Sunday, November 24, 2013

Scar tissue & pain/exercise

What is scar tissue and how does it hurt you?

"Muscle scar tissue usually forms after an injury. The scar tissue that forms doesn't function as optimally as the old tissue did, and therefore can cause pain. While muscle scar tissue can be painful, it may not always be apparent while you are exercising, unless the scar tissue is being stretched....When connective tissue is injured, the nerve tissue in that surrounding area is injured as well. When nerve tissue is damaged, it reacts by growing smaller, immature nerve branches, which the Doctor Schierling website explains are up to 1,000 times more pain sensitive than normal tissue."

"A build up of scar tissue makes muscles feel tight or achy, possible weak. This build-up or web-like 'muscle plaque' fixes itself in muscles, tendons or ligaments and can cause imbalance and pain. Scar tissue can also:
  • Cause muscles to "catch" between each other
  • Cause weakness
  • Cause repeated injury.
  • Prevent adequate blood flow
  • Restricts and binds nerves
  • Create Biomechanical Imbalance.

  • "Muscles that are in a constant state of tension or contraction will result in  'Tissue Hypoxia'. Not enough blood and oxygen flows within the muscle. A muscle that is tight is a muscle that is having to do work to stay tight, meaning that it is burning energy, and needs oxygen and glucose and other nutrients. But with a decreased blood supply, the muscle begins to starve and chemical damage occurs. This leads to the same process of inflammation, bleeding and scar-tissue adhesion buildup.  Injuring just a few microscopic strands of muscle leads to bleeding. Bleeding signals fibroblasts to come into the area and begin preparing the scar-tissue adhesion.

    "The entire injured area then becomes 'sticky'. Sticky "fibrin glue" seeps throughout the layers of damaged muscle like a web. As the healing process completes itself, the glue leads to a tough scar tissue buildup. The big problem with this process is that the body is NOT very specific about what it 'glues' together. What happens most of the time, is it glues ALL the tissue in the area back together... whether it's damaged or not!  The Vicious Adhesion / Cumulative Injury Cycle: Whether it's a small strain of your forearm muscles or years of tight hip flexors from sitting at a computer, the result often has to do with inflammation and scar tissue build up over time. If not treated early, the cycle continues, and the problem worsens."
    What can be done about it?
    "A scar’s healing progression consists of two phases, immature and mature.
    • Immature – Immediately after a wound heals, the scar is immature. During this period it may be painful, itchy or sensitive as nerve endings within the tissue heal. While it is typically red in appearance, most scars fade to normal flesh color with maturation. Exercise, massage and heat application will have the greatest positive effect on an immature scar.
    • Mature – Depending on the size and depth of the wound, scar tissue will cease production 3 to 18 months following wound healing. When scar tissue is no longer produced, the scar is considered mature. While techniques to reduce scar tissue in a mature scar are effective, a more disciplined and vigorous approach is necessary.

    Six Techniques

    As soon as the wound is knitted, massage therapy can be performed. During the initial immature stages of wound recovery, it is imperative that a gentle approach be taken. The following six techniques are well-known ways bodyworkers can improve scar tissue:
    1. Manual Lymph Drainage optimizes lymphatic circulation and drainage around the injured area. Gentle, circular, draining motions within the scar itself or a firm stretch to the skin above and below the scar, first in a straight line and then in a circular motion, are two drainage techniques. Placing the fingers above the scar, then making gentle circular pumping motions on the scar also helps drain congested lymph fluid. As the massage therapist gently works down the scar, the tissue will feel softer. Drainage techniques should not hurt or make the scar redden.
    2. Myofascial Release helps ease constriction of the affected tissue. To stretch the skin next to the scar, place two or three fingers at the beginning of the scar and stretch the skin above the scar in a parallel direction. Then move the fingers a quarter of an inch further along the scar and repeat the stretch of the adjacent tissue, working your way along the scar. An alternative method is to follow the same pattern of finger movements using a circular motion instead of straight stretches. Work your way along the scar in a clockwise and counterclockwise fashion.
    3. Deep Transverse Friction can prevent adhesion formation and rupture unwanted adhesions. Applied directly to the lesion and transverse to the direction of the fibers, this deep tissue massage technique can yield desirable results in a mature or immature scar. Never progress beyond a client’s comfort level.
    4. Lubrication of the scar helps soften and increase its pliability. Mediums such as lotion, castor oil, vitamin E oil or other oil can prevent the scar from drying out and re-opening.
    5. Stretching aids in increasing range of motion. This is most important when approaching scars that cross over a joint. Scar tissue will lengthen after being stretched, especially if the stretch is sustained for several seconds and is combined with massage.
    6. Heat Application helps the pliability and flexibility of the scar. Common tools used to apply heat are paraffin wax, moist heat packs or ultrasound."

    "Physical Therapy Exercises for Abdominal Adhesions

    Physical Therapy Exercises for Abdominal Adhesions
    An adhesion is another name for scar tissue. Abdominal adhesions most commonly form following abdominal surgery but can also be caused by inflammation related to appendicitis or infection in your organs. This scar tissue can be painful, causing you to experience cramping and even intestinal obstruction. If you experience abdominal adhesions, you can use physical therapy exercises to relieve symptoms and soften scar tissue. Obtain permission from your physician before beginning a stretching program to ensure you can stretch safely.

    Cobra Pose
    The cobra is a yoga pose that is very effective in stretching the abdominal wall. Begin by lying on your stomach, with your hands at your shoulders, palms facing down. Push your hands against the floor to lift your upper body. Your hipbones and pelvis should remain on the ground. Avoid letting your shoulders rise toward your earlobes. Take a few deep breaths as you feel the stretch in front of your abdomen and lower back. Hold for 15 to 30 seconds, and repeat three times.

    Side Twists

    Twisting stretches can stretch your adhesions from a different angle. You can perform this stretch while seated or standing. Hold your arms out to your sides at shoulder height, with your palms down. Maintain your arms at shoulder level as you twist to your right, putting the left hand forward and right arm backward. Take deep breaths as you feel the stretch in your abdomen. Hold this position for 15 seconds, then rest and alternate to your opposite side. Repeat three times for each side.

    Cat/Cow Stretch

    The cat/cow exercise gently massages your abdominal walls to facilitate abdominal stretching. Begin on all fours, with your back straight and pelvis tucked slightly in. Slowly arch your back and round your shoulders to create a C-curve -- like a cat with its back arched -- in the spine. Hold this position for 10 seconds. Release the stretch to lower the back, creating a reversed U shape with your back. Your head should look forward. Hold for 10 seconds, then release the stretch. Repeat the cat/cow position three times through.

    Supta Virasana

    For more advanced exercisers, the supta virasana, or reclining hero pose, stretches the lower pelvic region. Start by kneeling, with your hands at your sides. Slowly lower your buttocks toward the ground while moving your feet outward until you are seated. Lean backward, and place your hands on the ground, walking them back until your entire torso is on the ground. You may wish to place a rolled-up towel or bolster pillow under your back for support. Hold your arms at your sides with your palms facing up as you stretch and breathe deeply. Remain in this position for one to five minutes. Use your arms to push your torso up, and then unfold your legs."