Issue link: https://www.massageandbodyworkdigital.com/i/1256819
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 . 57 More Than Skin Deep: The Iceberg and Octopus Effects Scars are like icebergs—what you see on the surface is not always an accurate representation of what is happening below. According to Jean-Claude Guimberteau, MD, with irregular or abnormal healing, even though the surface tissue looks normal, below the surface is another story—tissue can be fibrotic (thick/dense) and devoid of loose connective tissue serving a sliding function. When viewed endoscopically or during cadaver dissection, octopus-like tentacles of scarring can be seen reaching out from the region of original injury—exerting far-reaching effects. Carpal Tunnel and Camitz Opponensplasty Patient X is a breast cancer survivor with ongoing lymphatic issues. Surgery was performed on the edematous side. Patient X was initially seen by Nancy Keeney-Smith one week postsurgery (left). Treatment consisted of lymphatic drainage and gentle scar tissue work— one-hour sessions, provided 1–2 times per week for six weeks (right). "Where you think it is . . . it ain't."—Ida P. Rolf Scarring in a seemingly unrelated region can impact function elsewhere. For example, following mastectomy, restricted shoulder range of motion can be related to fibrotic tethering or restriction around the surgical drain site, well below the glenohumeral joint. Surgical drain-site scarring is commonly problematic. Any midstream interruption in the healing process increases the risk of fibrosis. If standard protocols of care (e.g., joint mobilizations and range-of-motion exercises) are not achieving expected outcomes, look beyond the local area of complaint.