Myofascial adhesions and scar tissue may be dysfunctional is the sense that they are painful on movement. Scar tissue attaches to neighboring tissue without regard to functional movement. Its job is to “close the gap” and adhere tissues together in healing a wound.
Although this adhesive quality may serve a purpose in the acute healing stages, as time passes and normal movement is desired adhesions may cause pain. The following technique is an effective way of dealing with these painful, motion restricting adhesions. This is not appropriate for young scar tissue in the acute or subacute phases of healing.
1. Identify the point of concern by using restricted motion. Contract using an isometric contraction to isolate the exact location of the pain. Ask the client to point with one finger to the place where the pain is felt as the isometric contraction is performed. The pain may be on an tendon-bone attachment site, a ligament or in the belly of the muscle. Note that if the person can not point to a specific spot but, instead describes an area of discomfort, the pain is more likely to be myofascial in nature and not the result of scar tissue developed from a previous strain or sprain.
2. Apply 30 to 45 seconds of multi-directional friction to the site. Use a finger tip or thumb with light to moderate pressure on the pain producing site. Multi-directional friction will look like an asterisk.
3. Passively lengthen the tissue by taking it through a range of motion without the client offering any resistance or assisting.
4. Eccentrically load the tissue by asking the client to resist lightly while you continue to take the tissue through a range of motion. This action asks the muscle to contract while lengthening. It places a functional stress on the tissue and challenges it to move in a functional way while contracting. Active resistance should only be done in the eccentric direction and at a level of pain-free motion.
5. Repeat number 1 above and identify any additional spots that produce pain and require attention. The combination of these actions may need to be repeated several times and possibly during several sessions to clear out all the specific fibers that are causing the adhesions and creating pain.
This process is very useful for forearm scar tissue resulting from minor tears found in the extensors, as in tennis elbow. Recovery from knee surgery is often troubled with ongoing chronic pain on movement near the end range of the knee flexion. This technique is very helpful for restoring full-pain-free range of motion.
Treating scar tissue adhesions in this manner does not remove scar tissue or change the nature of the tissue. It works to remodel dysfunctional scar tissue into functional scar tissue. Functional scar tissue still holds the wound together and it allows for pain-free movement.
My clients have labeled this technique “The Magic Trick” because of its profound effectiveness. Try it with your clients and let me know how it works for you.
James Waslaski, http://www.orthomassage.net/, taught me this and other useful Orthopedic Massage techniques.
Don Miller, MA, LMT