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A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 73 texture, organization, and relationships. As you touch a scar, consider the structural anatomy in the area of injury, including what healthy tissue relationships would feel like from surface to deep. 2 As you explore scar tissue, look for contrasts in tissue density, stiffness, and elasticity between the scar tissue and adjacent tissues. Generally speaking, a scar's texture can feel denser, stiffer, and less elastic than the original tissue. The organization of fibers in a scar might feel more random and chaotic instead of regular and patterned. Scars can change relationships between tissues from being able to easily glide around each other to being firmly stuck. All of this can be felt with a sensitive, exploratory touch, helping you get to know the nature of each unique scar. WHY WE CARE While there are many techniques for working with scars, you'll be better at all of them with increased palpatory awareness. And just like other investigative styles of massage, sometimes the assessment becomes the treatment. The inquiry alone can be a path to better integration and healing. TEACHABLE TISSUE The kind of input a wounded area gets during the remodeling phase can have a significant effect on how the scar tissue is organized as it matures. Whether from the natural movement demands of daily life or from structured hands-on therapy, physical forces apply traction, compression, shearing, pushing, and pulling on the injured tissues. These types of mechanical input help inform how the tissue needs to be reorganized as the new fibers are laid down. This means there can be a big difference between a scar that receives no activity or treatment while it's forming versus one that does. As you might expect, massage interventions have the most potential to make an impact during the remodeling phase. 1 PALPATE LIKE A PRO Working with scars starts with respect for the sometimes life-saving process that creates them. And it serves us well to remember that scars often originate from some kind of trauma. Treating our clients with sensitivity and skillful touch can be healing on many levels. Skillful palpation for scar tissue depends on how well you can perceive the difference between normal tissue architecture and the changes that happen when an injury heals. This goes beyond just knowing anatomy; it requires an understanding of tissue RESOURCES Scott, H., et al. "Is Massage an Effective Intervention in the Management of Post-Operative Scarring? A Scoping Review." Journal of Hand Therapy 35, no. 2 (April 2022): 186–99. https://doi.org/10.1016/j. jht.2022.01.004. Smith, N., and C. Ryan. Traumatic Scar Tissue Management: Massage Therapy Principles, Practice and Protocols. Edinburgh: Handspring Publishing, 2016. Stecco, C., et al. Functional Atlas of the Human Fascial System. Churchill Livingstone Elsevier, 2015. ANATOMY FOR TOUCH Let's Explore Check out the authors' additional resources at abmp.com/anatomy. Notes 1. A 2022 review of literature found that there is extensive anecdotal and some research-based evidence that massage and manipulation have positive outcomes for different types of scars, from improving scar characteristics to reducing pain and increasing range of movement. The study authors concluded that while these studies are a good start, more substantial research is needed (see Scott, H., "Is Massage an Effective Intervention in the Management of Post-Operative Scarring? A Scoping Review" in Resources). 2. For a sample exploration of "surface to deep" tissue relationships, see "The Plantar Foot—From Surface To Deep" Anatomy for Touch column in Massage & Bodywork magazine, May/June 2023, 66 –9. Rachelle Clauson and Nicole Trombley, massage therapists, authors, teachers, and co-directors of AnatomySCAPES, lead you beneath the surface in their highly interactive Dissection Lab Workshops and online continuing education courses for hands-on professionals. They help you discover what real anatomy looks and feels like, and how it moves and relates to its surroundings. Find out more about scars in their fascia-focused online courses on Scar Tissue, C-section Scars, and Peritoneal Adhesions. ABMP members save 20 percent at anatomyscapes.com/ABMP. WATCH: "SCAR TISSUE: THE ANATOMY OF A SCAR" 1. Open your camera 2. Scan the code 3. Tap on notification