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

Developing a sound treatment strategy includes selecting and administering the
appropriate interventions, namely MT techniques, that will achieve the client’s
expressed goals and therapist’s intended outcomes – technique effects and
application considerations are covered in more detail later in this chapter. Hot
and cold therapy will not be covered in any great detail in this book with the
exception of some client self- and/or home care recommendations which are
provided in Chapter 10.
Ongoing documentation and periodic reassessment will be necessary. If results
are not forth-coming in a reasonable amount of time, it may be necessary to reevaluate
your assessment and/or treatment approach. If this proves unsuccessful,
another modality or practitioner may be the answer. It is imperative to make the
client’s well-being the number one priority.
Early stages of Wound Healing: Inflammation and Proliferation
Although treatment during the early stages of healing may prevent or reduce
pathophysiological scarring, care and caution is advised. Although motion,
including manual mobilization of tissue, plays an important role in collagen
regeneration, excessive stretch of newly forming tissue/repeat wound trauma can
interfere with healing.
Generally, manual manipulation is not indicated in the first 48–72 hours posttrauma,
allowing fractured tissue fibers time to reunite and achieve sufficient
strength needed to avoid subsequent separation (Kaariainen et al. 2001). Good
wound closure is an important component in achieving physiological scars. Once
epithelium has covered the wound, MFBs normally disappear by apoptosis and
the granulation tissue eventually evolves into a scar containing few cells. Under
pathological conditions, including poor wound closure and conditions that lead
to fibrosis; however, the MFBs do not undergo apoptosis but instead proliferate
and 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 areas
of the body. Direct manipulation of scar tissue typically begins no sooner than 2
weeks post-trauma and during the first few weeks, tread lightly. It is important to
avoid aggressive manipulation so as not to disrupt the healing tissue and prolong
or instigate inflammation, which can result in exacerbating fibrosis and adhesion
formation (Fourie 2012).