Issue link: https://www.massageandbodyworkdigital.com/i/70551
PATHOLOGY PERSPECTIVES Breast Cancer Surgery. Breast cancer surgeries range from lumpectomies to full mastectomies, and can also involve axillary lymph node dissection, creating scar tissue at an additional site. The postsurgical scarring that accumulates over the pectoral and axillary areas can affect tissues far beyond the chest and shoulder, and it is particularly capable of trapping branches of the brachial plexus to create chronic nerve pain that can be tremendously difficult to treat. Normal range of motion can be severely limited, which affects a patient's ability to return to work or normal daily activities. (An additional problem, although not yet well documented, is the possibility of postsurgical scarring that changes posture and locomotion to the extent that falls may become more likely; for breast cancer patients, who are often mature women also at risk for osteoporosis, this is a significant danger.) The use of soft-tissue manipulation to help treat postsurgical scarring for mastectomy demonstrates that this intervention can restore a functioning range of motion and significantly decrease pain. Similar findings were documented for women who had undergone lymph node dissection, as those treated with advice, exercise, and soft-tissue manipulation found that pain and shoulder mobility were restored to better levels than those who were given informative brochures for self-treatment. Abdominal and Pelvic Surgery. Internal adhesions follow abdominal and pelvic surgery close to 100 percent of the time, and this is true whether the surgery is open or laparoscopic. For many patients, this is not a significant problem, but for some, postsurgical adhesions can interfere with peristalsis and cause a dangerous bowel obstruction. Other surgeries can cause adhesions that interfere with the ovaries, uterine tubes, and other structures, leading to infertility and chronic pelvic pain. Many people who undergo surgery require a repeat procedure to destroy adhesions (adhesiolysis), which, naturally, puts them at risk for more adhesions. Much research has gone into creating tools or protocols to reduce the rate of postsurgical adhesions. Mesh, sprays, and other strategies have been employed, with mostly disappointing results. Until recently, massage for this problem was not considered a viable option. Then, a team induced abdominal adhesions in rats and had a massage therapist who was experienced with visceral massage work on the healing rodents to mobilize the abdominal contents of some of the rats. A clinician who was not informed as to which rats received massage evaluated the animals postmortem. Not surprisingly, the massaged animals had a much lower rate of adhesions than the control group. This finding challenges a few things about how massage is taught and utilized. For one thing, it requires that massage therapists work with the abdomen—an area of the body that many prefer to skip. It requires that they develop palpation skills to become sensitive to sites of adherence. And for best results, it requires that massage therapists begin this work long before the four to six week delay that is often suggested for working with patients after surgery. That is a guideline developed out of conservatism and passed down out of respect for tradition, but as long as the skin can withstand gentle movement, stitches aren't disrupted, and the risk of infection is avoided, then abdominal manipulation can be safe and effective within pain tolerance very soon after surgery. In some ways, this is simply another application of the "use it as soon as possible" strategy that we've seen with musculoskeletal injuries. WORK IN PROGRESS Scar tissue as a pathology topic is a tricky issue for several reasons. Scar tissue isn't tied to any specific disease or condition; its development can be not only desirable, but lifesaving; and the line between enough scar tissue and too much can be razor thin. But it seems clear that humans' propensity to form scar tissue sometimes outperforms its usefulness, and the result can range from annoying to debilitating to downright life-threatening. If massage can safely and effectively intervene when scar tissue becomes problematic, then it is a benefit we should explore. I encourage readers to do that with a certain level of caution and a lot of education—and I encourage them to report back to us the results of their work. Ruth Werner is a writer and educator approved by the NCBTMB as a provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2012), now in its fifth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com. Celebrate ABMP's 25th anniversary and you may win a refund on your membership. ABMP.com. 45