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Do you feel comfortable working with clients that have matured scar tissue?
The biggest question I receive from therapists that take one of my classes is their "fear" of working with and approaching clients with scar tissue. Some clients are not forthcoming about their scars, others do not wish to discuss their scars and others refuse to allow the therapist to touch their scar.
What is your experience?
Views: 259
Replies to This Discussion
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Permalink Reply by Therese Schwartz on
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Nancy, one of my regular clients since I started doing massage 3 1/2 years ago is a Special Forces Vietnam Veteran. He was 5' away from a grenade when it went off; he is one big collection of mature scar tissue! The only thing I'm very aware of is the shrapnel in his bicep that is sitting over a nerve - that I stay away from, but everything else I work just like it's "normal" tissue. I've done some MFR scar release work on most of it and that's helped quite a bit with adhesions.
I have a woman coming to me right now who specifically wants help with a terrible scar from breast reconstruction. The scar is at the bottom of her latissimus dorsi muscle and the adhesions are fierce. It is affecting so much of her and is so painful that she is willing to deal with the discomfort that happens at times with scar tissue. The MFR work has done some really good things for her.
I understand your students' "fear" about working with scar tissue, and I've never dealt with a client who had real issues with not allowing me to touch an area. But maybe if your students know that MT's are out there dealing with scar tissue on a regular basis it will give them some confidence!
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Permalink Reply by Dr. Ross Turchaninov on
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Dear Nancy
The work on the matured scare tissue suppose to be a must component of massage session of course with the permission of the client. It is MT direct responsibility to maintain elasticity of the scar tissue because no one else do it in the rehabilitative services. At the same time the MT must have enough knowledge to explain the necessity of this treatment for the client as well as have enough expertise to conduct it correctly. Matured scar tissue is constant origin of tension in the soft tissue and these lines of tension which slowly build up the fascia and other tissues during life time catching your clients later in life. This is why the work of MT is so important.
Dr. Ross Turchaninov
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Permalink Reply by Darcy Neibaur on
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I have one client who was burned years ago. She plays tennis on a regular basis. The first time I met her she asked me to work on the scar tissue. I personally have no problem with it.
Also, worked on a client from Desert Storm. Lost a leg at the hip joint. It was very interesting. His wife told me I was the only person he had ever allowed to work that area before. I was honored to serve one of our Veterans.
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Permalink Reply by Nancy Keeney Smith on
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Thank you for your reply, Therese. And thank you for working with these wonderful people. To be clear, is MFR myofascial release? There are so many labels to techniques now I want to make sure I understand your protocol. You are doing some amazing work. At the end of my classes we have a clinic with various types of scar tissue. It is such a gift to watch a therapist gain confidence and use all their new information to put a client at ease while changing their tissue. Thank you so much for sharing.
Therese Schwartz said:Nancy, one of my regular clients since I started doing massage 3 1/2 years ago is a Special Forces Vietnam Veteran. He was 5' away from a grenade when it went off; he is one big collection of mature scar tissue! The only thing I'm very aware of is the shrapnel in his bicep that is sitting over a nerve - that I stay away from, but everything else I work just like it's "normal" tissue. I've done some MFR scar release work on most of it and that's helped quite a bit with adhesions.
I have a woman coming to me right now who specifically wants help with a terrible scar from breast reconstruction. The scar is at the bottom of her latissimus dorsi muscle and the adhesions are fierce. It is affecting so much of her and is so painful that she is willing to deal with the discomfort that happens at times with scar tissue. The MFR work has done some really good things for her.
I understand your students' "fear" about working with scar tissue, and I've never dealt with a client who had real issues with not allowing me to touch an area. But maybe if your students know that MT's are out there dealing with scar tissue on a regular basis it will give them some confidence!
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Wow! Where are you located? I receive requests from survivors all the time when I speak at conferences for referrals. I am so glad to hear you work with survivors. And so glad to hear about your client playing tennis. If it wasn't for the work of my LMT and Acupuncturist, I would not be back on the tennis court either. May I ask where her scar tissue is? Prior to your work did she have issues with ROM or specific aches and pains due to the contractures? We are doing some additional research on contractures and structural changes so anything you can add would be so helpful.
Darcy Neibaur said:
I have one client who was burned years ago. She plays tennis on a regular basis. The first time I met her she asked me to work on the scar tissue. I personally have no problem with it.
Also, worked on a client from Desert Storm. Lost a leg at the hip joint. It was very interesting. His wife told me I was the only person he had ever allowed to work that area before. I was honored to serve one of our Veterans.
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Agreed. Thank you Dr. Turchaninov. That is part of what I teach in my classes is the approach, assessment and developing long term protocol for maximum recovery. Client compliance develops with trust and results from the LMT. Thank you for recognizing the role of the LMT in working with matured scar tissue. Admittedly it has been quite a challenge to get the doctors on board. That is why research is so important. There is not much documented scientific data on the change in tissue with massage but we are working on it.
Dr. Ross Turchaninov said:
Dear Nancy
The work on the matured scare tissue suppose to be a must component of massage session of course with the permission of the client. It is MT direct responsibility to maintain elasticity of the scar tissue because no one else do it in the rehabilitative services. At the same time the MT must have enough knowledge to explain the necessity of this treatment for the client as well as have enough expertise to conduct it correctly. Matured scar tissue is constant origin of tension in the soft tissue and these lines of tension which slowly build up the fascia and other tissues during life time catching your clients later in life. This is why the work of MT is so important.
Dr. Ross Turchaninov
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Permalink Reply by Daniel Cohen on
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Why not work on it? This is what we do, help the body restore itself through touch. If your aren't sure how to deal with it, that is what continuing education is about. Take classes that deal with scar tissue. There are many out there. Continuing education is about enlarging your tool box to help even more.
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Hi Nancy,
I am in Pensacola , FL. Her scar tissue is all of her upper right arm and around onto her back. Her serving and playing arm for tennis I might add.
Nancy Keeney Smith said:Wow! Where are you located? I receive requests from survivors all the time when I speak at conferences for referrals. I am so glad to hear you work with survivors. And so glad to hear about your client playing tennis. If it wasn't for the work of my LMT and Acupuncturist, I would not be back on the tennis court either. May I ask where her scar tissue is? Prior to your work did she have issues with ROM or specific aches and pains due to the contractures? We are doing some additional research on contractures and structural changes so anything you can add would be so helpful.
Darcy Neibaur said:I have one client who was burned years ago. She plays tennis on a regular basis. The first time I met her she asked me to work on the scar tissue. I personally have no problem with it.
Also, worked on a client from Desert Storm. Lost a leg at the hip joint. It was very interesting. His wife told me I was the only person he had ever allowed to work that area before. I was honored to serve one of our Veterans.
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You bet. That is why I developed the classes. When I could not find a therapist that was comfortable enough to work with my injury, I started researching and found no one was teaching anything in depth about scar tissue. So I started teaching and researching. I am happy to say there are some great instructors putting their own twist on the subject. I mainly deal with traumatic scarring- especially burns in adults and children, mastectomy scars and other injuries where the dermis and subcanteneous tissue is compromised.
I am glad to hear you speak with confidence about helping your clients. That's what I am hoping for-that all LMT's will embrace this exciting work.
Daniel Cohen said:Why not work on it? This is what we do, help the body restore itself through touch. If your aren't sure how to deal with it, that is what continuing education is about. Take classes that deal with scar tissue. There are many out there. Continuing education is about enlarging your tool box to help even more.
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I know she loves you. How's her neck and low back? Any contractures on the ribs or asis? How long have you been working with her?
Darcy Neibaur said:
Hi Nancy,
I am in Pensacola , FL. Her scar tissue is all of her upper right arm and around onto her back. Her serving and playing arm for tennis I might add.
Nancy Keeney Smith said:Wow! Where are you located? I receive requests from survivors all the time when I speak at conferences for referrals. I am so glad to hear you work with survivors. And so glad to hear about your client playing tennis. If it wasn't for the work of my LMT and Acupuncturist, I would not be back on the tennis court either. May I ask where her scar tissue is? Prior to your work did she have issues with ROM or specific aches and pains due to the contractures? We are doing some additional research on contractures and structural changes so anything you can add would be so helpful.
Darcy Neibaur said:I have one client who was burned years ago. She plays tennis on a regular basis. The first time I met her she asked me to work on the scar tissue. I personally have no problem with it.
Also, worked on a client from Desert Storm. Lost a leg at the hip joint. It was very interesting. His wife told me I was the only person he had ever allowed to work that area before. I was honored to serve one of our Veterans.
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There is plenty of work for all of us helping others to restore scar tissue to its fluid state. The worst ones I have worked on are from lung removal, mastectomy, and breast reduction. They are all satisfying when you hear the appreciation of moving and breathing better. Thoracic work even without scars can improve breathing and even improve a singer's performance. it is great that you are sharing through classes what you have learned.
Nancy Keeney Smith said:
You bet. That is why I developed the classes. When I could not find a therapist that was comfortable enough to work with my injury, I started researching and found no one was teaching anything in depth about scar tissue. So I started teaching and researching. I am happy to say there are some great instructors putting their own twist on the subject. I mainly deal with traumatic scarring- especially burns in adults and children, mastectomy scars and other injuries where the dermis and subcanteneous tissue is compromised.
I am glad to hear you speak with confidence about helping your clients. That's what I am hoping for-that all LMT's will embrace this exciting work.
Daniel Cohen said:Why not work on it? This is what we do, help the body restore itself through touch. If your aren't sure how to deal with it, that is what continuing education is about. Take classes that deal with scar tissue. There are many out there. Continuing education is about enlarging your tool box to help even more.
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Hi Nancy, thanks for your comments!! And yes, MFR is Myofascial Release. I was just too lazy to type it earlier! The protocol I learned is very simple: run your finger lightly over the scar tissue and ask the client which area feels the most - either tight or tender or painful, just what gets their attention. Then with light pressure on that area gently take it to 12 o'clock, 3, then 6, then 9 and ask which direction they noticed as the biggest issue. (A lot of times the practitioner can of course feel it but it's really good to get client feedback and include them in the process.) Then you just put gentle traction on that tissue with the pad of your index finger and wait for release.
With my breast reconstruction client I also end up working areas that she feels referred pain or pressure while I'm releasing the scar. I just do light traction away from the scar.
Nancy Keeney Smith said:Thank you for your reply, Therese. And thank you for working with these wonderful people. To be clear, is MFR myofascial release? There are so many labels to techniques now I want to make sure I understand your protocol. You are doing some amazing work. At the end of my classes we have a clinic with various types of scar tissue. It is such a gift to watch a therapist gain confidence and use all their new information to put a client at ease while changing their tissue. Thank you so much for sharing.
Therese Schwartz said:Nancy, one of my regular clients since I started doing massage 3 1/2 years ago is a Special Forces Vietnam Veteran. He was 5' away from a grenade when it went off; he is one big collection of mature scar tissue! The only thing I'm very aware of is the shrapnel in his bicep that is sitting over a nerve - that I stay away from, but everything else I work just like it's "normal" tissue. I've done some MFR scar release work on most of it and that's helped quite a bit with adhesions.
I have a woman coming to me right now who specifically wants help with a terrible scar from breast reconstruction. The scar is at the bottom of her latissimus dorsi muscle and the adhesions are fierce. It is affecting so much of her and is so painful that she is willing to deal with the discomfort that happens at times with scar tissue. The MFR work has done some really good things for her.
I understand your students' "fear" about working with scar tissue, and I've never dealt with a client who had real issues with not allowing me to touch an area. But maybe if your students know that MT's are out there dealing with scar tissue on a regular basis it will give them some confidence!
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