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

Clinical Consideration
Various forms of thermotherapy (i.e. heat in the therapeutic range) can be
utilized during and after treatment to produce a variety of results. In
addition to commonly known circulatory and muscular effects and other
effects noted in this chapter (e.g. the effect of heat on HA), it is suggested
that an increase in local tissue temperature results in a shift in GS viscosity,
which in turn improves tissue mobility and reduces stiffness and painful
contractures associated with rigid collagenous fibers in fascia (Klingler
2012). Thermotherapy in the form of paraffin wax application can help
render scar tissue softer and more pliable, resulting in decreased stiffness,
improved collagen fiber extensibility and mobility (Sandqvist et al. 2004,
Sinclair 2007). Utilizing a local paraffin bath application before working
with scar tissue from a burn injury can yield significant, measurable
increases in local freedom of movement (Sinclair 2007). Heating scar
tissue, thus rendering the tissue more pliable, prior to applying myofascial
techniques can facilitate technique productivity and reduce potential client
discomfort during and post treatment.
When targeting tissue restrictions, techniques are generally applied just before or
at barrier or the point of bind, at varying angles to the restriction. With some
approaches pressure or force is sustained at a constant throughout application in
a specific locale (Fritz 2013). Another approach employs slow drag or
movement of tissue along a particular line or vector at the rate of approximately
2–3 mm or ⅛ of an inch per client breath cycle. This slow-movement approach
is also recommended for self-treatment using a foam roller (Schleip & Baker
2015). Attempting to drag the tissue too quickly increases the incidence of
injury.
The primary treatment focus is restoration of normal tissue barrier end-feel. A
layer approach to treatment is typically applied, working from superficial to
deep. Superficial restrictions are resolved before moving into deeper layers.
When working with long-standing/chronic scars, local concerns are typically