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N e w ! A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 59 Working successfully with problematic scars or adhesions requires expert navigation, not only of the physicality of the scar material but also inclusive of the whole clinical presentation and the whole person. A meta-analysis of massage therapy research suggests that some of the positive responses to treatment are attributable to the positive regard of the therapist toward the client and the development of a professional alliance between the therapist and the client. According to Fitch, "Our clients are often seeking meaningful professional/interpersonal experiences, such as caring, connectedness, and compassion, along with facilitating productive treatment outcomes." 10 The Inclusion Conclusion Over the last several decades, advancements in medical technology have led to improved surgical techniques and emergency care. More people are surviving injuries that would have been fatal even 20 years ago. An increase in survival rate means an increased need for knowledgeable and skilled professionals to assist with prevention and treatment of problematic scars or adhesions. Postsurgical client self-care instructions commonly include a recommendation to self-massage the scar, for the purpose of improving the scar quality and function. However, there is a paucity in clients receiving direction to seek out early treatment administered by an manual therapy professional, constituting an important missed opportunity in patient care. Knowledgeable and skilled manual therapy professionals can assist the medical management team with augmenting the wound-healing process (which in turn can reduce the risk of pathological scars or adhesions), early detection of nascent issues, and evaluating and treating existing issues. The inclusion of manual therapy into an interprofessional approach to client-centered scar tissue management will contribute to achieving better outcomes and mitigating cost and other burdens associated with pathological scarring. "Surgeons and manual therapists share similarities," writes Jean-Claude Guimberteau, MD, and Thomas Hausner, MD. "We are both in direct contact with tissues. Patients would be better served by surgeons and manual therapists working together." 11 Notes 1. David Lesondak, "Fascial Syndromes: Emerging, Treatable Contributors to Musculoskeletal Pain," in Metabolic Therapies in Orthopedics, 2nd ed., eds. Ingrid Kohlstadt and Kenneth Cintron (Boca Raton: CRC Press, 2018), 357–68; H. Chaudhry et al., "Three-Dimensional Mathematical Model for Deformation of Human Fasciae in Manual Therapy," Journal of the American Osteopathic Association 108, no. 8 (August 2008): 379–90, 2. Gil Hedley, "Fascia is All Around Us," accessed May 2020, 3. Jean-Claude Guimberteau, MD, Skin, Scars and Stiffness DVD, en/cicatrices,inflammation,dvd.php. 4. Justin D. Crane et al., "Massage Therapy Attenuates Inflammatory Signaling after Exercise-Induced Muscle Damage," Science Translational Medicine 4, no. 119 (February 2012): 119ra13, scitranslmed.3002882; L. Berrueta et al., "Stretching Impacts Inflammation Resolution in Connective Tissue," Journal of Cellular Physiology 231, no. 7 (2016): 1621–27,; Geoffrey M. Bove et al., "Manual Therapy Prevents Onset of Nociceptor Activity, Sensorimotor Dysfunction, and Neural Fibrosis Induced by a Volitional Repetitive Task," Pain 160, no. 3 (March 2019): 632–44, https:// 5. Sandy Fritz, Mosby's Fundamentals of Therapeutic Massage, 6th ed. (St. Louis: Elsevier, 2016); Nancy Keeney-Smith and Catherine Ryan, Traumatic Scar Tissue Management: Massage Therapy Principles, Practice and Protocols (Handspring 2016); Leon Chaitow, ed., Fascial Dysfunction: Manual Therapy Approaches, 2nd ed. (Pencaitland: Handspring Publishing, 2018). 6. Willem Fourie, "Management of Scars and Adhesions," in Fascial Dysfunction: Manual Therapy Approaches, ed. Leon Chaitow (Pencaitland, UK: Handspring, 2014), chapter 18. 7. Thomas A. Wynn, "Common and Unique Mechanisms Regulate Fibrosis in Various Fibroproliferative Diseases," Journal of Clinical Investigation 117, no. 3 (March 2007): 524–29,; Morten A. Karsdal et al., "Novel Insights into the Function and Dynamics of Extracellular Matrix in Liver Fibrosis," American Journal of Physiology-Gastrointestinal and Liver Physiology 308, no. 10 (May 2015): G807– G830, 8. Fascia Research Congress, 2020, www.fascia 9. Antonio Stecco et al., "Fascial Disorders: Implications for Treatment," PM&R 8, no. 2 (June 2015) 161–68,; Gary Fryer, "Integrating Osteopathic Approaches Based on Biopsychosocial Therapeutic Mechanisms, Part 1: The Mechanisms," International Journal of Osteopathic Medicine 25 (September 2017): 30–41,; Leon Chaitow, ed., Fascial Dysfunction: Manual Therapy Approaches, 2nd ed. 10. Pamela Fitch, Talking Body, Listening Hands: A Guide to Professionalism, Communication and the Therapeutic Relationship, 2nd ed. (Ottawa: Algonquin College Press, 2019). 11. Jean-Claude Guimberteau, MD, and Thomas Hausner, MD, "Surgery and Fasciatherapy" from the 4th International Fascia Research Congress (2015). Catherine Ryan is a CMTBC-registered massage therapist with a strong interest in patient- centered care, evidence informed practices, and lifelong learning. Over her 30-plus year career, Ryan has engaged in the profession in a variety of clinical, educational, and leadership capacities. An established continuing education instructor, Ryan has presented internationally at conferences, in the areas of scar-tissue management and myofascial pain and dysfunction, which also constitute her clinical practice focus. She has written numerous articles featured in various publications, co-authored Traumatic Scar Tissue Management: Massage Therapy Principles, Practice and Protocols (Handspring 2016), and written a chapter contribution in Fascia, Function and Medical Applications (2020) and Oncology Massage: An Integrative Approach to Cancer Care for Manual Therapists (Handspring 2020). Ryan is also the co-host of the podcast Massage Therapy Without Borders.

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