MFR and Scar Tissue MW

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and scar

by Ruth Duncan

The affects of scarring on
the fascial and connective
tissue network can harbour an enormous strain pattern
affecting structure and function as well as eliciting
symptomsand conditions that seem unrelated.
Many people don't realise that even the smallest of scars         same thing happens to the body's soft tissue network
from a cut to invasive surgery, including cosmetic surgery,       when a scar is introduced except that it is multiple layers of
can compound dysfunction, affect fluid flow and cause             tissue both horizontally and vertically. Scar tissue and
repetitive strain patterns due to loading of surrounding          adhesions are very much more solid and less fluid than
tissues. In fact we now know that anything injurious to the       normal tissue so, like the nail, its acts like a fulcrum or
human body will leave a scar which, over time, will grow          resistance to normal fluid movement.
and entwine its self around other structures in a three
dimensional manner creating system wide dysfunction.              Obviously a surgery scar is unavoidable but understanding
                                                                  what any scarring can do to the human body is paramount
Soft tissue and scar tissue dysfunction does not show up          in the care of any client or patient.
on any type of scan and often are disregarded as the
cause of the presenting symptom. However scar tissue              Scars can create dysfunction in the normal joint and
release plays an important role in all therapist practices        muscle range of movement as well as a spider web type of
providing increased flexibility and function for the patient or   restriction throughout the delicate fibres of the connective
client. Whilst we can physically see the scar on the skin,        tissue network which surround, protect and support all the
what we don't see is the layer upon layer of scarring and         other living structures of the body. The connective tissue
chronic adhesions beneath the visible scar, through the           network, also known as the fascial network, is like a 3D
superficial, deep and visceral tissues and through and            web of continuous tissue that conforms to the shape of its
around muscle, bone, vessels and nerves. But it doesn't           container and responds to pressure both internally and
stop there.                                                       externally. In other words, the fascial network supports the
                                                                  physical and emotional requirements that you and your
Imagine you have laid a sheet flat out on a wooden floor or       lifestyle demand of it whilst living in gravity.
table. If you pull this sheet from one of its corners you can
clearly see a strain pattern through the sheet to its other       The soft tissue networks should be fluid providing us with
corners and the sheet moves fluidly when pulled. Now              constant ebb and flow in order for us to maintain balance
imagine you have nailed a huge nail somewhere through             and function. As soon as you add a scar, you lose that ebb
the sheet to the wood below and try to pull the sheet at          and flow and your body has to compensate somewhere.
one of its corners. Due to the nail, the sheet has lost its       Over time the scar begins to stick to its neighbouring 3D
fluidity and can now only pull around its restriction. The        structures increasing the size of the scar in mass. It is this

32 _-August/September       2011
                        mass that affects joint range and
                        muscle function and can also affect
                       the overall health of the organs and
                                                                    '* Case Studies
                                                                    A 73 year old grandmother presented with intermittent
                       vessels and nerves.                          abdominal pain and a burning sensation in the suprapubic
                                                                    region and a feeling of fullness of the bladder that could not be
                      It is not uncommon for abdominal              relieved.
                      surgery scarring to affect the stability of
                     the back and pelvis as well as the scar        She had undergone sterilisation via keyhole surgery in 1970, a
                     pulling the front of the body downwards        hysterectomy by internal surgery in 1981, a right total hip
                                                                    replacement in 2000 and a hysterectomy repair, again by
                     eventually cascading into the neck, jaw
                                                                    internal in 2001. Since the internal hysterectomy repair she
                    and head creating a myriad of
                                                                    had been experiencing her symptoms. She had undergone
                    symptoms we know as labels of
                                                                    tests and attended consultant appointments which did not
                                                                    offer any explanation for her discomfort. Her consultant had
                                                                    referred her to a physiotherapist for internal work which had
                   It is also important to realise that scar
                                                                    provided some relief but this relief had been short lived.
                  tissue can also form from a repetitive
strain pattern and poor posture. The scar tissue will build         This lady contacted our myofascial clinic and underwent both
up to try and protect the area from injury and also support         myofascial treatment and pilates movement and balance
the demand imposed but this tension and scar tissue will            training. Her posture showed a general falling forward of her
eventually exhaust and injury will occur.                           posture with an asymmetrical pelvis and shoulder girdle,
                                                                    lumbar lordosis and head forward posture.
When obtaining a medical evaluation from the patient or
                                                                    She was treated with myofascial techniques across her
client it is important to ask each patient and client that you      abdomen, anterior hips and legs to provide as much stability
treat if they, at any time in their life, have had any type of      as possible to support her body. Techniques were applied to
surgery, broken any bones or injured themselves in any way          her back to de-rotate her spine and to soften her lumbar
even if there is no visible scarring, so as we can work with        lordosis. Her feet were treated to ensure correct arch and
the scars to ensure that we can get the maximum ebb and             contact stability and her thoracic and cervical area were
flow back into the body.                                            treated to maintain fluidity throughout her spine.

                                                                    Her suprapubic region was treated with superficial to deep
Myofascial release is an excellent way of treating all the soft
                                                                    myofascial stretches which began to alleviate her bladder
tissues of the body from the skin to the visceral tissues.
                                                                    fullness. Scar tissue work, deep slow sustained stretches, was
Once a therapist understands the role that the soft tissue,
                                                                    used along the line of her hip replacement scar. When working
in particular the fascial network, plays in the role of function
                                                                    this scar it elicited the burning sensation in her suprapubic
and dysfunction and can also feel the different layers of           area. Myofascial cross hand release were done around the
fascia opposed to muscle they then can apply effective              scar and general hip area as well as internal and external leg
techniques to treat and release system wide restrictions            compressions up and into the hip joint followed by gentle
that are harbouring pain and dysfunction.                           tractioning techniques which she could feel releasing from her
                                 ,   .\                             legs, through her hips into her abdominal area.
MFRUK offers post graduate workshops around the UK for
healthcare professionals providing a wealth of techniques           General hip work was done to release the deep lateral hip
                                                                    rotators as well as the gluteal and piriformis muscles bilaterally.
which can be incorporated into existing practices.
                                                                    MFR cross hand releases were performed over her
                                                                    lumbosacral area which also elicited the burning sensation in
                                                                    her abdomen. Once this area was released the burning

                                                                    This lady continued her myofascial therapy as well as building
                                                                    up her stability with Pilates. Her posture and mobility improved
                                                                    and she now feels that her pain and discomfort has been
                                                                    treated successfully.

                                                                                                   August/September2011 _           33

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