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
August/September2011 _ 33