The management of scar tissue is a huge and growing problem for massage and other manual therapists. Many are afraid to deal with it but research has showed that appropriate massage treatment can have significant results both physically and psychologically.
Existing books have chapters on the problem but there is no practical manual available on the subject at the present time which tells the therapist what to do (and what not to do). This book fills that gap, explaining the physiologic and pathophysiologic background, and providing practical guidance about how to help patients.
1. Introduction
- What if … the Value of Early Intervention
- What Defines Traumatic Scarring – How they Differ from Other Scars
- Reverence for the Person [emotional and physical being]
- Why Isn’t Massage Therapy More Accessible for Those in Need?
- The Quest for Scientific Data to Support What is Happening in the Tissue and the Effects of the Work
- Reverence for the Heart and Science of the Work
2. Scars: Adversary or Ally?
- Basic Skin and Fascia Histology
- How the Body Responds to Injury [basic process/physiology, purpose, strength and matrix of healthy scar formation]
- Scars are Not Surface Dwellers – The Dermis and Beyond [what is happening beneath the surface]
- What Constitutes and Contributes to Healthy and Unhealthy/Problematic Scars
- Types of Abnormal Scars [hypertrophic, keloids, contracture and burns]
3. The Lymphatic System
- Basic Lymphatic System Anatomy & Physiology
- The Lymphatic System’s role in healing and scar formation
- How the Lymphatic System Heals
4. The Nervous System
- Basic Nervous System Anatomy & Physiology
- The Nervous System’s Role in Healing and Scar Formation
- Comparisons of Depth of Scar Tissue and Nerve Insult
- Types of Pain [acute, chronic and the Effects of amyelinated Nerve Cells and Phantom Pain]
- How the Nervous System Heals
5. Burns, Mastectomy and other Traumatic Injuries
- A Deeper Look at Hypertrophic and Keloid Scars
- How “Tacked-down” Scar Tissue Effects the Body [functional impact on various tissues and organs]
- Anecdotal Evidence From a Clinical Perspective
6. Trauma – the Physical and the Emotional
- The Effects of Trauma on the Tissues
- The Cortisol Dump and Other Brain Mediated Chemical Reactions
- Brief Over-view of the Inflammatory Process [acute and chronic]
- The Psychological Impact
7. Traumatic Scars and Massage Therapy
- What Our Hands Can Effect
- Appeasing the Amplified [SNS distress, central/peripheral sensitization]
- Diluting the Soup [inflammation]
- Un-sticking the Stuck [fibrosis, contracture]
8. In the Treatment Room – On the Table
- Connecting the Dots – Putting it all Together
- Assessment/Evaluation [how to use pressure scales to help guide the therapist, tissue excursion]
- Treatment Protocols
- Guidelines for Different Depths of Scar Tissue
- Critical Thinking [staying flexible in the approach & making informed decisions]
- Safety, Precautions and Contraindications
9. Communication is Key
- The Power of Hope the Power of Words [communicating with the client, Foley Poem]
- Ethical Considerations [patient-focused care, boundaries]
- Interprofessional Communication and Collaboration
10. The Road to Recovery and Restoration
- Stories From the Other Side of the Table – The Client’s Perspective
- From the Therapists Perspective – Clinical Experiences
11. Beyond the Table
- Client Self-Care
- Therapist Self-Care
12. Appendices A: Glossary of Terms, B: FAQ’s, C: Research Resources, D: Communication and Psychological Support Resources
