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Slemp AE, Kirschner RE (2006) Keloids and scars: a review of keloids and scars, their pathogenesis, riskfactors, and management. Current Opinion in Pediatrics 18(4): 396–402.Springer BA, Levy E, McGarvey C et al (2010) Preoperative assessment enables early diagnosis andrecovery of shoulder function in patients with breast cancer. Breast Cancer Research and Treatment 120:135–147.Spurr ED, Shakespeare PG (1990) Incidence of hypertrophic scarring in burn-injured children. Burns 16(3):179–81.Stanton AW, Modi S, Mellor RH et al (2009) Recent advances in breast cancer-related lymphedema of thearm: lymphatic pump failure and predisposing factors. Lymphatic Research and Biology 7(1): 29–45.Stecco C, Porzionato A, Lancerotto L et al (2008) Histological study of the deep fasciae of the limbs.Journal of Bodywork and Movement Therapies 12(3): 225–230.Stout Gergich NL, Pfalzer LA, McGarvey C et al (2008) Preoperative assessment enables the earlydiagnosis and successful treatment of lymphedema. Cancer 112: 2809–2819.Thompson CM, Hocking AM, Honari S (2013) Genetic risk factors for hypertrophic scar development.Journal of Burn Care and Research 34(5): 477.Torres Lacomba M, Yuste Sanchez MJ, Zapico Goni A et al (2010) Effectiveness of early physiotherapy toprevent lymphoedema after surgery for breast cancer: randomised, single blinded, clinical trial. BMJ340:b5396.Tredget EE (2008) Pathophysiology of wound healing: the basis of fibrosis and wound healing disorders.Chicago, American Burn Association.Van der Veer WM, Bloemen MCT, Ulrich MMW et al (2009) Potential cellular and molecular causes ofhypertrophic scar formation. Burns 35(1): 15–29.Warren AG, Slavin SS (2007) Scar lymphedema: fact or fiction? Available at:http://www.ncbi.nlm.nih.gov/pubmed/17589258.Wójcicki P, Wojtkiewicz W, Drozdowski P (2011) Severe lower extremities degloving injuries — medicalproblems and treatment results. Polski Przeglad Chirurgiczny 83(5): 276–282.World Health Organization (2015) Violence and injury prevention. Available at:http://www.who.int/violence_injury_prevention/other_injury/burns/en/ [Accessed 13 February 2015].Yan H, Gao W, Li Z, Wang C et al (2013) The management of degloving injury of lower extremities:Technical refinement and classification. Journal of Trauma and Acute Care Surgery 74(2): 604–610.Yosipovitch G, Goon A, Wee J et al (2000) The prevalence and clinical characteristics of pruritus amongpatients with extensive psoriasis. British Journal of Dermatology 143: 969–73. Doi: bjd3829 [pii].Yosipovitch G, Ansari N, Goon A et al (2002a) Clinical characteristics of pruritus in chronic idiopathicurticaria. British Journal of Dermatology 147: 32–6.Yosipovitch G, Goon AT, Wee J et al (2002b) Itch characteristics in Chinese patients with atopic dermatitisusing a new questionnaire for the assessment of pruritus. International Journal of Dermatology 41:212–6.Doi: 1460 [pii].Zuther JE (2011) Lymphedema management: the comprehensive guide for practitioners. Stuttgart: Thieme.Resource and further readingThe Wound Healing Society. Available at: http://woundheal.org/
CHAPTER 7TraumaThe quality of outcome must be worth the pain of survivalFiona WoodTrauma can be defined as an insult or injury to the physical body orpsychological state (Barral & Croibier 1999). Physically, trauma can occur in theform of a wound or injury; and in psychological terms, in the form of a deeplydisturbing, frightening or disquieting experience or event. Traumatic scars, asdefined by the authors, embody this dual representation of trauma.The authors submit that psychological traumatic responses can occur as a resultof: a physically traumatic wound or injury; life-preserving interventions(surgery); experiences that occur during wound healing; and the impact ofimpairments, disabilities and disfigurements that can occur withpathophysiological scars.As massage therapists (MTs), when we touch a person’s body, we touch thetraumatic events that their body has experienced. According to van der Kolk(1994), ‘The body keeps the score’, and so we often find that our clients’ bodiestell their stories to our hands (Fitch 2014).The potential for the revealing of psychological trauma during a massagetherapy (MT) scar management session, in the authors’ opinion, is very high.The psychological impact of trauma may not be as immediately evident as thephysical or aesthetic presentations and so therapist awareness of what to lookand listen for presents particular consideration.The aim of this chapter is to inform and offer a bridge of understanding to assistwith safely and appropriately navigating the psychological impact of traumatic
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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
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EdemaEdema - the medical term for s
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Lymphatic treatment protocols will
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CHAPTER 4NeurologyEach human nervou
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NS StructureThe human NS comprises
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Figure 4.1B Functional composition
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Pathophysiological ConsiderationWhe
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Figure 4.2Dorsal and ventral compon
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Figure 4.3Neuron anatomy: most neur
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Figure 4.4Classic axon to dendrite
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Figure 4.6PNS efferent (motor) and
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Clinical ConsiderationPSNS afferent
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Clinical ConsiderationSNS activatio
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Figure 4.8Anterior and posterior di
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Figure 4.9Neurofascial envelopes.
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Pathophysiological ConsiderationA n
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Clinical ConsiderationThere is an e
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Clinical ConsiderationDiane Jacobs
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Clinical ConsiderationIt appears th
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Clinical ConsiderationAlthough musc
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Clinical ConsiderationThe form of s
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Example 2Ruffini stimulation result
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Table 4.1Summary of receptor typolo
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• Therapeutic outcome include enh
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NS FunctionThe primary functions of
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Clinical ConsiderationMechanorecept
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Clinical ConsiderationIn addition t
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Clinical ConsiderationManual techni
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large enough, a voltage spike is pr
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PathophysiologicalconsiderationUnde
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Table 4.2Important pain terms. Vari
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Clinical ConsiderationAccording to
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disorders (diabetes mellitus), drug
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forms of negative plasticity includ
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Central and peripheral sensitizatio
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Clinical ConsiderationFollowing per
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ExampleHypersensitive nerves (assoc
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Example 1Hypersensitized nerve fibe
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Clinical ConsiderationIt is suggest
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Clinical ConsiderationNeuropathic p
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Wound HealingThe NS plays an import
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Clinical ConsiderationNeural and ci
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Compression SyndromesAlthough perip
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Pathophysiological ConsiderationIf
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Pathophysiological ConsiderationUni
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Clinical ConsiderationAs is the cas
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Pathophysiological ConsiderationFas
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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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Pathophysiological ConsiderationAcc
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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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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 ConsiderationAccording to
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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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Pathophysiological ConsiderationAcc
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Clinical ConsiderationAccording to
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DissociationDissociation is describ
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Clinical ConsiderationAccording to
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not only does the brain carry memor
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Clinical ConsiderationAccording to
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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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Clinical ConsiderationAccording to
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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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Page 719 and 720:
Clinical ConsiderationStecco and co
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Page 721 and 722:
Safety FirstMT appears to have few
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Page 723 and 724:
Deep workThe deep techniques noted
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Page 725 and 726:
Psychological considerationsIt is w
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Page 727 and 728:
Clinical ConsiderationMT dosage and
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Page 729 and 730:
Developing a sound treatment strate
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Page 731 and 732:
Treatment outcomesEssentially, earl
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Page 733 and 734:
Dosage considerationsThe presence o
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Page 735 and 736:
Clinical ConsiderationNumerous syst
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Page 737 and 738:
Clinical ConsiderationHeat in the t
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Page 739 and 740:
Clinical ConsiderationBest and co-w
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Page 741 and 742:
Pathophysiological considerationCom
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Page 743 and 744:
Clinical ConsiderationTiming is eve
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Clinical ConsiderationEvidence sugg
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Clinical ConsiderationSeveral studi
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Page 749 and 750:
Clinical ConsiderationPreventive me
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Pathophysiological ConsiderationWit
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Page 753 and 754:
TechniquesCommonly employed techniq
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Page 755 and 756:
Treatment outcomesThe later stages
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Page 757 and 758:
Clinical ConsiderationsNon-threaten
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Page 759 and 760:
Clinical ConsiderationsIt has been
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Page 761 and 762:
Clinical ConsiderationsMT may be a
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Page 763 and 764:
Pathophysiological ConsiderationUnd
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Page 765 and 766:
Clinical ConsiderationsIn the early
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Page 767 and 768:
Clinical ConsiderationsAs the remod
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Page 769 and 770:
Treatment outcomesEssentially, the
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Page 771 and 772:
Dosage considerationsThe presence o
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Page 773 and 774:
TechniquesAny carpenter will tell y
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Page 775 and 776:
Pressure Level 4 - Strong pressure/
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Page 777 and 778:
Grade 7 and 8• Firm, deep• Trig
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Page 779 and 780:
Neutralize pHFacilitate healing pro
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Page 781 and 782:
Manual Lymphatic TechniquesEarly ma
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Page 783 and 784:
Table 9.4Treatment guideline summar
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Page 785 and 786:
Clinical ConsiderationEdema, excess
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Page 788 and 789:
Figure 9.2Half-moon/circles: cleari
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Page 791 and 792:
Figure 9.3Pumping: clearing the ext
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Page 793:
RotaryThe rotary technique is commo
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Page 797:
Figure 9.5Rotary (thorax). Half-moo
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Page 800 and 801:
One of the most obvious differences
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Page 802 and 803:
Clinical ConsiderationVarious forms
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Page 804:
Box 9.10Sensory amnesia and proprio
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Page 808 and 809:
Clinical ConsiderationAs all of the
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Page 810 and 811:
Compression techniqueCompression te
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Page 812 and 813:
Figure 9.8Tension. The lower leg is
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Page 814:
Figure 9.9Approximation-compression
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Page 818 and 819:
Figure 9.11(A) Shear: begin by enga
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Page 820 and 821:
Clinical ConsiderationIt is common
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Page 823 and 824:
Figure 9.12Torsion/rotation. Begin
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Page 826 and 827:
Figure 9.13Lifting. Begin by graspi
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Page 828 and 829:
Gross stretchGross stretch techniqu
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Page 830 and 831:
Figure 9.15‘Cs’. Begin as noted
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Page 833 and 834:
Figure 9.17J-stroke. Begin at one e
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Page 835 and 836:
Clinical ConsiderationIrritated ner
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Page 837 and 838:
Pathophysiological ConsiderationCha
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Page 839 and 840:
Clinical ConsiderationAs the mechan
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Page 841 and 842:
Clinical ConsiderationIn various st
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Page 843 and 844:
Chaudhry H, Schleip R, Ji Z et al (
-
Page 845 and 846:
principles and methods. Philadelphi
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Page 847 and 848:
Pilat A (2003) Myofascial therapies
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Page 849 and 850:
Yang G, Im HJ, Wang JHC (2005) Repe
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Page 851 and 852:
Medial thigh 4th degree skin grafts
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Page 853:
Figure B.2 Post-treatmentSurgical s
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Page 857 and 858:
Figure C.2 Post-treatment2 December
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Page 859 and 860:
and to be consistent with any selfc
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Page 861 and 862:
ability to resume social responsibi
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Page 863 and 864:
Clinical ConsiderationTrauma can be
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Page 865 and 866:
MaintenanceSelfcare maintenance is
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Page 867 and 868:
ManagementSelfcare management is de
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Page 869 and 870:
Client and Therapist PartnershipTo
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Page 871 and 872:
Box 10.1Factors affecting, effectiv
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Page 873 and 874:
Strategies to Facilitate Engagement
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Page 875 and 876:
Clinical ConsiderationThe authors u
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Page 877 and 878:
instances. Make your clients aware
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Page 879 and 880:
Relaxation MeasuresVarious relaxati
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Page 881 and 882:
scope of practice, such as relaxati
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Page 883 and 884:
Silicone gel and silicone sheetingS
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Page 885 and 886:
Medicinal honeyThe use of honey for
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Page 887 and 888:
Wise Use of Your BodyIt is not esse
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Page 889 and 890:
Empathy Strain and BurnoutEmpathy,
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Page 891 and 892:
Box 10.3A reflection on reasons for
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Page 893 and 894:
Clinical ConsiderationIn the author
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Page 895 and 896:
trauma are the therapist’s person
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Page 897 and 898:
Care for the care providerIt is imp
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Page 899 and 900:
body. Edinburgh: Churchill Livingst
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Page 901 and 902:
Salvo SG (2015) Body mechanics, cli
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Page 903 and 904:
Research databases and repositories
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Page 905 and 906:
Funding for massage therapy researc
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Page 907 and 908:
Journals and magazinesInternational
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Page 909 and 910:
INDEX
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Page 911 and 912:
see also parasympathetic nervous sy
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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
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Page 919 and 920:
Eedema 40-1, 69burns-related 112-13
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Page 921 and 922:
Ffascia 11-22assessment 186client-r
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Page 923 and 924:
Gglia 48glucocorticoids 137, 138, 1
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Page 925 and 926:
see also dehydrationhyperalgesia 63
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Page 927 and 928:
JJ-stroke 221joint instability 190
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Page 929 and 930:
Llarge Pacini and paciniform corpus
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Page 931 and 932:
Mmacrophages 13, 63, 80, 81, 89lymp
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Page 933 and 934:
Nnecrosisbreast implant-related 119
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Page 935 and 936:
Oobservation 180-2occupational inju
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Page 937 and 938:
peripheral nervous system 45, 49-50
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Page 939 and 940:
Rradiation therapy 193breast cancer
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Page 941 and 942:
interviewing 169-71skin 5-11fascia
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Page 943 and 944:
TT cells 37technology 2, 242-3tempe
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Page 945 and 946:
safety see safetysee also post-trea
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Page 947 and 948:
Vvagus nerve 124polyvagal theory 14