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

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Grade 9 and 10• Deep• Client likely to experience extreme uncomfortableness and/or pain• Strong potential for tissue damage and subsequent inflammation• Deep transverse fractioning falls into this range• Consistent with Walton’s pressure level 5.Adapted from Fourie & Robb 2009.Identifying the target tissue/structure (e.g. lymph vessel, fascia, muscle), whatthe issue is (e.g. swelling, neural hypersensitivity, tissue adherence), anddetermining desired outcome (e.g. shift in fluid dynamics or volume, sedation,decreased tone) will guide selection of technique type and application, whichincludes dosage considerations and the area treated (e.g. the scar itself, tissuearound the scar and scar-associated impairments in nearby or distant tissues).(See Table 9.3).Basic techniques common to MTs worldwide will not be covered in this book(e.g. gliding, kneading and compressions with use of a lubricant).As lymph, CT and fascia are key target tissues in scar tissue management, somedetail will be provided for the safe and effective application of these tissue/issuespecific techniques.Influence fluidInfluence the CNS,PNS and integrinsClevemicroadhesionsand pathologicalcrosslinksInfluence HAEdema transport Localblood circulation ECMvolume and concentrationFacilitate neural,physiological andmechanotransductionmediatedeffectsDisengage orrelease stuck fibersand tissueNormalize HA chains IncreaseHAAttenuate edema-mediatedhysteresisDilute inflammatory milieuBalance ANSDampen or acceleratecellular activityReduce neuraldistress and painImprove: slideReduce: neural distress and painImprove: fluid gap betweenfibers/layers, hydration, slide
Neutralize pHFacilitate healing processesShift GS viscosityReduce: neural distress andpainImprove: hydration, fluidgap between fiber/layers,slide potential,viscoelasticity, pliabilityand mobility(including MFBs)Reduce: neuraldistress, pain andundue tissuetension/toneFacilitate fluid shift(see fluid shiftoutcomes)Facilitate immunesystem activitypotential,proprioception,mobility, andmuscle contractilecapabilitiesNormalization ofmovement patternspotential, proprioceptionviscoelasticity, pliability,mobility, and muscle contractilecapabilities Normalization ofmovement patterns
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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
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CHAPTER 9Assessment and treatmentHe
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MT. Additionally, sometimes people
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Traumatic Scars and Associated Impa
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Clinical ConsiderationReduction of
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Clinical ConsiderationMT has been f
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Clinical ConsiderationMassage can h
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Health History and InterviewA stand
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surrounding muscle structures that
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we are gathering information about
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Keep in mind that the therapist’s
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Continuous evaluation during the se
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Pre-treatment assessment/evaluation
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Scar scalesScar scales can be used
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response to negative pressure. It h
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• Client self-management strategi
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BindOnce barrier is reached or surp
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Table 9.1Comparative of normal and
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2-3 times a year effectively addres
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Myofascial meridian exampleSuperfic
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Clinical ConsiderationKnee and back
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Clinical ConsiderationApplication t
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Pathophysiological ConsiderationMec
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Clinical ConsiderationStecco and co
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Safety FirstMT appears to have few
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Deep workThe deep techniques noted
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Psychological considerationsIt is w
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
Page 775 and 776: Pressure Level 4 - Strong pressure/
Page 777: Grade 7 and 8• Firm, deep• Trig
Page 781 and 782: Manual Lymphatic TechniquesEarly ma
Page 783 and 784: Table 9.4Treatment guideline summar
Page 785 and 786: Clinical ConsiderationEdema, excess
Page 788 and 789: Figure 9.2Half-moon/circles: cleari
Page 791 and 792: Figure 9.3Pumping: clearing the ext
Page 793: RotaryThe rotary technique is commo
Page 797: Figure 9.5Rotary (thorax). Half-moo
Page 800 and 801: One of the most obvious differences
Page 802 and 803: Clinical ConsiderationVarious forms
Page 804: Box 9.10Sensory amnesia and proprio
Page 808 and 809: Clinical ConsiderationAs all of the
Page 810 and 811: Compression techniqueCompression te
Page 812 and 813: Figure 9.8Tension. The lower leg is
Page 814: Figure 9.9Approximation-compression
Page 818 and 819: Figure 9.11(A) Shear: begin by enga
Page 820 and 821: Clinical ConsiderationIt is common
Page 823 and 824: Figure 9.12Torsion/rotation. Begin
Page 826 and 827: 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
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Chaudhry H, Schleip R, Ji Z et al (
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principles and methods. Philadelphi
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Pilat A (2003) Myofascial therapies
Page 849 and 850:
Yang G, Im HJ, Wang JHC (2005) Repe
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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
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Clinical ConsiderationTrauma can be
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MaintenanceSelfcare maintenance is
Page 867 and 868:
ManagementSelfcare management is de
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Client and Therapist PartnershipTo
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Box 10.1Factors affecting, effectiv
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Strategies to Facilitate Engagement
Page 875 and 876:
Clinical ConsiderationThe authors u
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instances. Make your clients aware
Page 879 and 880:
Relaxation MeasuresVarious relaxati
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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,
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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
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safety see safetysee also post-trea
Page 947 and 948:
Vvagus nerve 124polyvagal theory 14
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[libribook.com] Traumatic Scar Tissue Management 1st Edition

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