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

Box 9.10
Sensory amnesia and proprioceptive disinformation example
KS is a burn survivor. Her injury was over 20 years old when she came to my clinic.
KS’s scar tissue was adhered to multiple layers of muscle, bone and structures of the left lower
extremity, including the deep rotators of the hip that all insert on or very near the greater trochanter
of the femur and ischial tuberosity.
The scar tissue restrictions resulted in dysfunctional and undifferentiated movement patterns
involving the pelvis and hip joint. Assessment showed that her left sacral iliac (SI) joint lacked
mobility and there was abnormal activation of the deep rotators during hip extension.
Each session released another small section of scar tissue that led to changes in the pelvic, thoracic
and lumbar regions.
During one session, we targeted scar tissue that adhered to the biceps femoris, quadratus femoris and
the obturator muscles – near their collective attachments on/around the ischial tuberosity and greater
trochanter.
Upon release of scarred tissue in these areas, KS reported immediate improved hip and pelvis
mobility but also some soreness. And so it was suggested that KS take it easy that evening and the
next day, to allow her body a chance to integrate the work and new found freedom. However, she
decided to go to her tennis practice that night.
At practice, as she was moving backward for an overhead, KS fell. And fell again three times that
evening at practice, each time while moving backward. At the next tennis practice she was a little
hesitant but decided to try the overhead/backward movement again. This time she did not fall.
KS reported her experience at the next treatment session. What happened? The long-standing scar
tissue had changed her movement pattern and these changes impacted her proprioception and
muscle activation sequencing (i.e. timing and velocity of muscle contraction).
It was explained to KS that after the tissues bound by scar tissue are freed, it may take a while for
proprioception to normalize. As various fibers and bundles of fibers have been inactive or
underactive … it is as if they are waking up from a deep sleep. These elements, previously in their
state of suspended animation, can be proprioceptively confused or even in a state of amnesia until
they become re-familiarized with a particular demand and newly available movement pattern.
Basically, the muscles had to relearn their function when called into action.