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

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Figure 9.8Tension. The lower leg is being anchored by the therapist’s right hand, while the left hand engagesthe tissue by applying compression (begin at pressure grade 1–3 (see Box 9.8) and slowly increaseuntil barrier is felt), then glide slowly, creating drag and tensioning in a proximal direction.
ShearOblique or laterally applied gliding type movement of one tissue or layer inreference to another. Intended outcome is to influence fluid dynamics (e.g. GSand HA changes: shift GS viscosity and increase the lubrication potential of HAin the sliding layers), generate heat and mechanical cleavage/disengagement ofundue cross-links – culminating in improved tissue mobility and slide/glidecapabilities (see Fig. 9.10).Torsion/rotationTorsion/rotation is twisting-type loading; essentially, a combination ofcompression and tension where there is simultaneous compression of somefibers with elongation of others. Multiple intended outcomes associated withcompression and tension as noted above, as illustrated in Figure 9.11.
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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
Page 426 and 427:
Damasio AR, Grabowski TJ, Bechara A
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Magee DJ (2008) Orthopedic physical
Page 430 and 431:
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
Page 493 and 494:
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
Page 503 and 504:
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
Page 522 and 523:
treatment strategies are difficult
Page 524 and 525:
Clinical ConsiderationSkin rolling
Page 526 and 527:
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
Page 534 and 535:
Implants and painPain of fluctuatin
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LymphedemaBreast cancer treatment o
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volume of fluid that accumulates or
Page 540 and 541:
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
Page 556 and 557:
BreastCancer.org (2015c) Side Effec
Page 558 and 559:
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
Page 564 and 565:
Physiological ResponseAs discussed
Page 566 and 567:
• 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
Page 583 and 584:
Pathophysiological ConsiderationNor
Page 585 and 586:
Pathophysiological ConsiderationStr
Page 587 and 588:
Page 589 and 590:
Clinical ConsiderationEvidence sugg
Page 591 and 592:
Page 593 and 594:
Clinical ConsiderationThe effects o
Page 595 and 596:
Stress DisordersFollowing a traumat
Page 597 and 598:
Clinical ConsiderationThe Task Forc
Page 599 and 600:
Clinical ConsiderationCertainly it
Page 601 and 602:
ASD symptoms include (DSM-V 2013):
Page 603 and 604:
Box 7.1Why do medical events potent
Page 605 and 606:
Rehabilitation and reintegrationThi
Page 607 and 608:
Page 609 and 610:
Page 611 and 612:
DissociationDissociation is describ
Page 613 and 614:
Page 615 and 616:
not only does the brain carry memor
Page 617 and 618:
Page 619 and 620:
Somatoemotional ResponseDuring trea
Page 621 and 622:
• If the client asks what happene
Page 623 and 624:
Clinical ConsiderationWorking with
Page 625 and 626:
Given the impact of trauma on the b
Page 627 and 628:
Page 629 and 630:
The Massage Therapist and TraumaThe
Page 631 and 632:
Bordoni B, Zanier E (2014) Skin, fa
Page 633 and 634:
Foex (2013) Surgical Tutor UK Avail
Page 635 and 636:
Kutner JS, Smith MC, Corbin L et al
Page 637 and 638:
Schmidt NB, Richey JA, Zvolensky MJ
Page 639 and 640:
CHAPTER 8Communication and the ther
Page 641 and 642:
The Therapeutic RelationshipThe the
Page 643 and 644:
Needs assessment, treatment plannin
Page 645 and 646:
Clinical ConsiderationIt is importa
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Therapeutic Closeness and Vulnerabi
Page 649 and 650:
BoundariesOver the course of our li
Page 651 and 652:
Box 8.1Aside from obvious sexually
Page 653 and 654:
Box 8.2Eight principles that guide
Page 655 and 656:
Effective Listening and Empathetic
Page 657 and 658:
Clinical ConsiderationNever underst
Page 659 and 660:
Clinical ConsiderationAs manual the
Page 661 and 662:
Interview exampleMary is a client w
Page 663 and 664:
SummarySeveral pieces of informatio
Page 665 and 666:
with traumatic scar tissue clients.
Page 667 and 668:
‘Physicians’ perspective of mas
Page 669 and 670:
Referral exampleTonya, a 21-year-ol
Page 671 and 672:
Referral exampleJane experienced me
Page 673 and 674:
CHAPTER 9Assessment and treatmentHe
Page 675 and 676:
MT. Additionally, sometimes people
Page 677 and 678:
Traumatic Scars and Associated Impa
Page 679 and 680:
Clinical ConsiderationReduction of
Page 681 and 682:
Clinical ConsiderationMT has been f
Page 683 and 684:
Clinical ConsiderationMassage can h
Page 685 and 686:
Health History and InterviewA stand
Page 687 and 688:
surrounding muscle structures that
Page 689 and 690:
we are gathering information about
Page 691 and 692:
Keep in mind that the therapist’s
Page 693 and 694:
Continuous evaluation during the se
Page 695 and 696:
Pre-treatment assessment/evaluation
Page 697 and 698:
Scar scalesScar scales can be used
Page 699 and 700:
response to negative pressure. It h
Page 701 and 702:
• Client self-management strategi
Page 703 and 704:
BindOnce barrier is reached or surp
Page 705 and 706:
Table 9.1Comparative of normal and
Page 707 and 708:
2-3 times a year effectively addres
Page 709 and 710:
Myofascial meridian exampleSuperfic
Page 711:
Clinical ConsiderationKnee and back
Page 715 and 716:
Clinical ConsiderationApplication t
Page 717 and 718:
Pathophysiological ConsiderationMec
Page 719 and 720:
Clinical ConsiderationStecco and co
Page 721 and 722:
Safety FirstMT appears to have few
Page 723 and 724:
Deep workThe deep techniques noted
Page 725 and 726:
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 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 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 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
Page 853: Figure B.2 Post-treatmentSurgical s
Page 857 and 858: Figure C.2 Post-treatment2 December
Page 859 and 860: and to be consistent with any selfc
Page 861 and 862: ability to resume social responsibi
Page 863 and 864:
Clinical ConsiderationTrauma can be
Page 865 and 866:
MaintenanceSelfcare maintenance is
Page 867 and 868:
ManagementSelfcare management is de
Page 869 and 870:
Client and Therapist PartnershipTo
Page 871 and 872:
Box 10.1Factors affecting, effectiv
Page 873 and 874:
Strategies to Facilitate Engagement
Page 875 and 876:
Clinical ConsiderationThe authors u
Page 877 and 878:
instances. Make your clients aware
Page 879 and 880:
Relaxation MeasuresVarious relaxati
Page 881 and 882:
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,
Page 891 and 892:
Box 10.3A reflection on reasons for
Page 893 and 894:
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
Page 945 and 946:
safety see safetysee also post-trea
Page 947 and 948:
Vvagus nerve 124polyvagal theory 14
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