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

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• Therapeutic outcome include enhanced proprioceptive feedback and motorcontrol.Merkel cellsMerkel cells:• Are found in superficial skin• Respond to localized pressure, sustained loading and tissue displacement• Therapeutic outcomes may include certain neuromodulation andneuroendocrine responses.Ruffini organsRuffini organs:• Are found below the skin in dense CT/fascia and joint related tissues• Are especially responsive to slow, sustained, deeper pressure, slow deepstrokes and lateral/tangential forces or stretch (Kruger 1987)• Therapeutic outcomes include sedation of sympathetic activity.IRsIRs:• Are plentiful in various presentations of fascia, including periosteum• Are multi-modal in their function as noci (pain), thermo, chemo, and themajority as mechanoreceptors (e.g. intrafascial mechanoreceptors)• In their role as mechanoreceptors, respond to tension, pressure, tissue stretchand ultralight touch• Therapeutic outcomes include the ability to influence autonomic responses, e.g.blood pressure changes and improved parasympathetic/sympathetic balance.
NociceptorsA nociceptor is a receptor specialized in detecting stimuli that objectivelycan damage tissue and subjectively are perceived as painful.Dommerholt (RMTBC Pain Conference 2014)Nociceptors, which are threat detectors, are responsive to various noxiousstimuli (e.g. extreme hot, cold, swelling, tissue damage or prior tissue damage)(Winkelstein 2004, Jacobs 2014). Although there is a common tendency toidentify nociceptors as pain receptors, not all nociceptive signals are interpretedas pain and not every pain sensation originates from a nociceptor. However,acute pain almost always originates from nociceptors in somatic or visceraltissue. Pain mechanisms and various types of pain will be discussed in greaterdetail later in this chapter.As is the case with mechanoreceptors, nociceptor condensations vary fromregion to region; for example, the thoracolumbar fascia (aka lumbodorsal fascia)is densely innervated with nociceptors, and nociceptors in this region have amore extensive distribution in the spinal cord than is seen in other tissues (e.g.more so than what is seen in the gastroc/soleus). The higher nociceptorcondensation and more extensive spinal cord distribution may explain why wesee a higher prevalence of chronic low back pain (ChLBP) in comparison tochronic lower limb pain (Tesarz 2009, Tesarz et al. 2011).
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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
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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
Page 327 and 328: EdemaEdema - the medical term for s
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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 352 and 353: Clinical ConsiderationPSNS afferent
Page 354 and 355: Clinical ConsiderationSNS activatio
Page 357 and 358: Figure 4.8Anterior and posterior di
Page 360 and 361: Figure 4.9Neurofascial envelopes.
Page 362 and 363: Pathophysiological ConsiderationA n
Page 364 and 365: Clinical ConsiderationThere is an e
Page 366 and 367: Clinical ConsiderationDiane Jacobs
Page 368 and 369: Clinical ConsiderationIt appears th
Page 370 and 371: Clinical ConsiderationAlthough musc
Page 372 and 373: Clinical ConsiderationThe form of s
Page 374 and 375: Example 2Ruffini stimulation result
Page 376 and 377: Table 4.1Summary of receptor typolo
Page 380 and 381: NS FunctionThe primary functions of
Page 382 and 383: Clinical ConsiderationMechanorecept
Page 384 and 385: Clinical ConsiderationIn addition t
Page 386 and 387: Clinical ConsiderationManual techni
Page 388 and 389: large enough, a voltage spike is pr
Page 390 and 391: PathophysiologicalconsiderationUnde
Page 392 and 393: Table 4.2Important pain terms. Vari
Page 394 and 395: Clinical ConsiderationAccording to
Page 396 and 397: disorders (diabetes mellitus), drug
Page 398 and 399: forms of negative plasticity includ
Page 400 and 401: Central and peripheral sensitizatio
Page 402 and 403: Clinical ConsiderationFollowing per
Page 404 and 405: ExampleHypersensitive nerves (assoc
Page 406 and 407: Example 1Hypersensitized nerve fibe
Page 408 and 409: Clinical ConsiderationIt is suggest
Page 410 and 411: Clinical ConsiderationNeuropathic p
Page 412 and 413: Wound HealingThe NS plays an import
Page 414 and 415: Clinical ConsiderationNeural and ci
Page 416 and 417: Compression SyndromesAlthough perip
Page 418 and 419: Pathophysiological ConsiderationIf
Page 420 and 421: Pathophysiological ConsiderationUni
Page 422 and 423: Clinical ConsiderationAs is the cas
Page 424 and 425: Pathophysiological ConsiderationFas
Page 426 and 427: Damasio AR, Grabowski TJ, Bechara A
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Magee DJ (2008) Orthopedic physical
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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
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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
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Clinical ConsiderationScar complica
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BreastCancer.org (2015c) Side Effec
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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
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Stress Response and Stress Hormones
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dissociation and inner shakiness) (
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Figure 7.1(A) Summary of the HPA me
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Chronic Stress ResponseChronic stre
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Pathophysiological ConsiderationChr
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Clinical ConsiderationProlonged str
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Psychological Stress and Wound Heal
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Pathophysiological ConsiderationNor
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Pathophysiological ConsiderationStr
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Clinical ConsiderationAccording to
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Clinical ConsiderationEvidence sugg
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Clinical ConsiderationThe effects o
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Stress DisordersFollowing a traumat
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Clinical ConsiderationThe Task Forc
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Clinical ConsiderationCertainly it
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ASD symptoms include (DSM-V 2013):
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Box 7.1Why do medical events potent
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Rehabilitation and reintegrationThi
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DissociationDissociation is describ
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not only does the brain carry memor
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Somatoemotional ResponseDuring trea
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• If the client asks what happene
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Clinical ConsiderationWorking with
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Given the impact of trauma on the b
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Page 629 and 630:
The Massage Therapist and TraumaThe
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Bordoni B, Zanier E (2014) Skin, fa
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Foex (2013) Surgical Tutor UK Avail
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Kutner JS, Smith MC, Corbin L et al
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Schmidt NB, Richey JA, Zvolensky MJ
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CHAPTER 8Communication and the ther
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The Therapeutic RelationshipThe the
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Needs assessment, treatment plannin
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Clinical ConsiderationIt is importa
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Therapeutic Closeness and Vulnerabi
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BoundariesOver the course of our li
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Box 8.1Aside from obvious sexually
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Box 8.2Eight principles that guide
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Effective Listening and Empathetic
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Clinical ConsiderationNever underst
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Clinical ConsiderationAs manual the
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Interview exampleMary is a client w
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SummarySeveral pieces of informatio
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with traumatic scar tissue clients.
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‘Physicians’ perspective of mas
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Referral exampleTonya, a 21-year-ol
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Referral exampleJane experienced me
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CHAPTER 9Assessment and treatmentHe
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MT. Additionally, sometimes people
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Traumatic Scars and Associated Impa
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Clinical ConsiderationReduction of
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Clinical ConsiderationMT has been f
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Clinical ConsiderationMassage can h
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Health History and InterviewA stand
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surrounding muscle structures that
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we are gathering information about
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Keep in mind that the therapist’s
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Continuous evaluation during the se
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Pre-treatment assessment/evaluation
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Scar scalesScar scales can be used
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response to negative pressure. It h
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• Client self-management strategi
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BindOnce barrier is reached or surp
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Table 9.1Comparative of normal and
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2-3 times a year effectively addres
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Myofascial meridian exampleSuperfic
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Clinical ConsiderationKnee and back
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Clinical ConsiderationApplication t
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Pathophysiological ConsiderationMec
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Clinical ConsiderationStecco and co
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Safety FirstMT appears to have few
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Deep workThe deep techniques noted
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Psychological considerationsIt is w
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Clinical ConsiderationMT dosage and
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Developing a sound treatment strate
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Treatment outcomesEssentially, earl
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Dosage considerationsThe presence o
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Clinical ConsiderationNumerous syst
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Clinical ConsiderationHeat in the t
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Clinical ConsiderationBest and co-w
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Pathophysiological considerationCom
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Clinical ConsiderationTiming is eve
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Clinical ConsiderationEvidence sugg
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Clinical ConsiderationSeveral studi
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Clinical ConsiderationPreventive me
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Pathophysiological ConsiderationWit
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TechniquesCommonly employed techniq
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Treatment outcomesThe later stages
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Clinical ConsiderationsNon-threaten
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Clinical ConsiderationsIt has been
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Clinical ConsiderationsMT may be a
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Pathophysiological ConsiderationUnd
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Clinical ConsiderationsIn the early
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Clinical ConsiderationsAs the remod
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Treatment outcomesEssentially, the
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Dosage considerationsThe presence o
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TechniquesAny carpenter will tell y
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Pressure Level 4 - Strong pressure/
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Grade 7 and 8• Firm, deep• Trig
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Neutralize pHFacilitate healing pro
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Manual Lymphatic TechniquesEarly ma
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Table 9.4Treatment guideline summar
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Clinical ConsiderationEdema, excess
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Figure 9.2Half-moon/circles: cleari
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Figure 9.3Pumping: clearing the ext
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RotaryThe rotary technique is commo
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Figure 9.5Rotary (thorax). Half-moo
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One of the most obvious differences
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Clinical ConsiderationVarious forms
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Box 9.10Sensory amnesia and proprio
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Clinical ConsiderationAs all of the
Page 810 and 811:
Compression techniqueCompression te
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Figure 9.8Tension. The lower leg is
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Figure 9.9Approximation-compression
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Figure 9.11(A) Shear: begin by enga
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Clinical ConsiderationIt is common
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Figure 9.12Torsion/rotation. Begin
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Figure 9.13Lifting. Begin by graspi
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Gross stretchGross stretch techniqu
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Figure 9.15‘Cs’. Begin as noted
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Figure 9.17J-stroke. Begin at one e
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Clinical ConsiderationIrritated ner
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Pathophysiological ConsiderationCha
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Clinical ConsiderationAs the mechan
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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
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Figure B.2 Post-treatmentSurgical s
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Figure C.2 Post-treatment2 December
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and to be consistent with any selfc
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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
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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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