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

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stretch, gross 222–3structural proteins of extracellular matrix 5, 7subcutaneous tissue (hypodermis) 8, 9lymphatic system and 33substance P 69, 70, 91–2, 93, 94superficial fascia 16, 17–19superficial layer of lymphatic structures 33surgery 103breast cancer see breast cancerlymphatic system affected by 39stress response 140see also postoperative period; pre-operative period sweat glands 10,112sympathetic nervous system (SNS) 10, 51, 52, 239hyperarousal 140, 146, 147, 150, 177, 194, 224progressive muscle relaxation and 245PTSD and 147stress response and 52, 136, 137, 137–8sympatho-adrenomedullary (SAM) axis 136, 137see also autonomic nervous systemsynapses 48–9systemic factors impairing wound healing 86
TT cells 37technology 2, 242–3temperature regulation 111–12see also cold exposure; cryotherapy; thermoreceptors; thermotherapytemporal dimensions see timetend and befriend 135tendon sliding system 88tensegrity 13tensionclient’s feeling of 190therapeutic technique of 218in J-stroke 223tensional tensegrity 13TGF-β see transforming growth factor betatherapists (clinicians)barriers and facilitators to effective selfcare engagement 241communication with clients see communicationself care 154, 246–50therapeutic relationship with clients 2, 150, 163–7, 168, 169, 240trauma and 154–5see also caregiver; professionalstherapy see treatmentthermoreceptors 56thermoregulation 111–12thermotherapy/heat application 197, 216, 226, 244thickness assessment 184thoracic duct 33–5thorax (chest)lymphatic techniques 212–15shallow breathing 245thymus 32tightness (client’s feeling of) 190
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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
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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
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Keep in mind that the therapist’s
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Continuous evaluation during the se
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Pre-treatment assessment/evaluation
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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
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Clinical ConsiderationBest and co-w
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Pathophysiological considerationCom
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Clinical ConsiderationTiming is eve
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Clinical ConsiderationEvidence sugg
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Clinical ConsiderationSeveral studi
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Clinical ConsiderationPreventive me
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Pathophysiological ConsiderationWit
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TechniquesCommonly employed techniq
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Treatment outcomesThe later stages
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Clinical ConsiderationsNon-threaten
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Clinical ConsiderationsIt has been
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Clinical ConsiderationsMT may be a
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Pathophysiological ConsiderationUnd
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Clinical ConsiderationsIn the early
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Clinical ConsiderationsAs the remod
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Treatment outcomesEssentially, the
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Dosage considerationsThe presence o
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TechniquesAny carpenter will tell y
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Pressure Level 4 - Strong pressure/
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Grade 7 and 8• Firm, deep• Trig
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Neutralize pHFacilitate healing pro
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Manual Lymphatic TechniquesEarly ma
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Table 9.4Treatment guideline summar
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Clinical ConsiderationEdema, excess
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Figure 9.2Half-moon/circles: cleari
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Figure 9.3Pumping: clearing the ext
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RotaryThe rotary technique is commo
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Figure 9.5Rotary (thorax). Half-moo
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One of the most obvious differences
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Clinical ConsiderationVarious forms
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Box 9.10Sensory amnesia and proprio
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Clinical ConsiderationAs all of the
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Compression techniqueCompression te
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Figure 9.8Tension. The lower leg is
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Figure 9.9Approximation-compression
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Figure 9.11(A) Shear: begin by enga
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Clinical ConsiderationIt is common
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Figure 9.12Torsion/rotation. Begin
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Figure 9.13Lifting. Begin by graspi
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Gross stretchGross stretch techniqu
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Figure 9.15‘Cs’. Begin as noted
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Figure 9.17J-stroke. Begin at one e
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Clinical ConsiderationIrritated ner
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Pathophysiological ConsiderationCha
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Clinical ConsiderationAs the mechan
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Clinical ConsiderationIn various st
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Chaudhry H, Schleip R, Ji Z et al (
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principles and methods. Philadelphi
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Pilat A (2003) Myofascial therapies
Page 849 and 850:
Yang G, Im HJ, Wang JHC (2005) Repe
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Medial thigh 4th degree skin grafts
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Figure B.2 Post-treatmentSurgical s
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Figure C.2 Post-treatment2 December
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and to be consistent with any selfc
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ability to resume social responsibi
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Clinical ConsiderationTrauma can be
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MaintenanceSelfcare maintenance is
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ManagementSelfcare management is de
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Client and Therapist PartnershipTo
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Box 10.1Factors affecting, effectiv
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Strategies to Facilitate Engagement
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Clinical ConsiderationThe authors u
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instances. Make your clients aware
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Relaxation MeasuresVarious relaxati
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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: interviewing 169-71skin 5-11fascia
Page 945 and 946: safety see safetysee also post-trea
Page 947 and 948: Vvagus nerve 124polyvagal theory 14
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[libribook.com] Traumatic Scar Tissue Management 1st Edition

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