When a client with pain comes to physiotherapy, they are asked about their body history, as accidents and surgeries play an important role in determining the cause of pain. The physiotherapist examines the body's movements, movement patterns, and the mobility of scars and tissues according to the myofascial model, says Marita Karppinen .
In practical physiotherapy work, one sees old and tight or hard and tender scars that have hardly been touched since the incident. Scars can cause movement disorders, and their palpation can reveal reflected pain or symptoms of autonomic nervous system activation, and sometimes also emotional memories of the incident. For example, an old C-section scar can be the cause of pelvic floor or lower limb dysfunction.
The body's densely innervated, three-dimensional fascial network includes superficial and deep fascia, visceral (associated with internal organs) fascia, and neural (associated with nervous structures) fascia. Sensory nerves that enter the skin pass through these fascial layers. It is essential that the different layers of fascia maintain their sliding relative to each other and that the tissues adapt to body movement.
Active scars are dysfunctions of myofascial tissue. Normal tissue adaptation is impaired, and friction, compression, and sensitization of nerves passing through the superficial and deep fascia layers can cause pain. Receptors located in the fascia of the muscle, the myofascial medulla, affect the tension or tension of the fascia, regulating muscle tone or tension, and changes in the fascia, in turn, affect the function of the myofascial medulla. Scarring can cause irritation of these receptors and prevent muscle activation. Fascia also contains various nerve endings, some of which react to affect the function of the autonomic nervous system.
Wounds and bruises from accidents are repaired as the healing process progresses into scars. The collagen in scar tissue rearranges itself according to the load and tension. The active healing process takes about a year.
In the acute phase, it is important to reduce tension on the wound and treat swelling and inflammation. After removing the stitches, when the wound is dry, it is advisable to start greasing the wound area with a good quality oil to keep the wound area moist and flexible. Applying oil will make the wound more tolerant to touch.
During the maturation phase of the wound, a scar forms. Oiling is continued and the scar is gently and calmly slid and stretched in all different directions. This way, the scar, or connective tissue, adjusts to the directions of movement required by the body and the different fascia layers maintain their sliding ability in relation to each other.
Using oil or fat supports skin healing after surgery and prevents scar tearing and itching.
The goal of scar treatment is to improve tissue elasticity and mobility, increase lymphatic flow through the superficial fascia, promote blood circulation and the delivery of nutrients to the injured area, prevent the formation of adhesions, improve proprioception, and relieve pain.
The importance of scar care cannot be overemphasized. Get a quality treatment oil, start self-care for your scar, and seek help from a qualified physiotherapist if necessary. Other scar care methods include wound or silicone tape, kinesiology taping, acupuncture, LPG treatments, suction cupping, and dynamic stretching combined with breathing exercises.
Article author Marita Karppinen
Timjame Oy/ Physiotherapy Marita Karppinen (fascia manipulation Stecco, psychophysical physiotherapy, acupuncture, sexual therapy)
Sources:
Lahtinen-Suopanki Tiina 2018. The role of fascial structures in musculoskeletal function and pain. Physiotherapy 5/2018:28-32.
Luomala Tuulia and Philman Mika 2016. From the perspective of fascia therapy and movement. Published by VK-kustannut Oy.
Stecco Carla 2015. Functional Atlas of the Human Fascial System. Churchill Livingstone.
Myers Thomas W. 2009. Anatomy Trains. VK-Kustannus Oy.
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