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Table 5.1
Stages of wound healing
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Table 5.1
Stages of wound healing
Table 5.1Stages of wound healing
Pathophysiological ConsiderationUnderstanding the mechanisms involved in regulating TGF-β signalingprovides important insights into how to prevent or reduce aberrant woundhealing and excessive scarring (Finnson et al. 2013)
Traumatic Scar Tissue ManagementMas
Letter to NKS - from Camp Amigo cam
Important noticeNeither the publish
FOREWORDEveryone has scars: visible
stories about how basic massage the
to the events that resulted in the
PREFACEMore people are surviving tr
and
ACKNOWLEDGEMENTSA thank you to the
Lastly, thank you, the reader; the
GLOSSARY AND KEY CONCEPTSAll the wo
AdhesionsScar-like tissue that form
Alphabet techniquesCs, Js, and Ss -
AngiogenesisGrowth of new blood ves
AponeurosesDense, sheet-like fascia
Autonomic balanceHomeostatic and co
BarrierIs defined as the point wher
Best research evidenceThe best avai
Body AwarenessConscious, attentiona
BradykininInflammatory mediator - a
Capsular contractureEnvelopment of
ChemokinesSmall molecules released
CicatrixAnother term for scar - the
Collagen crimpThe wavy formation se
Compassion fatigueThe profound emot
Compression techniqueA therapeutic
Consolidated edemaChronic stage ede
CortisolHormone released in respons
CreepA time-dependent response of v
DebridementRemoval of foreign mater
Degloving injuryA form of avulsion
DermatomeAreas of skin supplied by
Direct release techniqueCommonly us
Dry needlingA procedure involving i
Empathy strainA healthcare provider
EndoneuriumFascia surrounding indiv
Endothelial cellsSimple squamous ce
EndoscopeAn instrument that is used
EpidermisThe tough, outermost layer
EpineuriumOutermost covering of fas
Epithelial cellsCells that line the
FasciaFibrocollagenous CT, its morp
FibrinFibrous protein involved bloo
FibroblastsSynthesize the component
FibrosisA process culminating in th
Fluid techniquesTechniques employed
Gentle circles techniqueCircular mo
Gross stretch techniqueCombination
HomeostasisState of physiological e
HyperalgesiaHeightened pain sensati
HyperexcitationNeurons firing too e
Hypertrophic scarA thickened, red a
HysteresisA property of systems (ti
Indirect release techniqueMechanica
Informed consentProcess involving t
Intense versus invasiveAn important
InteroceptionIncludes a wide range
KeratinA structural protein that pr
KininsPeptides (e.g. bradykinin) pr
Linking fasciaPlays a role in augme
Lymph nodesFilter and clean the lym
LymphangiogenesisFormation of new l
Lymphatic drainageThe movement of f
Lymphatic returnVolume of lymph ret
Lymphatic transportThe movement of
Lymphatic vesselsTri-laminar vessel
LymphocyteThe main cell type found
MacrophageA type of phagocytic whit
MastectomySurgical removal of all b
MechanotransductionThe mechanism by
MucopolysaccharidesSee GAGs.Myofasc
Nerve receptorsNerve terminations t
NeurofasciaTri-laminar, continuous
Neuropathic painPain due to damage
NeuropeptidesSignaling molecules th
NociceptionThreatening stimuli acti
Nociceptive painPain that arises fr
OxytocinHormone that plays role in
ParesthesiaAltered sensations; e.g.
Peripheral sensitizationIncreased r
PerineuriumFascia surrounding/inves
Pitting edemaAn edematous region wh
Proprioceptive disinformationRecept
Provisional matrixDuring the early
Pumping techniqueA lymphatic techni
Referred painPain perceived at a lo
RetinaculaeDense fascial bands that
ScarMark left in various tissues or
Secondary lymphedemaOccurs as a res
Self careThose practices and activi
Selfcare managementResponse to sens
SensitizationChanges in the PNS or
SerotoninNeurotransmitter involved
Shear techniqueA therapeutic loadin
Skin graftMedical procedure where a
SomatizationA tendency to experienc
State anxietyThe experience of unpl
Stress response adaptationAny of th
Stress responseAny cognitive, physi
Substance PA neuropeptide acting as
Therapeutic environmentEncompasses
Therapeutic relationshipEncompasses
Trait anxietyA more intense degree
TraumaInsult or injury to the physi
Traumatic scarPathophysiological sc
ViscoelasticityThe ability of a med
Nowadays it is common to see massag
A Reasonable NexusPrecise etiologic
integration of art and science are
Diamond M (2012) Scars and adhesion
General HistologyExtracellular Matr
Clinical ConsiderationVitamin C has
Ground substanceGround substance (G
Pathophysiological ConsiderationIn
HyaluronanThis hydrophilic, viscous
Clinical ConsiderationHA and its fr
Figure 2.1Layers and components of
Skin HistologyThe skin comprises:
Figure 2.2The delicate, well-hydrat
DermisThe dermis is made up of laye
Fascia Structure and FunctionsIn th
fundamental characteristic is its c
tensional properties co-exist in bo
HistologyFascia comprises:• ECM (
Clinical ConsiderationManual therap
Clinical ConsiderationTransforming
CollagenCollagen is the most abunda
Clinical ConsiderationSignificant c
Fascia Layers and FunctionsFascia t
Clinical ConsiderationSuperficial a
Clinical ConsiderationWhen thickene
LinkingLinking fascia is sub-divide
FascicularFascicular fascia augment
Clinical ConsiderationMuscle spindl
SeparatingSeparating fascia provide
Clinical ConsiderationFascia suppor
Andrade C-K (2013) Outcome-based ma
Ingber D (2008) Tensegrity and mech
tendons: organisation in vivo and r
Zorn A, Hodeck K (2011) Walk with e
Discovery of the Lymphatic SystemTh
Hematic SystemThe heart, blood vess
Lymphatic System Structure and Func
Clinical ConsiderationNerves, blood
Figure 3.1Lymph tissue structure.In
Lymphoid OrgansThe lymphoid organs
ThymusThe thymus is a lymphoid glan
Lymphatic Drainage and TransportIn
SuperficialThe superficial layer is
Primary upper lymphatic structuresT
Primary lower lymphatic structuresT
Left side lymphatic drainageThe lef
Lymphatic System FunctionsA brief o
Fig 3.5Brain lymphatic vessels.Give
ImmunityLymph nodes play an importa
Wound HealingAs with the blood vasc
Clinical ConsiderationFour continuo
Lymphatic InadequacyInadequacy in t
EdemaEdema - the medical term for s
Lymphatic treatment protocols will
CHAPTER 4NeurologyEach human nervou
NS StructureThe human NS comprises
Figure 4.1B Functional composition
Pathophysiological ConsiderationWhe
Figure 4.2Dorsal and ventral compon
Figure 4.3Neuron anatomy: most neur
Figure 4.4Classic axon to dendrite
Figure 4.6PNS efferent (motor) and
Clinical ConsiderationPSNS afferent
Clinical ConsiderationSNS activatio
Figure 4.8Anterior and posterior di
Figure 4.9Neurofascial envelopes.
Pathophysiological ConsiderationA n
Clinical ConsiderationThere is an e
Clinical ConsiderationDiane Jacobs
Clinical ConsiderationIt appears th
Clinical ConsiderationAlthough musc
Clinical ConsiderationThe form of s
Example 2Ruffini stimulation result
Table 4.1Summary of receptor typolo
• Therapeutic outcome include enh
NS FunctionThe primary functions of
Clinical ConsiderationMechanorecept
Clinical ConsiderationIn addition t
Clinical ConsiderationMechanical fo
Table 5.4Role of neuropeptides (NP)
Fitch P (2005) Scars of life. Journ
Langevin HM (2006) Connective tissu
active scars. Journal of Bodywork a
trauma.
Clinical ConsiderationPostsurgical
following burn injury,bacterial col
Table 6.1Comparison of scars (Ogawa
Pathophysiological ConsiderationAcc
BurnsA burn injury to the skin or o
Figure 6.1Depth of burn trauma and
• Stimulate ECM formation• Regu
Clinical ConsiderationIt has been i
Clinical ConsiderationMT may be a v
ThermoregulationThermoregulation (t
from the tissues and taken up by th
treatment strategies are difficult
Clinical ConsiderationSkin rolling
Sequelae and ComplicationsAdvances
• Paresthesia - 47%• Arm/should
breast or around the edge of the ar
Radiation scarringScar tissue as a
Implants and painPain of fluctuatin
LymphedemaBreast cancer treatment o
volume of fluid that accumulates or
OneTwoThreeCommonly referred to as
myokinetic chain/myofascial meridia
• Loss of touch sensation• Clum
Figure 6.3Distribution of nerves in
include preservation of as much of
complication is present there is de
Clinical ConsiderationScar complica
BreastCancer.org (2015c) Side Effec
323-9.Kania A (2012) Scars. In: Dry
Slemp AE, Kirschner RE (2006) Keloi
scar tissue, while being mindful of
Physiological ResponseAs discussed
• The realization that one is abo
Stress Response and Stress Hormones
dissociation and inner shakiness) (
Figure 7.1(A) Summary of the HPA me
Chronic Stress ResponseChronic stre
Pathophysiological ConsiderationChr
Clinical ConsiderationProlonged str
Psychological Stress and Wound Heal
Pathophysiological ConsiderationNor
Pathophysiological ConsiderationStr
Clinical ConsiderationAccording to
Clinical ConsiderationEvidence sugg
Clinical ConsiderationAccording to
Clinical ConsiderationThe effects o
Stress DisordersFollowing a traumat
Clinical ConsiderationThe Task Forc
Clinical ConsiderationCertainly it
ASD symptoms include (DSM-V 2013):
Box 7.1Why do medical events potent
Rehabilitation and reintegrationThi
Pathophysiological ConsiderationAcc
Clinical ConsiderationAccording to
DissociationDissociation is describ
Clinical ConsiderationAccording to
not only does the brain carry memor
Clinical ConsiderationAccording to
Somatoemotional ResponseDuring trea
• If the client asks what happene
Clinical ConsiderationWorking with
Given the impact of trauma on the b
Clinical ConsiderationAccording to
The Massage Therapist and TraumaThe
Bordoni B, Zanier E (2014) Skin, fa
Foex (2013) Surgical Tutor UK Avail
Kutner JS, Smith MC, Corbin L et al
Schmidt NB, Richey JA, Zvolensky MJ
CHAPTER 8Communication and the ther
The Therapeutic RelationshipThe the
Needs assessment, treatment plannin
Clinical ConsiderationIt is importa
Therapeutic Closeness and Vulnerabi
BoundariesOver the course of our li
Box 8.1Aside from obvious sexually
Box 8.2Eight principles that guide
Effective Listening and Empathetic
Clinical ConsiderationNever underst
Clinical ConsiderationAs manual the
Interview exampleMary is a client w
SummarySeveral pieces of informatio
with traumatic scar tissue clients.
‘Physicians’ perspective of mas
Referral exampleTonya, a 21-year-ol
Referral exampleJane experienced me
CHAPTER 9Assessment and treatmentHe
MT. Additionally, sometimes people
Traumatic Scars and Associated Impa
Clinical ConsiderationReduction of
Clinical ConsiderationMT has been f
Clinical ConsiderationMassage can h
Health History and InterviewA stand
surrounding muscle structures that
we are gathering information about
Keep in mind that the therapist’s
Continuous evaluation during the se
Pre-treatment assessment/evaluation
Scar scalesScar scales can be used
response to negative pressure. It h
• Client self-management strategi
BindOnce barrier is reached or surp
Table 9.1Comparative of normal and
2-3 times a year effectively addres
Myofascial meridian exampleSuperfic
Clinical ConsiderationKnee and back
Clinical ConsiderationApplication t
Pathophysiological ConsiderationMec
Clinical ConsiderationStecco and co
Safety FirstMT appears to have few
Deep workThe deep techniques noted
Psychological considerationsIt is w
Clinical ConsiderationMT dosage and
Developing a sound treatment strate
Treatment outcomesEssentially, earl
Dosage considerationsThe presence o
Clinical ConsiderationNumerous syst
Clinical ConsiderationHeat in the t
Clinical ConsiderationBest and co-w
Pathophysiological considerationCom
Clinical ConsiderationTiming is eve
Clinical ConsiderationEvidence sugg
Clinical ConsiderationSeveral studi
Clinical ConsiderationPreventive me
Pathophysiological ConsiderationWit
TechniquesCommonly employed techniq
Treatment outcomesThe later stages
Clinical ConsiderationsNon-threaten
Clinical ConsiderationsIt has been
Clinical ConsiderationsMT may be a
Pathophysiological ConsiderationUnd
Clinical ConsiderationsIn the early
Clinical ConsiderationsAs the remod
Treatment outcomesEssentially, the
Dosage considerationsThe presence o
TechniquesAny carpenter will tell y
Pressure Level 4 - Strong pressure/
Grade 7 and 8• Firm, deep• Trig
Neutralize pHFacilitate healing pro
Manual Lymphatic TechniquesEarly ma
Table 9.4Treatment guideline summar
Clinical ConsiderationEdema, excess
Figure 9.2Half-moon/circles: cleari
Figure 9.3Pumping: clearing the ext
RotaryThe rotary technique is commo
Figure 9.5Rotary (thorax). Half-moo
One of the most obvious differences
Clinical ConsiderationVarious forms
Box 9.10Sensory amnesia and proprio
Clinical ConsiderationAs all of the
Compression techniqueCompression te
Figure 9.8Tension. The lower leg is
Figure 9.9Approximation-compression
Figure 9.11(A) Shear: begin by enga
Clinical ConsiderationIt is common
Figure 9.12Torsion/rotation. Begin
Figure 9.13Lifting. Begin by graspi
Gross stretchGross stretch techniqu
Figure 9.15‘Cs’. Begin as noted
Figure 9.17J-stroke. Begin at one e
Clinical ConsiderationIrritated ner
Pathophysiological ConsiderationCha
Clinical ConsiderationAs the mechan
Clinical ConsiderationIn various st
Chaudhry H, Schleip R, Ji Z et al (
principles and methods. Philadelphi
Pilat A (2003) Myofascial therapies
Yang G, Im HJ, Wang JHC (2005) Repe
Medial thigh 4th degree skin grafts
Figure B.2 Post-treatmentSurgical s
Figure C.2 Post-treatment2 December
and to be consistent with any selfc
ability to resume social responsibi
Clinical ConsiderationTrauma can be
MaintenanceSelfcare maintenance is
ManagementSelfcare management is de
Client and Therapist PartnershipTo
Box 10.1Factors affecting, effectiv
Strategies to Facilitate Engagement
Clinical ConsiderationThe authors u
instances. Make your clients aware
Relaxation MeasuresVarious relaxati
scope of practice, such as relaxati
Silicone gel and silicone sheetingS
Medicinal honeyThe use of honey for
Wise Use of Your BodyIt is not esse
Empathy Strain and BurnoutEmpathy,
Box 10.3A reflection on reasons for
Clinical ConsiderationIn the author
trauma are the therapist’s person
Care for the care providerIt is imp
body. Edinburgh: Churchill Livingst
Salvo SG (2015) Body mechanics, cli
Research databases and repositories
Funding for massage therapy researc
Journals and magazinesInternational
INDEX
see also parasympathetic nervous sy
breathing exercises 245burning sens
CGRP (calcitonin gene-related pepti
Ddanger (perceived) 135, 150fight-o
Eedema 40-1, 69burns-related 112-13
Ffascia 11-22assessment 186client-r
Gglia 48glucocorticoids 137, 138, 1
see also dehydrationhyperalgesia 63
JJ-stroke 221joint instability 190
Llarge Pacini and paciniform corpus
Mmacrophages 13, 63, 80, 81, 89lymp
Nnecrosisbreast implant-related 119
Oobservation 180-2occupational inju
peripheral nervous system 45, 49-50
Rradiation therapy 193breast cancer
interviewing 169-71skin 5-11fascia
TT cells 37technology 2, 242-3tempe
safety see safetysee also post-trea
Vvagus nerve 124polyvagal theory 14
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