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

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Figure 4.7PSNS and SNS control.
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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
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Clinical ConsiderationTransforming
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CollagenCollagen is the most abunda
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Clinical ConsiderationSignificant c
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Fascia Layers and FunctionsFascia t
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Clinical ConsiderationSuperficial a
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Clinical ConsiderationWhen thickene
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LinkingLinking fascia is sub-divide
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FascicularFascicular fascia augment
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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
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
Page 339 and 340: Pathophysiological ConsiderationWhe
Page 341 and 342: Figure 4.2Dorsal and ventral compon
Page 344 and 345: Figure 4.3Neuron anatomy: most neur
Page 346 and 347: Figure 4.4Classic axon to dendrite
Page 349: Figure 4.6PNS efferent (motor) and
Page 353 and 354: Clinical ConsiderationStress and th
Page 355: • Areas of skin supplied by a sin
Page 358: • A loose collagenous matrix that
Page 361 and 362: Clinical ConsiderationThe space bet
Page 363 and 364: Innervation of Skin and FasciaNerve
Page 365 and 366: Clinical ConsiderationHigher nerve
Page 367 and 368: MechanoreceptorsMechanoreceptors ar
Page 369 and 370: Figure 4.10Mechanoreceptor mediated
Page 371 and 372: Clinical ConsiderationRetinaculae i
Page 373 and 374: Example 1According to Cottingham (1
Page 375 and 376: Example 3IRs, found in abundance th
Page 377 and 378: Clinical ConsiderationSignificant n
Page 379 and 380: NociceptorsA nociceptor is a recept
Page 381 and 382: Clinical ConsiderationAccording to
Page 383 and 384: Pathophysiological ConsiderationTra
Page 385 and 386: Clinical ConsiderationIn addition t
Page 387 and 388: Clinical ConsiderationMassage immun
Page 389 and 390: Pathophysiological considerationEle
Page 391 and 392: Referred painSensitizationPain perc
Page 393 and 394: Figure 4.11Lowered threshold outcom
Page 395 and 396: Clinical ConsiderationAcute and chr
Page 397 and 398: heightened nociceptive responses an
Page 399 and 400: 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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Clinical ConsiderationAccording to
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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
Page 431 and 432:
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
Page 482 and 483:
Clinical ConsiderationMassage thera
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Clinical ConsiderationIn the treatm
Page 486 and 487:
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
Page 523 and 524:
Clinical ConsiderationBurn rehabili
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Breast CancerThe breast is made up
Page 527 and 528:
Early detectionBreast cancer is typ
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effectively prevent or reduce unnec
Page 531 and 532:
Table 6.2Types of mastectomiesAs ma
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Capsular contractureCapsular contra
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Implants and necrosisNecrosis - the
Page 537 and 538:
Table 6.3Baker scaleCancer treatmen
Page 539 and 540:
Clinical ConsiderationEarly detecti
Page 541 and 542:
Table 6.4Stages of lymphedema: 0-3A
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Clinical ConsiderationIt has been d
Page 546:
Figure 6.2Nerves plexuses in the ch
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Degloving InjuryDegloving - named f
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LiposuctionBrief consideration is g
Page 553 and 554:
Neurological SequelaeHypoesthesia i
Page 555 and 556:
Traumatic Scars and MTWhen working
Page 557 and 558:
207-227.Derderian CA, Bastidas N, L
Page 559 and 560:
Monocryl vs. Vicryl-rapide. Annals
Page 561 and 562:
CHAPTER 7TraumaThe quality of outco
Page 563 and 564:
Traumatic Events and Traumatic Resp
Page 565 and 566:
Psychological ResponsePsychological
Page 567 and 568:
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
Page 580 and 581:
Clinical ConsiderationStress and th
Page 582 and 583:
Silverstein 1992, Leproult et al. 1
Page 584 and 585:
Pathophysiological ConsiderationEle
Page 586 and 587:
Pathophysiological ConsiderationTho
Page 588 and 589:
Clinical ConsiderationMultiple stud
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Clinical ConsiderationListing and c
Page 592 and 593:
Clinical ConsiderationRapid develop
Page 594 and 595:
Clinical ConsiderationData demonstr
Page 596 and 597:
physical impairments that fall with
Page 598 and 599:
Page 600 and 601:
Clinical ConsiderationMainstream tr
Page 602 and 603:
ASD can occur as a result of medica
Page 604 and 605:
The critical care phaseA patient ma
Page 606 and 607:
physical sensations). The inability
Page 608 and 609:
Clinical Considerationvan der Kolk
Page 610 and 611:
Clinical ConsiderationMT is commonl
Page 612 and 613:
amygdala that is primed to go into
Page 614 and 615:
Scope of Practice ConsiderationsWe
Page 616 and 617:
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
Page 634 and 635:
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
Page 642 and 643:
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
Page 666 and 667:
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
Page 686 and 687:
Clinical ConsiderationAnything that
Page 688 and 689:
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
Page 700 and 701:
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
Page 708 and 709:
Clinical ConsiderationChronic and/o
Page 710 and 711:
Myofascial sequence exampleAnatomic
Page 714 and 715:
Fig 9.1Yellow lines represent palpa
Page 716 and 717:
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
Page 930 and 931:
inadequacy 40manual work 207-15radi
Page 932 and 933:
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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