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

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Clinical ConsiderationA recent study found that a 60-minute ‘dose’ of Swedish MT deliveredonce a week for pain due to osteoarthritis of the knee was both optimal andpractical, establishing a standard for use in future research (Perlman et al.2012). Sherman and colleagues (2014) showed that multiple 60-minutemassage treatments per week (x 2–3) were more effective than fewer orshorter sessions for people with chronic neck pain, suggesting that severalhour-long massage treatments per week may be the best ‘dose’ for peoplewith this condition (Sherman et al. 2014).Treatment Planning: Goal Setting and Intended OutcomesBy implementing the appropriate technique at the correct intensity and time, MTcan facilitate inflammation, repair and remodeling.Excessive inflammatory response, undue mechanical tension and delayedhealing time are primary factors in pathophysiological scar formation. In brief,early scar management can help facilitate the healing process and guide the newtissue in its ability to attain normal collagen architecture, culminating in a scarcapable of transmitting normal mechanical signals and force transmission. Whenaddressing chronic presentations, mobilizing techniques can be utilized toaddress any adhesion and fibrosis driven impairments/dysfunctions with theultimate outcome being restoration of function and ability to engage in allactivities of daily living with minimal or no pain, discomfort or limitations(Fourie 2012, Rodríguez & del Río 2013).First and foremost, the client’s expressed goals are of utmost importanceand will drive treatment planning. If the client’s stated goal is complex, breakthis down into a series of smaller or more attainable goals.In consideration of the client’s expressed goals, and the process that is unfoldingduring each stage of healing, the therapist will draw on his/her professionalexpertise to identify specific intended outcomes for each session and for thelong-term.

Developing a sound treatment strategy includes selecting and administering theappropriate interventions, namely MT techniques, that will achieve the client’sexpressed goals and therapist’s intended outcomes – technique effects andapplication considerations are covered in more detail later in this chapter. Hotand cold therapy will not be covered in any great detail in this book with theexception of some client self- and/or home care recommendations which areprovided in Chapter 10.Ongoing documentation and periodic reassessment will be necessary. If resultsare not forth-coming in a reasonable amount of time, it may be necessary to reevaluateyour assessment and/or treatment approach. If this proves unsuccessful,another modality or practitioner may be the answer. It is imperative to make theclient’s well-being the number one priority.Early stages of Wound Healing: Inflammation and ProliferationAlthough treatment during the early stages of healing may prevent or reducepathophysiological scarring, care and caution is advised. Although motion,including manual mobilization of tissue, plays an important role in collagenregeneration, excessive stretch of newly forming tissue/repeat wound trauma caninterfere with healing.Generally, manual manipulation is not indicated in the first 48–72 hours posttrauma,allowing fractured tissue fibers time to reunite and achieve sufficientstrength needed to avoid subsequent separation (Kaariainen et al. 2001). Goodwound closure is an important component in achieving physiological scars. Onceepithelium has covered the wound, MFBs normally disappear by apoptosis andthe granulation tissue eventually evolves into a scar containing few cells. Underpathological conditions, including poor wound closure and conditions that leadto fibrosis; however, the MFBs do not undergo apoptosis but instead proliferateand overproduce extracellular matrix (ECM) (Desmouliere et al. 1993, Ng et al.2005).Early treatment is generally directed at tissue peripheral to the scar or other areasof the body. Direct manipulation of scar tissue typically begins no sooner than 2weeks post-trauma and during the first few weeks, tread lightly. It is important toavoid aggressive manipulation so as not to disrupt the healing tissue and prolongor instigate inflammation, which can result in exacerbating fibrosis and adhesionformation (Fourie 2012).

Clinical Consideration

A recent study found that a 60-minute ‘dose’ of Swedish MT delivered

once a week for pain due to osteoarthritis of the knee was both optimal and

practical, establishing a standard for use in future research (Perlman et al.

2012). Sherman and colleagues (2014) showed that multiple 60-minute

massage treatments per week (x 2–3) were more effective than fewer or

shorter sessions for people with chronic neck pain, suggesting that several

hour-long massage treatments per week may be the best ‘dose’ for people

with this condition (Sherman et al. 2014).

Treatment Planning: Goal Setting and Intended Outcomes

By implementing the appropriate technique at the correct intensity and time, MT

can facilitate inflammation, repair and remodeling.

Excessive inflammatory response, undue mechanical tension and delayed

healing time are primary factors in pathophysiological scar formation. In brief,

early scar management can help facilitate the healing process and guide the new

tissue in its ability to attain normal collagen architecture, culminating in a scar

capable of transmitting normal mechanical signals and force transmission. When

addressing chronic presentations, mobilizing techniques can be utilized to

address any adhesion and fibrosis driven impairments/dysfunctions with the

ultimate outcome being restoration of function and ability to engage in all

activities of daily living with minimal or no pain, discomfort or limitations

(Fourie 2012, Rodríguez & del Río 2013).

First and foremost, the client’s expressed goals are of utmost importance

and will drive treatment planning. If the client’s stated goal is complex, break

this down into a series of smaller or more attainable goals.

In consideration of the client’s expressed goals, and the process that is unfolding

during each stage of healing, the therapist will draw on his/her professional

expertise to identify specific intended outcomes for each session and for the

long-term.

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