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MYOSKELETAL ALIGNMENT TECHNIQUES Disc Nerve one tissue to another, usually across a virtual space such as the peritoneal cavity, the Scar tissue body deposits around nerve Face joint fibrin onto the Spinal cord injured tissues. The fibrin acts like a glue to seal the injury Epidural fibrosis occurs postsurgically as scar tissue binds nerve and builds root to bone. the fledgling adhesion. At the sites where abdominal adhesions Rodríguez's trained hands manipulated occur, scar-tissue tentacles sometimes the adhesive layers, allowing them grab a piece of the small intestine. to once again glide on one another. As internal pressure causes the Through real-time sonoelastography intestine to twist and tangle on imaging, Rodríguez was able to visually itself, peristaltic action is stalled and demonstrate the process of manual scar the putrefaction process begins. remodeling and how it can be effectively Adhesions require treatment used to guide massage and bodywork because the body has no mechanism treatments. Although many clinicians for mobilizing these strands of scar in the audience were well acquainted tissue naturally. Although the body can with the palpatory sensation of sometimes adapt and tolerate a certain restoring local elasticity to injured and amount of adhesive scar tissue, it will sometimes painful tissue, witnessing fail to function optimally, predisposing the process in action was spellbinding. itself to repeated injury. There are many According to a 2013 study conducted by types and styles of manual therapy for Rodríguez and Galán del Río, fascia is the treatment of adhesions. Clearly, the "skeleton of muscle fibers organized the sooner therapy begins, the more as a network and may be responsible effective it will be. Semifresh scars for the pathophysiology and healing respond more quickly to treatment, process of all muscular injuries."2 but hope still exists for old injuries, But injury is not the only cause too, as seen in Rodríguez's brilliant of scar tissue. In clinical practice, we sonoelastography demonstration. commonly palpate fibrous connective The goal is to restore function to tissues associated with plantar inflexible tissues and normalize cellular fasciitis, tennis elbow, and rotator and organ metabolism. Much like the cuff pain. When scar tissue arises stretching and torsional maneuvers near a nerve root, it is referred to used by Rodríguez on the injured as epidural fibrosis (Image 3). This bullfighter, hands-on modalities using is a frequent occurrence in those varying degrees of pressure and depth experiencing failed back surgeries. may also help soften and functionalize tough, fibrous connective tissues ADHESIONS resulting from an abdominal scar. In Adhesions are bands of scar-like tissue Images 4 and 5, fingers and thumbs that form between two surfaces inside search for underlying adhesions and the body and cause them to stick together. When the scar extends from 3 108 massage & bodywork january/february 2014 4 Searching for adhesions, the therapist's fingers and thumb glide under the scar working the tissue in opposing directions. 5 To release entangled nerves and intestines, therapist's curled fingers hook and scoop fibrous adhesions anteriorly. slowly work to free entrapped nerves responsible for referred pelvic pain patterns. To speed recovery, teach your clients how to perform these simple techniques at home. Notes 1. Jonathan A. Sherratt, "Mathematical Modeling of Scar Tissue Formation," Department of Mathematics, Heriot-Watt University (2010). 2. Raúl Martínez Rodríguez and Fernando Galán del Río, "Mechanistic Basis of Manual Therapy in Myofascial Injuries. Sonoelastographic Evolution Control," Journal of Bodywork and Movement Therapies 17, no. 2 (2013): 221–34. Erik Dalton is executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, Dalton has maintained a practice in Oklahoma City, Oklahoma, for more than three decades. For more information, visit www.erikdalton.com.