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[libribook.com] Traumatic Scar Tissue Management 1st Edition
Pathophysiological ConsiderationImmobilizationAs noted in Chapter 5, immobilization can lead to the formation ofpathological cross-links and microadhesions between the pre-existing ornon-injured collagen fibers as well as newly forming fibers, which in turncan impact slide/glide potential between the tissue layers. Impaired slidingbetween layers can result in tissue strain and subsequent inflammation.Immobilization also has a negative impact on tissue hydration and fascia’sviscoelastic capabilities (e.g. underhydrated and more viscous GS) and theresultant stiffness can further impact mobility. Immobilization has also beenshown to cause a decrease in correlating gray matter and to negativelyimpact relative neuroplasticity (Granert et al. 2011). As tissues becomemore stuck, the potential for movement diminishes even further,constituting a vicious cycle. Cramer et al. (2010) confirmed that inactivityand immobilization result in the development of adhesions in the facetjoints. Duration of immobility was shown to correlate with the size, andfrequency of the adhesions – longer duration is linked to more extensiveadhesions.
Clinical ConsiderationsIn the early stages of injury pain, pain medications, seriousness of injuries,casting and other interventions may impact the patient’s ability to move.The authors offer that manual mobilization of skin and fascia may providea means to prevent or reduce pathological cross-link formation during thetime when the patient is not able to move in ways that would support theretention of slide/glide between tissue layers. Additionally, fasciahydrodynamically responds to mechanically applied strain in ways that canpositively impact tissue pliability, improve tissue hydration, reduce edemaand stiffness and improve ease of movement. If the patient is able to movewith greater ease and less pain, they are more likely to do so and thereforemore likely to be compliant with rehabilitation programs and exercises tobe done at home.
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Clinical Considerations
In the early stages of injury pain, pain medications, seriousness of injuries,
casting and other interventions may impact the patient’s ability to move.
The authors offer that manual mobilization of skin and fascia may provide
a means to prevent or reduce pathological cross-link formation during the
time when the patient is not able to move in ways that would support the
retention of slide/glide between tissue layers. Additionally, fascia
hydrodynamically responds to mechanically applied strain in ways that can
positively impact tissue pliability, improve tissue hydration, reduce edema
and stiffness and improve ease of movement. If the patient is able to move
with greater ease and less pain, they are more likely to do so and therefore
more likely to be compliant with rehabilitation programs and exercises to
be done at home.
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