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

Pathophysiological Consideration
To clarify, fibrosis associated with pathophysiological scars is essentially
aberrant collagen architecture in denser presentations of CT and fascia,
whereas Stecco’s defined densification occurs in the loose CT layers that
are found inside and around denser CT and fascia. The loose/sliding layers
are rich in water and other substances, such as adipose cells,
glycosaminoglycans (GAGs) and hyaluronic acid (HA), which can affect
CT and fascia’s biomechanical properties. In healthy tissue, HA, which is
highly hydrophilic, supports frictionless sliding, whereas over-use injury
causes HA chains to fragment, aggregate and entangle, impacting CT and
fascia’s hydrodynamic and normal viscoelastic properties. Densification
(increased viscosity) can impact normal sliding between adjacent tissues
and/or structures, such as between the DF and underlying muscle, and
between the muscle bundles and fibers. Stecco and colleagues suggest that
the entangled chains of HA may be a cause of soft tissue restriction and
myofascial pain (Stecco et al. 2013, Hammer 2013). The authors propose
that over-use type impairments, and subsequent HA changes, are a common
consequent of chronic scars.