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technique MYOSKELETAL ALIGNMENT TECHNIQUES Scar Remodeling, Adhesions, and Nerve Pain Restoring Function to Inflexible Tissues By Erik Dalton Scar tissue is nature's response to tissue damage (Image 1). This fibrous material of human healing is composed of the same protein (collagen) as the tissue it replaces, but lacks the ultraviolet absorption, circulation, and flexibility of the original tissue. Instead of the random basket-weave design found in normal tissue, scarred collagen forms a mangled alignment of crosslinks that bind themselves in a single direction.1 Nerves live for motion and relish the ability to slide and glide. If a nerve runs through impaired muscle, fascia, or visceral tissue, the entwined nerve can be pinched or pulled by the fibrous scar, causing pain signals to be sent. For example, scars sometimes grow long, tentacle-like strands called adhesions. It's not uncommon for the adhesions from a Cesarean-section scar to entrap nearby hypogastric and pudendal nerves feeding the bladder and urethra (Image 2). This, in turn, may cause referred nerve pain that mimics, and is often treated as, cystitis. Consequently, when a woman's fingers press firmly on a C-section scar, she may experience urethral burning, urgency, or frequency. That's why it's important to remember that pain caused by a scar may be referred far from where the scar is located. Moral of the story: don't chase the pain. In workshops, I find it helpful to use a paintbrush as an example of scar tissue crosslinking. The brush starts out as a soft, supple, parallel group of bristles that can bend easily in many directions. If the brush is cleaned and stored appropriately after use, it stays soft and can be effectively used for a future project. But, if the paint-covered bristles dry, they bind to one another and the brush loses flexibility and function. At this point, more care is required to rehabilitate the brush and get it back to work— which is why I encourage clients to have a scartissue injury assessed promptly, so effective C-section scar treatment can begin. 1 This classical Cesarean incision allows for a larger delivery area, but tends to form more adhesions. Photos courtesy of © erikdalton.com Pain caused by a scar may be referred far from where the scar is located. Moral of the story: don't chase the pain. Hypogastric nerve SCAR REMODELING Scar At the third adhesions International Fascial Research Congress in Bladder Vancouver, Canada, Raul Rodríguez, PT, DO, Urethra Pudendal presented a fascinating nerve clinical video of himself treating a bullfighter Pelvic floor who had suffered a nasty Classical Cesarean section with adhesions impinging on scar when he was gored hypogastric and pudendal nerves. through the thigh. The audience of 800 gasped as they watched layers of fibrous, crosslinked connective tissue give way for the first time, as 2 It pays to be ABMP Certified: www.abmp.com/go/certifiedcentral 107