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

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The critical care phaseA patient may experience one or all of the following upon being admitted to thehospital after a traumatic injury: anxiety, terror, pain, sadness and grief. Whetheradmitted to general in-hospital care or the intensive/critical care unit, clients mayalso experience ASD.In-hospital recuperationClinical experience has shown traumatic scar clients usually spend a largeamount of time recuperating in the hospital. Their hospital stay usually involvesincreased pain with exercise, and signs of anger and rage toward theircircumstances. It is typical to go through grief, depressive episodes and rapidemotional shifting.
Rehabilitation and reintegrationThis phase occurs after a hospital stay and, in some cases, may take years.During this phase there are adjustment difficulties, PTSD manifestations,additional anxiety and depression.Unless the MT works in a hospital setting, most therapists will see the traumaticscar patient in the rehab and reintegration phase.PTSDPTSD is associated with a wide range of psychiatric comorbidity, poor quality oflife, and social dysfunction.PTSD is characterized by three predominant categories of symptoms.• Re-experiencing symptoms including: flashbacks, frightening thoughts anddisturbing dreams• Avoidance symptoms including: staying away from places, events, or objectsthat are reminders of the experience, feeling emotionally numb, experiencingstrong guilt, depression, or worry, losing interest in activities that wereenjoyable in the past, difficulty remembering the dangerous event• Hyperarousal symptoms including: being easily startled, feeling tense or ‘onedge’, sleep disturbance, and/or having angry outbursts.A diagnosis of PTSD is considered when chronic alterations in the physiologicalstress response and classic PTSD symptoms persist beyond a month after thetraumatic event. PTSD symptoms can persist indefinitely.According to van der Kolk (2014), what distinguishes people who developPTSD from people who are temporarily overwhelmed by trauma is that peoplewho develop PTSD keep reliving it in thoughts, feelings or images. It is theconstant, intrusive reliving – not the actual trauma – that causes PTSD.In those with PTSD, sustained SNS hyperarousal can affect the ongoingevaluation of sensory stimuli. Although memory is ordinarily an active andconstructive process, in PTSD failure of declarative memory may lead toorganization of the trauma on a somatosensory level (as visual images or
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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
Page 554 and 555: Clinical ConsiderationScar complica
Page 556 and 557: BreastCancer.org (2015c) Side Effec
Page 558 and 559: 323-9.Kania A (2012) Scars. In: Dry
Page 560 and 561: Slemp AE, Kirschner RE (2006) Keloi
Page 562 and 563: scar tissue, while being mindful of
Page 564 and 565: Physiological ResponseAs discussed
Page 566 and 567: • The realization that one is abo
Page 568 and 569: Stress Response and Stress Hormones
Page 570 and 571: dissociation and inner shakiness) (
Page 572: Figure 7.1(A) Summary of the HPA me
Page 575 and 576: Chronic Stress ResponseChronic stre
Page 577 and 578: Pathophysiological ConsiderationChr
Page 579 and 580: Clinical ConsiderationProlonged str
Page 581 and 582: Psychological Stress and Wound Heal
Page 583 and 584: Pathophysiological ConsiderationNor
Page 585 and 586: Pathophysiological ConsiderationStr
Page 587 and 588: Clinical ConsiderationAccording to
Page 589 and 590: Clinical ConsiderationEvidence sugg
Page 593 and 594: Clinical ConsiderationThe effects o
Page 595 and 596: Stress DisordersFollowing a traumat
Page 597 and 598: Clinical ConsiderationThe Task Forc
Page 599 and 600: Clinical ConsiderationCertainly it
Page 601 and 602: ASD symptoms include (DSM-V 2013):
Page 603: Box 7.1Why do medical events potent
Page 607 and 608: Pathophysiological ConsiderationAcc
Page 611 and 612: DissociationDissociation is describ
Page 615 and 616: not only does the brain carry memor
Page 619 and 620: Somatoemotional ResponseDuring trea
Page 621 and 622: • If the client asks what happene
Page 623 and 624: Clinical ConsiderationWorking with
Page 625 and 626: Given the impact of trauma on the b
Page 629 and 630: The Massage Therapist and TraumaThe
Page 631 and 632: Bordoni B, Zanier E (2014) Skin, fa
Page 633 and 634: Foex (2013) Surgical Tutor UK Avail
Page 635 and 636: Kutner JS, Smith MC, Corbin L et al
Page 637 and 638: Schmidt NB, Richey JA, Zvolensky MJ
Page 639 and 640: CHAPTER 8Communication and the ther
Page 641 and 642: The Therapeutic RelationshipThe the
Page 643 and 644: Needs assessment, treatment plannin
Page 645 and 646: Clinical ConsiderationIt is importa
Page 647 and 648: Therapeutic Closeness and Vulnerabi
Page 649 and 650: BoundariesOver the course of our li
Page 651 and 652: Box 8.1Aside from obvious sexually
Page 653 and 654: 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
Page 757 and 758:
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
Page 785 and 786:
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
Page 812 and 813:
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
Page 853:
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
Page 861 and 862:
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
Page 873 and 874:
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
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Nnecrosisbreast implant-related 119
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Oobservation 180-2occupational inju
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peripheral nervous system 45, 49-50
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Rradiation therapy 193breast cancer
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interviewing 169-71skin 5-11fascia
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TT cells 37technology 2, 242-3tempe
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safety see safetysee also post-trea
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Vvagus nerve 124polyvagal theory 14
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[libribook.com] Traumatic Scar Tissue Management 1st Edition

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