, the therapi
Page 706 and 707:
Box 9.4Over-use/impairment example
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Clinical ConsiderationChronic and/o
Page 710 and 711:
Myofascial sequence exampleAnatomic
Page 714 and 715:
Fig 9.1Yellow lines represent palpa
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Pathophysiological ConsiderationTo
Page 718 and 719:
Clinical ConsiderationIt is suggest
Page 720 and 721:
Treatment ProtocolThe therapist’s
Page 722 and 723:
• Be mindful when working with th
Page 724 and 725:
Postsurgical and other intervention
Page 726 and 727:
DosageArguably, one of the most com
Page 728 and 729:
Clinical ConsiderationA recent stud
Page 730 and 731:
Recall from Chapter 5: the inflamma
Page 732 and 733:
TechniquesTechniques commonly emplo
Page 734 and 735:
Clinical ConsiderationA correlation
Page 736 and 737:
Clinical ConsiderationA meta-analys
Page 738 and 739:
Clinical ConsiderationUnder physiol
Page 740 and 741:
Clinical ConsiderationRecall from C
Page 742 and 743:
Pathophysiological ConsiderationA v
Page 744 and 745:
Clinical ConsiderationPruritus is m
Page 746 and 747:
Clinical ConsiderationMaximizing ox
Page 748 and 749:
Clinical ConsiderationThe ECM is a
Page 750 and 751:
Pathophysiological ConsiderationInc
Page 752 and 753:
General treatment guidelinesWhen wo
Page 754 and 755:
Table 9.2Principles to improve woun
Page 756 and 757:
Dosage considerationsThe presence o
Page 758 and 759:
Clinical ConsiderationsThe margins
Page 760 and 761:
Clinical ConsiderationsHypertrophic
Page 762 and 763:
Clinical ConsiderationsBurn rehabil
Page 764 and 765:
Pathophysiological ConsiderationImm
Page 766 and 767:
Clinical ConsiderationsPain-instiga
Page 768 and 769:
Pathophysiological considerationIn
Page 770 and 771:
TechniquesTechniques commonly emplo
Page 772 and 773:
Depth and Pressure GradingThe sensi
Page 774 and 775:
Pressure levelsPressure Level 1 - V
Page 776 and 777:
Depth and grading of touchGrade 1-3
Page 778 and 779:
Grade 9 and 10• Deep• Client li
Page 780 and 781:
Table 9.3Summary of manually mediat
Page 782 and 783:
• Initiate contact with a slow, s
Page 784 and 785:
Traumatic scarring can be a cause f
Page 786:
For the sequence for clearing the h
Page 789:
PumpingPumping technique is mainly
Page 792 and 793:
ScoopingScooping technique is used
Page 795:
Figure 9.4Scooping: clearing the ex
Page 799 and 800:
Figure 9.6Alternating pump and stat
Page 801 and 802:
Drag scale• 0: no drag• 1: move
Page 803 and 804:
addressed prior to global ones.When
Page 807 and 808:
Fig 9.7Traumatic scar formationGene
Page 809 and 810:
Tension techniqueTension technique
Page 811 and 812:
BendingBending technique combines c
Page 813 and 814:
ShearOblique or laterally applied g
Page 816:
Figure 9.10(A) Bend. Begin by grasp
Page 819 and 820:
OscillationsOscillation techniques,
Page 821:
Lifting techniquesThe techniques in
Page 824:
Alphabet TechniquesMost massage the
Page 827 and 828:
Figure 9.14Skin rolling. Begin by a
Page 829 and 830:
Gentle circlesGentle circle techniq
Page 831:
Figure 9.16‘Ss’. Begin by grasp
Page 834 and 835:
Clinical ConsiderationSome of the b
Page 836 and 837:
Clinical ConsiderationIt is importa
Page 838 and 839:
Clinical ConsiderationManual therap
Page 840 and 841:
intense verses invasive and distres
Page 842 and 843:
Aarabi S, Bhatt KA, Shi Y et al (20
Page 844 and 845:
Journal of Plastic Surgery 10: 354-
Page 846 and 847:
Lewit K, Olsanska S (2004) Clinical
Page 848 and 849:
massage for chronic neck pain. Anna
Page 850 and 851:
Comparison of before and aftertreat
Page 852 and 853:
Figure B.1 Pre-treatmentOpen carpal
Page 855:
Figure C.1 Pre-treatmentDe-gloving
Page 858 and 859:
CHAPTER 10Client and therapist self
Page 860 and 861:
Self CareSelf care as an all-encomp
Page 862 and 863:
Clinical ConsiderationClients can f
Page 864 and 865:
Clinical ConsiderationTrauma can be
Page 866 and 867:
MonitoringSelfcare monitoring compr
Page 868 and 869:
Page 870 and 871:
Client EngagementAll healthcare pro
Page 872 and 873:
Others, however, view self care as
Page 874 and 875:
their care.In addition to meeting p
Page 876 and 877:
likelihood of engagement is highly
Page 878 and 879:
Thermal and CryotherapyIt is sugges
Page 880 and 881:
Clinical ConsiderationThe authors s
Page 882 and 883:
tissue fibers (e.g. collagen and el
Page 884 and 885:
Topical onion extractOnion extract
Page 886 and 887:
Therapist Self CareSimply put, prac
Page 888 and 889:
Box 10.2Tips for reducing work rela
Page 890 and 891:
best/healthier answer, to support s
Page 892 and 893:
resentment every time you see the c
Page 894 and 895:
Compassion Fatigue and Indirect Tra
Page 896 and 897:
PreventionWays of coping and curren
Page 898 and 899:
management 6: 63-71.Boyera N, Galey
Page 900 and 901:
management/in-depth/stress-relief/a
Page 902 and 903:
Appendix Massage therapy research r
Page 904 and 905:
Massage Therapy Research Conference
Page 906 and 907:
BooksMenard MB (2009) Making sense
Page 908 and 909:
Research literacy coursesIt is impe
Page 910 and 911:
Aabdominal breathing 245abdominal l
Page 912 and 913:
BB cells 37back and knee relationsh
Page 914 and 915:
CC (alphabet technique) 221calciton
Page 916 and 917:
communication (therapist-client) 15
Page 918 and 919:
in late stages of wound healing 201
Page 920 and 921:
extent of trauma and scar 96-7, 103
Page 922 and 923:
fluidslymphatic transport 32manual
Page 924 and 925:
Hhabits (client) 241hair follicles
Page 926 and 927:
Iimmobilization, prolonged 89-90imm
Page 928 and 929:
Kkeloid scars 87, 91, 94-5, 104-8hy
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inadequacy 40manual work 207-15radi
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motivation (client) 241motor (effer
Page 934 and 935:
autonomic see autonomic nervous sys
Page 936 and 937:
PPacini and paciniform corpuscles,
Page 938 and 939:
professionalscollaboration between
Page 940 and 941:
Ssafety 192-4, 225therapeutic envir
Page 942 and 943:
stretch, gross 222-3structural prot
Page 944 and 945:
time (temporal/chronological dimens
Page 946 and 947:
Uultrasonography 184, 186
Page 948:
Wwater 6-7lymphatic transport 32see
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