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

hongchingyee
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Soft tissue mobility and barriersIn terms of CT and fascia assessment/evaluation and treatment, one fundamentalcomponent is determining and evaluating tissue barrier and bind.Similar to joints, soft tissues also have a specified range of available mobility(Andrade 2013). But unlike joint ROM testing, no instrument exists (goniometer,inclinometer) for soft tissue barrier assessment/evaluation.Barrier is defined as the point where the therapist perceives the first slightresistance to their manually applied tissue challenge (Lewit & Olsanska 2004).Engaging barrier is commonly used as both an assessment/evaluation andtreatment method. Barrier as a treatment method is covered in more detail laterin this chapter.In the context of an assessment/evaluation method, soft tissue barriers can beclassified as either normal or pathological (Table 9.1).Normal soft tissue has three barriers: physiologic (normal, available tissuerange); elastic (barrier reached when all available tissue slack is taken-up); andanatomic (final resistance to normal ROM beyond this barrier will result intissue damage). Pathological barriers occurring in skin, CT, fascia, muscles andother soft tissues are associated with tissue dysfunction, such as adhesions andscars. Pathological barriers change the quality and availability of movement andcan lead to dysfunctional movement patterns (Andrade 2013) – see Table 9.1.

BindOnce barrier is reached or surpassed, tissues shift from a state of relative easewhen challenged by therapist-applied motion/glide to a state of bind. Skin andfascia display increased bulk, firmness and tension when bind is reached (Pilat2003, Fritz 2013).Local and global assessment and evaluation considerationsOne of the most difficult or complex aspects of assessment is putting all thepieces together to create a complete picture of what is happening in order todeliver comprehensive treatment that will result in sustainable outcomes.In terms of scar-associated impairments, the authors have found it useful tobegin by addressing local concerns and eventually map out and address thebigger, global picture.Once a scar is fully matured, manual manipulation may not be effective inchanging the physicality or aesthetics of the scar. However, over-use typeimpairments that occur as a result of restrictions at the scar site are amenable toMT. As noted in the opening of this chapter, one aspect of care that massagetherapists provide is treatment of impairments that occur as a result of traumaticscars. Generally speaking this is the type of care provided for chronic or longstandingscars (see Box 9.4).With each client create an individual ‘body story’ by documenting all yourfindings: visual observation, palpation, objective findings and client subjectiveaccount. Locally assess which components may factor into the client’spresenting impairments and consequent pain and dysfunction.Normal barrierThree normal barriers:• Physiologic (normal,available tissue range)• Elastic (barrier reachedwhen all available tissueslack is taken-up)• Anatomic (final resistanceto normal range, motionbeyond this barrier willresult in tissue damage)Pathological barrierPathological barriers occurring in skin, CT, fascia, muscles and other soft tissues areassociated with tissue dysfunction, such as adhesions and scars. Pathologicalbarriers change the quality and availability of movement and can lead todysfunctional movement patterns

Bind

Once barrier is reached or surpassed, tissues shift from a state of relative ease

when challenged by therapist-applied motion/glide to a state of bind. Skin and

fascia display increased bulk, firmness and tension when bind is reached (Pilat

2003, Fritz 2013).

Local and global assessment and evaluation considerations

One of the most difficult or complex aspects of assessment is putting all the

pieces together to create a complete picture of what is happening in order to

deliver comprehensive treatment that will result in sustainable outcomes.

In terms of scar-associated impairments, the authors have found it useful to

begin by addressing local concerns and eventually map out and address the

bigger, global picture.

Once a scar is fully matured, manual manipulation may not be effective in

changing the physicality or aesthetics of the scar. However, over-use type

impairments that occur as a result of restrictions at the scar site are amenable to

MT. As noted in the opening of this chapter, one aspect of care that massage

therapists provide is treatment of impairments that occur as a result of traumatic

scars. Generally speaking this is the type of care provided for chronic or longstanding

scars (see Box 9.4).

With each client create an individual ‘body story’ by documenting all your

findings: visual observation, palpation, objective findings and client subjective

account. Locally assess which components may factor into the client’s

presenting impairments and consequent pain and dysfunction.

Normal barrier

Three normal barriers:

• Physiologic (normal,

available tissue range)

• Elastic (barrier reached

when all available tissue

slack is taken-up)

• Anatomic (final resistance

to normal range, motion

beyond this barrier will

result in tissue damage)

Pathological barrier

Pathological barriers occurring in skin, CT, fascia, muscles and other soft tissues are

associated with tissue dysfunction, such as adhesions and scars. Pathological

barriers change the quality and availability of movement and can lead to

dysfunctional movement patterns

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