How’s the Pressure Podcast

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This week I discuss scar tissue with Marjorie Brook. I get to ask some basic questions that I have always wondered about, like can you actually break up scar tissue? But the conversation goes much deeper than that, as we talk about the emotional and psychological considerations that therapists need to have in mind when addressing this type of work. There are extensive notes from this conversation, so instead of putting them here, you can find them at www.howsthepressure.com, under a newly created tab called “resources”. I have placed a PDF of some of Marjorie’s information and answers there

https://www.howsthepressure.com

 

 

Scar Tissue, the most overlooked issue in Healthcare

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What do all of the following have in common?

Cesarean “C” section

Breast reduction

Breast implant

Appendectomy

Laparoscopy

Arthroscopy

 

Well that is easy right?  They are all surgeries. But would it surprise you to know that 6 out of 10 women who walk into my office do not consider C- Sections or breast work surgeries? Yes, you did read that correctly.

There is an alarm gong off in my head.  At first it was a small ding and as the years have gone by it has been getting louder and louder. These days it is going off like an air raid siren.  When a new client comes to see me I have them fill out a medical history intake form. It is very common for people to “forget” about past injuries, illness and yes even a minor surgery.  It has always amazed me, I mean really how does one forget they broke an arm or an ankle?

Here are some of the many conversations/comments that have resulted from the “Please list all surgeries” section on the form:

“Surgery? No, not really… Well…I had a C-section but I do not consider that surgery.” 

“Why is that?”

“Well…it wasn’t planned… it was an emergency.”

 

“No surgery…I just had my breasts done but that doesn’t count.”

 

“I did have my toe chopped off, but they sewed it back on and that was so long ago it doesn’t matter.”

 

“No…No surgeries… just had some work done on my mouth twice.” 

“Do you mean you had Oral surgery?”

“Yes”

 

“Well I did have my uterus taken out. But they did that through my belly button- you can barely even see the scar… so no, no surgery.”

 

During a session I will observe a scar and inquired as to its origin. The client inevitably says “What scar? Where?  Oh right?  …That’s from when I wiped out on my motorcycle…yeah I ruptured my spleen and they had to do surgery”   and this one on your leg? “Oh that?  I was dragged by the bike on asphalt pretty gnarly huh?!”  

 

I have been a Licensed Massage Therapist for over 20 years and in all that time a reoccurring theme seems to have prevailed. The presence of scar tissue can have a lifelong physiological effect on the body — a fact that seems to have eluded traditional healthcare professionals. This realization combined with my clinical experience, education, teaching and research, has led to my developing the STRAIT (Scar Tissue Release and Integrated Therapies) Method to release restricted tissues and restore balance and freedom of movement.

 

During the course of my career I’ve treated many patients whose problems could be traced back to a scar they had forgotten they even had.  Everyone has a scar i.e. the bellybutton. While not every scar presents a problem, often they can.  This is due to the fact that the body is one large, three-dimensional piece of fascia that envelops us like an intricate spider web. Any kink, pull or restriction in one area affects the whole matrix.

 

Scar tissue and adhesions are the result of our body’s natural healing process and it occurs both internally and externally. The process, if working correctly, is supposed to eliminate the scars and adhesions once the wound is healed. In some cases, a person’s body does not remove all of the scar tissue. In other cases adhesions have built to help support the body due to poor posture, repetitive use or injury.  The adhered tissue continues to spread which can trigger a cascading effect of compensations through out the body.

 

The STRAIT Method is a series of fascial techniques that release and realign the restrictive tissue from the starting point (visible scar) to the end point (where the line of frozen fascia stops).  This release system differs from traditional methods because it approaches the multi faceted matrix of fascia three dimensionally.

 

What is Scar Tissue? 

Scars are areas of fibrous tissue that have replaced normal skin, or other tissue, after injury. A scar results from the biologic process of wound repair in the skin and other tissues of the body. Scar tissue is never as functional as the original tissue it has replaced. With the exception of very minor lesions, every wound (both internal and external) results in some degree of scarring.

 

What are Adhesions?

Adhesions are bands of scar tissue that anchor and support the wound. It binds all tissue it comes into contact with together. Adhesions will form whenever there is inflammation in the body. Although adhesions can occur anywhere, the most common locations are within the stomach, pelvis and heart.

 

Importance of Incorporating Scar Tissue Release Therapy into Your Repertoire of Services

Scars and the multitude of issues that can be traced back to them are generally overlooked by health professionals. Simply because the extent of physiological effects scars can have on the body have never really been acknowledged. As massage therapists we know that the slightest restriction in the elaborate matrix of fascia can have major repercussions from one end of the body to the other.

 

  • A simple scar from a childhood accident to major surgery can have a lifelong effect both physically and mentally for your client
  • Scar tissue has the potential to spread in any direction including internally throughout the body
  • Scar Tissue can restrict movement or function anywhere in the body from a joint to an organ

 

Working scar tissue is extraordinarily simple to learn, easy to apply and yields powerful results that can prevent a lifetime of compensation, complications and pain.

 

I do not know what amazes me more, the body’s ability to respond so quickly to the release of adhered tissues or the shock on the patient’s face when their body is freed from its restrictions and pain.  But the one thing I do know is that ignorance is not bliss.  The time has come for the public to be made aware of effects of scar tissue and adhesions.

 

It is my hope that with modern science starting to recognize the importance of fascia and the effects of scar tissue on the body that Scar Tissue Release will be brought to the forefront of therapy. Therapists can make significant and long lasting changes in the health and well being of their clients/patients by incorporating scar work into their treatments. It is my experience that release of scar tissue, followed by proper rehab exercises can play a major supportive and therapeutic role in helping anyone living with the physical, emotional and mental effects of scar tissue and adhesion restrictions.

Scar Tissue 101

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Scars- to some people they are trophies, war wounds to be proud of, reminders of traumas that they wish to forget, and to many, just something they have already forgotten. The truth of the matter is scars, and the restrictions they cause, can affect every system in the body.  Recognizing them can be the key to unlocking mysterious pain and other issues that have been interfering with the body’s ability to function and balance.

Historically scar tissue has been ignored or been viewed as having no consequence by the medical world.  With all of the current ongoing research and information compiling on the importance of fascia the medical world is starting to recognize the significance of scar tissue in the body.  As with most new fields of interest there have been many new versions of therapy popping up, which for the most part is a very good thing.  Unfortunately, the negative side of new frontiers is that many therapies are being administered without proper understanding of the subject matter.

I have been a massage therapist specializing in scar tissue release for over 20 years. In this time I have seen Scar tissue work go from being dismissed by doctors and a general population completely in the dark as to what is really causing their issues, to consideration by the medical profession that it may be a problem to some extent. Still there are many doctors ignoring the affects, while some have taking to using it as an excuse:  “I know I told you it would take 6 months for recovery but you have developed scar tissue.” Trust me on this – I get at least one phone call a week with that one.

The internet is now flooded with inaccurate information about scar tissue and ways to cure it.  Therapies are being applied with total lack of understanding of the physiology of scar tissue. There is little or worse no knowledge behind the events that caused the scars i.e. surgeries, accidents and what the corrective procedures actually did to the body. No attention is paid to the psychological & emotional trauma surrounding the event. Few look for the possible compensations the body may have complied in response to restrictions and what releasing those restrictions without proper rehab would do. Honestly it is terrifying to me.

So I thought we could take a moment to clear up some of the misinformation:

1)     Scar tissue cannot be broken down nor can it be removed. – Anyone who claims to breakdown scar tissue does not understand what scar tissue is.  Scar tissue replaces normal tissue that is damaged.  If you break it down you are essentially saying that you are causing a new wound. The only person who can remove scar tissue is a surgeon who is literally cutting it out – only for new scar tissue to form.

The goal of working with scar tissue is to release the adhered layers, attempting to re-establishing homeostasis, releasing and correcting the compensations from fascial restrictions all the while being acutely aware of possible emotional release.

 

2)     Scar tissue is dead fibrous tissue. This could not be further from the truth.  Scar tissue composition and structure are different than that of the normal tissue it replaces. Because of changes in the relative amounts, type and structure of collagen, it is inferior in function.

  • Scar tissue has less elasticity.
  • Scar tissue is not as strong as normal tissue.
  • Scar tissue does not oxygenate well, creating a low (acidic) PH:
  • Scar tissue is different neurologically.
  • Scar tissue does not contract.
  • Scars are less resistant to ultraviolet radiation.
  • Scar tissue does not contain sweat glands and hair follicles.
  • Scar tissue is prone to injury.

 

3)     Scars are only an esthetic issue.  Most people are only concerned with how the scars alter their appearance and have no idea how their scars and adhesions are affecting their bodies on so many different levels, or that scars are can be a major trigger for PTSD.

 

4)     Anyone can treat a scar.  Acknowledging that scar tissue may at the root of the problem is the first step in any therapy. After that simply massaging the affected area will bring about change.  However, that being said I want to caution therapists.  You need to thoroughly understand the event which caused the scar i.e. surgery, accident etc. and all the goes with it.  This includes emotions, all of the physical ramifications for the body, what type of rehab will be need once the massage is done.

I am not saying that one should never massage a scar I am saying that as with all diseases, disorders and dysfunctions (yes scar tissue is a cause of dysfunction), you need to understand what you are working with before you lay hands on.

 

5)     Physical scars cannot and do not show how much pain or suffering a person has experienced. Every scar has an emotional history surrounding it.

  • Shock
  • Guilt
  • Failure
  • Loss
  • Detachment
  • Trauma
  • Anger & Resentment
  • Low Self Esteem
  • Fear
  • Hopelessness/ Depression
  • Disgust when seeing or touching the scar
  • Sadness about the limits the scar places on everyday life
  • Humor – yes there can be funny stories behind accidents

The emotions surrounding the physical scars can and do have a direct emotional and psychological effect. It can bring about significant self-image issues and lower self-confidence.  Research on the after care of burn survivors or those with severe facial scarring has proven this. In the cases of patients with severe scarring suffering from depression (between 13-23% of cases) or post-traumatic stress disorder (between 13-45% of cases) have been documented.

 

6) Tools: There are many instruments and tools out there that are effective on scars but they are not the end all be all.  Rather they should be considered part of the therapy.

An example would be cupping. When a cup is placed on the scar tissue and its surrounding areas, the vacuum lifts the scar tissues above and below the skin, essentially pulling them apart so that fresh blood and lymph can circulate freely through them. This improved circulation in turn makes movement easier and as a result, healing of the scars is induced.

It is a great tool but again you should not just cup over a scar without full understanding of what you could be opening up (both emotionally and physically) and how altering that scar will affect the person in the long run.

 

7) Scars and adhesions are the same thing.  Not true as you can have adhesions without scars but you cannot have scars without adhesions.  Both need to be recognized and treated.

 

8) All scars need to be released. A very dangerous statement indeed.  What if the only thing holding that knee replacement together is the adhesions formed around it?  Something to consider before pulling out that cup or edge tool.

 

9) All scars are a problem.  Not necessarily, but all scars have a potential to be one and should be considered and examined.

 

10) Scars only affect the tissue. Again not true, but even if it is was, this is still cause to treat them.  Scar tissue can affect every system of the body:

  • integumentary
  • muscular-skeletal
  • nervous
  • circulatory
  • lymphatic
  • respiratory
  • endocrine
  • urinary/excretory
  • reproductive
  • digestive

Understanding how each of these systems can be affected by scar tissue can lead you to unraveling the mysteries of the pain and frustration your client/patient has been suffering, in some cases for years.

 

If your chosen area of therapy is to give relaxation massage then more power to you.  Not every massage need be a medical one and everyone needs to take time to release and relax.  But if you are administering a medically oriented therapy then it is imperative that as a therapist you know who the person is, what they went through and how they came to be on your table before putting your hands on them. Once you are informed of the specific surgery the client/patient has had your next step should be to watch videos of that type of surgery to see the extent of the damage done. You need to consider all of the possible emotional, psychological trauma you are tapping into before working on the scar. Most importantly you need to be prepared for the possible reactions and how to handle them for the protection of your client/patient and yourself.

There are so many wonderful forms of therapy available today to help people on their journey to balance health & wellness.  No one is better than the other, rather we have to find the right one, or combination thereof, that works for each individual.  That being said, there is nothing more important than recognizing the effect scars are having on a person. In order for any therapy to be fully affective you have to clear and release any and all scars that are impeding the body’s function. In other words, scar tissue release is the first step then you may proceed with any and all therapies that resonate with the patient.

How to Choose a Therapist

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You’ve just had the most stressful week of your life to date, or every muscle in your body aches from the workout at the gym, or you just want to relax and escape from reality (or the kids) for an hour. Wouldn’t a massage be an answer to all of the above? Of course it would, but where do you go? How do you choose a Massage Therapist?

With the ever growing popularity of massage, there are a number of salons and spas offering all types of massages and bodywork. There is also an increasing number of individuals advertising de-stressing, relaxing, “healing” treatments. The first thing you need to know is what the difference is between “hands-on” full body massages and energy work. Massage has been around since the beginning of time. Each culture has developed their own style, each with it’s own unique approach, but still based on the same principles and desired outcome. Overall health and balancing of the body and it’s many systems. The most common types of massage can be broken down into two categories: European/Swedish style and Oriental.

The European or Swedish style focuses on the manipulation of the body’s soft tissue including muscles, tendons, ligaments and connective tissues. It generally involves the use of oils or creams applied through gliding and squeezing strokes that affect the musculo-skeletal, circulatory, and lymphatic systems of the body. The therapeutic benefits are release of chronic tension and pain in muscles, improves circulation, increases flexibility in the joints and reduction of mental and physical fatigue. There are many different forms of therapy styles, Thai, Structural Integration, Trigger Point Therapy, Myofascial Release etc.  Please make sure you fully understand what the treatment entails before you get on the table.

There are numerous types of Oriental massages. The most common styles being the Japanese Shiatsu and the Chinese Amma. Both are ancient healing therapies which combine oriental medical principals and the understanding of the energy channels or meridians that run through the body, in order to restore, promote and maintain optimum health through treatment of the physical body. There are no oils involved, however there may be use of lineaments on specific areas. Gentle manipulations and the use of acupressure (not acupuncture, which requires the use of needles and an Oriental Medical Doctor’s Degree) points to restore, balance and facilitate the flow of energy through out the body. The benefits are numerous including relief from stress and tension and muscle ache, however these therapies are excellent for medical aliments such as respiratory infections, TMJ, digestive disorders, arthritis and many more.

Both types of massage are excellent and have many things in common including the fact that they must be given only by a qualified therapist. Some states require licensing others certification. Either one means that the therapist has gone to school and received the proper training to administer the treatment. You should never allow anyone to perform any type of physical manipulation on your body unless they have provided proper qualifications.

This brings me to the definition of energy work. Along with the new appreciation for massage and its benefits there has also been a rising interest in “energy healers”. Reiki and Chi Kung are currently two of the most popular forms of energy work. These types of therapies are wonderful and can be just as therapeutic as a full body massage, but they do not require hands-on manipulation of the body (sometimes hands are placed lightly on specific areas but no manipulations) and most importantly they are not regulated by the state. The practitioner concentrates on balancing the body through it’s energy fields. There are three levels to Reiki, the last resulting in Master ship, however the training for each level is only two days each. Now without regulation you can see how one can be taken in by a person claiming to be a healer. Unfortunately, the greedy ones ruin it for those who are true practitioners. So please make sure that you thoroughly check out the person before you go to them. No honest practitioner would be insulted if you asked for references.

I recommend that for your first massage you should try the European/Swedish style and then if you are comfortable with that and receptive to the idea of energy balancing you should then try the Oriental style. Be sure to try as many different styles as you never know which one will really “speak” to you.

Before you can consider which type of massage you would like you have to choose a therapist. The best way to pick a therapist is through referral. Your friends, family and your doctor can be a great source. As mentioned earlier, massage can be found at local spas, hair salons and chiropractor’s offices. There are therapists who have there own private practices with their own treatment rooms and/or will make out-calls to your home.  Here are a few things to remember when you are choosing a Massage Therapist:

• Make sure that the therapist is qualified and has presented proper certifications.
• You must be comfortable with the therapist. There is no point in getting a massage if you’re going to be on edge the whole time.
• Make sure that the therapist takes a complete medical history before starting the treatment. Certain conditions are considered contraindications for the European massage (i.e. high blood pressure).
• Understand that while you are usually required to disrobe, you may leave your underwear on and you should be properly draped (covered with towel or sheet) at all times. Only the area being worked on should be exposed.
• If you are uncomfortable with certain areas being touched or the therapist’s touch is too hard/soft for you, tell this to the therapist. Communication is essential, you need to work together.
• You may be a little sore after your first massage, however if you are in major pain then the therapist worked you too hard, so make sure to tell her the next time.
• If you did not like the massage or the therapist do not let that stop you from going to someone else. Finding the right therapist is like finding the right doctor. You need to feel secure with and have confidence in him or her.

The relationship between therapist and patient is one of confidentiality and trust. You work together to relieve the tension, aches and pains while balancing the body’s systems to maintain a healthy and happy life. Massage is one of the best ways to combat the daily stresses of our all to hectic lives. It is not asking a lot, even though you may feel like it is, to take time out for yourself. Your health and piece of mind are worth an hour of your time!