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

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Figure 9.3Pumping: clearing the extremities (right arm). Pumping is mainly used on the extremities and alsoinvolves circle-shaped stretching of the skin and SF. The MT may use their entire palm, f lat on theskin surface and may use one or both hands to achieve the result. The hand is in wrist f lexion withulnar deviation and transitions into radial deviation and wrist extension at the end of the stroke. Allstrokes begin proximal to the terminus and move distal. (A) Directional movements of thehand/wrist; (B–D) arrows indicate the direction of lymph f low.
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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
Page 639 and 640:
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
Page 691 and 692:
Keep in mind that the therapist’s
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Continuous evaluation during the se
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Pre-treatment assessment/evaluation
Page 697 and 698:
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
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Clinical ConsiderationMT dosage and
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Developing a sound treatment strate
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Treatment outcomesEssentially, earl
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Dosage considerationsThe presence o
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Clinical ConsiderationNumerous syst
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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 and 778: Grade 7 and 8• Firm, deep• Trig
Page 779 and 780: Neutralize pHFacilitate healing pro
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 792 and 793: ScoopingScooping technique is used
Page 795: Figure 9.4Scooping: clearing the ex
Page 799 and 800: Figure 9.6Alternating pump and stat
Page 801 and 802: Drag scale• 0: no drag• 1: move
Page 803 and 804: addressed prior to global ones.When
Page 807 and 808: Fig 9.7Traumatic scar formationGene
Page 809 and 810: Tension techniqueTension technique
Page 811 and 812: BendingBending technique combines c
Page 813 and 814: ShearOblique or laterally applied g
Page 816: Figure 9.10(A) Bend. Begin by grasp
Page 819 and 820: OscillationsOscillation techniques,
Page 821: Lifting techniquesThe techniques in
Page 824: Alphabet TechniquesMost massage the
Page 827 and 828: Figure 9.14Skin rolling. Begin by a
Page 829 and 830: Gentle circlesGentle circle techniq
Page 831: Figure 9.16‘Ss’. Begin by grasp
Page 834 and 835: Clinical ConsiderationSome of the b
Page 836 and 837: Clinical ConsiderationIt is importa
Page 838 and 839: Clinical ConsiderationManual therap
Page 840 and 841:
intense verses invasive and distres
Page 842 and 843:
Aarabi S, Bhatt KA, Shi Y et al (20
Page 844 and 845:
Journal of Plastic Surgery 10: 354-
Page 846 and 847:
Lewit K, Olsanska S (2004) Clinical
Page 848 and 849:
massage for chronic neck pain. Anna
Page 850 and 851:
Comparison of before and aftertreat
Page 852 and 853:
Figure B.1 Pre-treatmentOpen carpal
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Figure C.1 Pre-treatmentDe-gloving
Page 858 and 859:
CHAPTER 10Client and therapist self
Page 860 and 861:
Self CareSelf care as an all-encomp
Page 862 and 863:
Clinical ConsiderationClients can f
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Clinical ConsiderationTrauma can be
Page 866 and 867:
MonitoringSelfcare monitoring compr
Page 868 and 869:
Page 870 and 871:
Client EngagementAll healthcare pro
Page 872 and 873:
Others, however, view self care as
Page 874 and 875:
their care.In addition to meeting p
Page 876 and 877:
likelihood of engagement is highly
Page 878 and 879:
Thermal and CryotherapyIt is sugges
Page 880 and 881:
Clinical ConsiderationThe authors s
Page 882 and 883:
tissue fibers (e.g. collagen and el
Page 884 and 885:
Topical onion extractOnion extract
Page 886 and 887:
Therapist Self CareSimply put, prac
Page 888 and 889:
Box 10.2Tips for reducing work rela
Page 890 and 891:
best/healthier answer, to support s
Page 892 and 893:
resentment every time you see the c
Page 894 and 895:
Compassion Fatigue and Indirect Tra
Page 896 and 897:
PreventionWays of coping and curren
Page 898 and 899:
management 6: 63-71.Boyera N, Galey
Page 900 and 901:
management/in-depth/stress-relief/a
Page 902 and 903:
Appendix Massage therapy research r
Page 904 and 905:
Massage Therapy Research Conference
Page 906 and 907:
BooksMenard MB (2009) Making sense
Page 908 and 909:
Research literacy coursesIt is impe
Page 910 and 911:
Aabdominal breathing 245abdominal l
Page 912 and 913:
BB cells 37back and knee relationsh
Page 914 and 915:
CC (alphabet technique) 221calciton
Page 916 and 917:
communication (therapist-client) 15
Page 918 and 919:
in late stages of wound healing 201
Page 920 and 921:
extent of trauma and scar 96-7, 103
Page 922 and 923:
fluidslymphatic transport 32manual
Page 924 and 925:
Hhabits (client) 241hair follicles
Page 926 and 927:
Iimmobilization, prolonged 89-90imm
Page 928 and 929:
Kkeloid scars 87, 91, 94-5, 104-8hy
Page 930 and 931:
inadequacy 40manual work 207-15radi
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motivation (client) 241motor (effer
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autonomic see autonomic nervous sys
Page 936 and 937:
PPacini and paciniform corpuscles,
Page 938 and 939:
professionalscollaboration between
Page 940 and 941:
Ssafety 192-4, 225therapeutic envir
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stretch, gross 222-3structural prot
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time (temporal/chronological dimens
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Uultrasonography 184, 186
Page 948:
Wwater 6-7lymphatic transport 32see
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