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

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Postsurgical and other interventionconsiderations• Mastectomy: check with doctor whether massage in the area (anterior andposterior shoulder girdle and arm) is indicated. Sometimes it is not advisableto increase the lymphatic flow in that area.• Pain medication: use caution regarding reduced sensation and greaterpossibility of tissue or nerve damage.• Radiated tissue: take extreme care as tissue is delicate and easily damaged,avoid causing further pain and tissue irritation or damage.• Cancer treatment: the National Cancer Institute urges MTs to take specificprecautions with cancer patients and avoid massaging directly over:• the tumor site• open wounds• bruises• areas with skin breakdown• areas with a blood clot in a vein, and• sensitive areas following radiation therapy.
Psychological considerationsIt is well documented that one of the benefits of receiving MT treatment is thegeneral relaxation effect. For those who experience mental illness (e.g. stressdisorders), finding ways to relax and stay in the present may perhaps offer asubstantial benefit (Fitch 2014). However, as covered in Chapter 7, it isimportant for massage therapists working with traumatic scar clients torecognize certain behaviors that may require a need for concurrent psychologicalcare. Numerous types of mental illness include symptoms of psychosis,delusions or profound mood swings (Fitch 2014).Caution is advised for those diagnosed as borderline, the intermediary ofneurosis and full psychosis, as there have been reports (although very few) aboutdeep work triggering a psychotic episode. In a state of psychosis, the individualmay not be able to understand or appreciate the nature of MT, and therefore MTwill likely not provide significant benefit, or in some cases may make thingsworse. It cannot be emphasized enough that unless your client is receivingproper medical care for his or her condition, MT may exacerbate the symptomsand possibly put both therapist and client at risk.In 2012, an estimated 9.6 million adults in the US experienced a serious mentalillness in the past year, representing 4.1% of all US adults (NIMH 2015). It isimperative that massage therapists recognize potential indictor signs andsymptoms before implementing treamtent. Traumatic scar tissue clients mayexhibit significant mood disturbances, psychosis, hypermania or post-traumaticstress disorder (PTSD). Some clients may experience touch triggered responseswhen receiving bodywork. Medications that are prescribed for some of the abovementioned conditions can alter a client’s ability to perceive reality, dull thesenses or can enhance a clients delusion. When you encounter disturbing or outof the ordinary client behavior, you should refer the client for psychological care.If the client is currently in treatment, with the client’s consent, contact with themental health professional to discuss client-centered considerations andappropriate treatment can be of benefit to the client and lower therapist risk.
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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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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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Slemp AE, Kirschner RE (2006) Keloi
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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 ConsiderationEvidence sugg
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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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DissociationDissociation is describ
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not only does the brain carry memor
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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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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
Page 673 and 674: CHAPTER 9Assessment and treatmentHe
Page 675 and 676: MT. Additionally, sometimes people
Page 677 and 678: Traumatic Scars and Associated Impa
Page 679 and 680: Clinical ConsiderationReduction of
Page 681 and 682: Clinical ConsiderationMT has been f
Page 683 and 684: Clinical ConsiderationMassage can h
Page 685 and 686: Health History and InterviewA stand
Page 687 and 688: surrounding muscle structures that
Page 689 and 690: we are gathering information about
Page 691 and 692: Keep in mind that the therapist’s
Page 693 and 694: Continuous evaluation during the se
Page 695 and 696: Pre-treatment assessment/evaluation
Page 697 and 698: Scar scalesScar scales can be used
Page 699 and 700: response to negative pressure. It h
Page 701 and 702: • Client self-management strategi
Page 703 and 704: BindOnce barrier is reached or surp
Page 705 and 706: Table 9.1Comparative of normal and
Page 707 and 708: 2-3 times a year effectively addres
Page 709 and 710: Myofascial meridian exampleSuperfic
Page 711: Clinical ConsiderationKnee and back
Page 715 and 716: Clinical ConsiderationApplication t
Page 717 and 718: Pathophysiological ConsiderationMec
Page 719 and 720: Clinical ConsiderationStecco and co
Page 721 and 722: Safety FirstMT appears to have few
Page 723: Deep workThe deep techniques noted
Page 727 and 728: Clinical ConsiderationMT dosage and
Page 729 and 730: Developing a sound treatment strate
Page 731 and 732: Treatment outcomesEssentially, earl
Page 733 and 734: Dosage considerationsThe presence o
Page 735 and 736: Clinical ConsiderationNumerous syst
Page 737 and 738: Clinical ConsiderationHeat in the t
Page 739 and 740: Clinical ConsiderationBest and co-w
Page 741 and 742: Pathophysiological considerationCom
Page 743 and 744: Clinical ConsiderationTiming is eve
Page 745 and 746: Clinical ConsiderationEvidence sugg
Page 747 and 748: Clinical ConsiderationSeveral studi
Page 749 and 750: Clinical ConsiderationPreventive me
Page 751 and 752: Pathophysiological ConsiderationWit
Page 753 and 754: TechniquesCommonly employed techniq
Page 755 and 756: Treatment outcomesThe later stages
Page 757 and 758: Clinical ConsiderationsNon-threaten
Page 759 and 760: Clinical ConsiderationsIt has been
Page 761 and 762: Clinical ConsiderationsMT may be a
Page 763 and 764: Pathophysiological ConsiderationUnd
Page 765 and 766: Clinical ConsiderationsIn the early
Page 767 and 768: Clinical ConsiderationsAs the remod
Page 769 and 770: Treatment outcomesEssentially, the
Page 771 and 772: Dosage considerationsThe presence o
Page 773 and 774: 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
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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
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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
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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
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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
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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
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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
Page 933 and 934:
Nnecrosisbreast implant-related 119
Page 935 and 936:
Oobservation 180-2occupational inju
Page 937 and 938:
peripheral nervous system 45, 49-50
Page 939 and 940:
Rradiation therapy 193breast cancer
Page 941 and 942:
interviewing 169-71skin 5-11fascia
Page 943 and 944:
TT cells 37technology 2, 242-3tempe
Page 945 and 946:
safety see safetysee also post-trea
Page 947 and 948:
Vvagus nerve 124polyvagal theory 14
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