Traumatic Scar Tissue Management


The management of scar tissue is a huge and growing problem for massage and other manual therapists. Research has showed that appropriate massage treatment can have significant results both physically and psychologically. This practical manual tells the therapist what to do (and what not to do) in the management of patients with traumatic scars.

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Traumatic Scar Tissue Management, Therapeutic massage principles, practice and protocols by Nancy Keeney SMITH, Cathy RYAN

The management of scar tissue is a huge and growing problem for massage and other manual therapists.  Many are afraid to deal with it but research has showed that appropriate massage treatment can have significant results both physically and psychologically.  Existing books have chapters on the problem but there is no practical manual available on the subject at the present time which tells the therapist what to do (and what not to do). This book fills that gap, explaining the physiologic and pathophysiologic background, and providing practical guidance about how to help patients.


Nancy Keeney Smith is a Licensed Massage Therapist, Certified Manual Lymph Drainage Therapist, and a Florida and NCTMB Provider of Scar Management Workshops. Nancy’s Working with Matured Scar Tissue workshop has been taught internationally to massage school students, LMT’s, PT’s and OT’s. Nancy is a member of the Associate Research Team at the Florida School of Massage in Gainesville, Florida, founder and Director of The Happy Plus Foundation, member of the American Burn Association, the National Lymphedema Association. Her private practice in Gainesville, Florida includes treatment of burn survivors, clients battling cancer, mastectomy scar management, as well as others with traumatic scarring. Nancy consults with physical and occupational therapists on burn massage techniques and on developing a long-term protocol for scar management after care programs.

Catherine Ryan is a Canadian trained Registered Massage Therapist with over 20 years of clinical and Massage Therapy (MT) educator experience. Embracing a firm commitment to life-long learning, her extensive postgraduate roster includes training in various approaches to myofascial therapy and scar management. As a regularly featured writer for Massage Therapy Canada and RMT Matters Canada magazines – she may be best recognized for her fascia enthusiasm and voracious interest in all things massage therapy. Where MT is concerned, Cathy is never at a loss for words and is driven by a passion for the profession – co-authoring a book seemed a logical next step in her professional explorations!


1. Introduction
What if … the Value of Early Intervention
What Defines Traumatic Scarring – How they Differ from Other Scars
Reverence for the Person [emotional and physical being]
Why Isn’t Massage Therapy More Accessible for Those in Need?
The Quest for Scientific Data to Support What is Happening in the Tissue and the Effects of the Work
Reverence for the Heart and Science of the Work
2. Scars: Adversary or Ally?
Basic Skin and Fascia Histology
How the Body Responds to Injury [basic process/physiology, purpose, strength and matrix of healthy scar formation]
Scars are Not Surface Dwellers – The Dermis and Beyond [what is happening beneath the surface]
What Constitutes and Contributes to Healthy and Unhealthy/Problematic Scars
Types of Abnormal Scars [hypertrophic, keloids, contracture and burns]
3. The Lymphatic System
Basic Lymphatic System Anatomy & Physiology
The Lymphatic System’s role in healing and scar formation
How the Lymphatic System Heals
4. The Nervous System
Basic Nervous System Anatomy & Physiology
The Nervous System’s Role in Healing and Scar Formation
Comparisons of Depth of Scar Tissue and Nerve Insult
Types of Pain [acute, chronic and the Effects of amyelinated Nerve Cells and Phantom Pain]
How the Nervous System Heals
5. Burns, Mastectomy and other Traumatic Injuries
A Deeper Look at Hypertrophic and Keloid Scars
How “Tacked-down” Scar Tissue Effects the Body [functional impact on various tissues and organs]
Anecdotal Evidence From a Clinical Perspective
6. Trauma – the Physical and the Emotional
The Effects of Trauma on the Tissues
The Cortisol Dump and Other Brain Mediated Chemical Reactions
Brief Over-view of the Inflammatory Process [acute and chronic]
The Psychological Impact
7. Traumatic Scars and Massage Therapy
What Our Hands Can Effect
Appeasing the Amplified [SNS distress, central/peripheral sensitization]
Diluting the Soup [inflammation]
Un-sticking the Stuck [fibrosis, contracture]
8. In the Treatment Room – On the Table
Connecting the Dots – Putting it all Together
Assessment/Evaluation [how to use pressure scales to help guide the therapist, tissue excursion]
Treatment Protocols
Guidelines for Different Depths of Scar Tissue
Critical Thinking [staying flexible in the approach & making informed decisions]
Safety, Precautions and Contraindications
9. Communication is Key
The Power of Hope the Power of Words [communicating with the client, Foley Poem]
Ethical Considerations [patient-focused care, boundaries]
Interprofessional Communication and Collaboration
10. The Road to Recovery and Restoration
Stories From the Other Side of the Table – The Client’s Perspective
From the Therapists Perspective – Clinical Experiences
11. Beyond the Table
Client Self-Care
Therapist Self-Care
12. Appendices A: Glossary of Terms, B: FAQ’s, C: Research Resources, D: Communication and Psychological Support Resources
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