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[libribook.com] Traumatic Scar Tissue Management 1st Edition
Clinical ConsiderationVarious forms of thermotherapy (i.e. heat in the therapeutic range) can beutilized during and after treatment to produce a variety of results. Inaddition to commonly known circulatory and muscular effects and othereffects noted in this chapter (e.g. the effect of heat on HA), it is suggestedthat an increase in local tissue temperature results in a shift in GS viscosity,which in turn improves tissue mobility and reduces stiffness and painfulcontractures associated with rigid collagenous fibers in fascia (Klingler2012). Thermotherapy in the form of paraffin wax application can helprender 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 workingwith scar tissue from a burn injury can yield significant, measurableincreases in local freedom of movement (Sinclair 2007). Heating scartissue, thus rendering the tissue more pliable, prior to applying myofascialtechniques can facilitate technique productivity and reduce potential clientdiscomfort during and post treatment.When targeting tissue restrictions, techniques are generally applied just before orat barrier or the point of bind, at varying angles to the restriction. With someapproaches pressure or force is sustained at a constant throughout application ina specific locale (Fritz 2013). Another approach employs slow drag ormovement of tissue along a particular line or vector at the rate of approximately2–3 mm or ⅛ of an inch per client breath cycle. This slow-movement approachis also recommended for self-treatment using a foam roller (Schleip & Baker2015). Attempting to drag the tissue too quickly increases the incidence ofinjury.The primary treatment focus is restoration of normal tissue barrier end-feel. Alayer approach to treatment is typically applied, working from superficial todeep. Superficial restrictions are resolved before moving into deeper layers.When working with long-standing/chronic scars, local concerns are typically
addressed prior to global ones.When working to improve tissue slide/glide, by impacting the state of HA in thesliding layer – resulting in increased HA lubrication potential – vertically appliedvibration, tangential/laterally applied oscillation and shearing force applicationappear to achieve the best results (Day et al. 2012, Roman et al. 2013).Skin, CT and Fascial/Myofascial TechniquesDifferent types of mechanical force-loading are used to treat variouspresentations in skin CT and fascia/myofascia and to achieve specific outcomes(Pilat 2003, Chaitow & DeLany 2008, Chaudhry et al. 2008, Fritz 2013, Fourie2014, Chaitow 2014, Pilat 2014). The amount of force or pressure used will varydepending upon presentation and depth of target tissue.Therapeutic Loading TechniquesThese techniques are typically used to address CT and fascia.CT and fascia respond biomechanically to compression and tension.Determining and engaging barrier are key elements in CT, fascial/myofascialloading techniques. When used in a treatment context, barrier is engaged and aconsistent force or pressure is sustained until a release is felt. Release iscommonly felt as a decrease in resistance or softening of tissue that renders thetissue more pliable and mobile. Release allows for the ability to move the tissuebeyond the initial barrier without having to apply more pressure (Andrade 2013).
- 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 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 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
- Page 828 and 829: Gross stretchGross stretch techniqu
- Page 830 and 831: Figure 9.15‘Cs’. Begin as noted
- Page 833 and 834: Figure 9.17J-stroke. Begin at one e
- Page 835 and 836: Clinical ConsiderationIrritated ner
- Page 837 and 838: Pathophysiological ConsiderationCha
- Page 839 and 840: Clinical ConsiderationAs the mechan
- Page 841 and 842: Clinical ConsiderationIn various st
- Page 843 and 844: Chaudhry H, Schleip R, Ji Z et al (
- Page 845 and 846: principles and methods. Philadelphi
- Page 847 and 848: Pilat A (2003) Myofascial therapies
- Page 849 and 850: Yang G, Im HJ, Wang JHC (2005) Repe
- Page 851 and 852: Medial thigh 4th degree skin grafts
addressed prior to global ones.
When working to improve tissue slide/glide, by impacting the state of HA in the
sliding layer – resulting in increased HA lubrication potential – vertically applied
vibration, tangential/laterally applied oscillation and shearing force application
appear to achieve the best results (Day et al. 2012, Roman et al. 2013).
Skin, CT and Fascial/Myofascial Techniques
Different types of mechanical force-loading are used to treat various
presentations in skin CT and fascia/myofascia and to achieve specific outcomes
(Pilat 2003, Chaitow & DeLany 2008, Chaudhry et al. 2008, Fritz 2013, Fourie
2014, Chaitow 2014, Pilat 2014). The amount of force or pressure used will vary
depending upon presentation and depth of target tissue.
Therapeutic Loading Techniques
These techniques are typically used to address CT and fascia.
CT and fascia respond biomechanically to compression and tension.
Determining and engaging barrier are key elements in CT, fascial/myofascial
loading techniques. When used in a treatment context, barrier is engaged and a
consistent force or pressure is sustained until a release is felt. Release is
commonly felt as a decrease in resistance or softening of tissue that renders the
tissue more pliable and mobile. Release allows for the ability to move the tissue
beyond the initial barrier without having to apply more pressure (Andrade 2013).
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