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Be Prepared: Managing Scar Tissue

Disney’s The Lion King is one of my favorite stories. The tale of a boy confronting his devious uncle in an attempt to avenge his father’s death, a theme borrowed from William Shakespeare’s Hamlet, evokes the pain in each of us that grows when wounds don’t heal. Yes its about the anguish of a son who has lost his father, and the ache of a community after their noble leader has fallen. But also it is the story of a man who stands in the shadow of his brother and the hardness that develops when that darkness suffocates him. In my opinion, the uncle in the story is one of the most intriguing characters to have been written. Not only because he is deliciously complicated and dark. But also because his name is Scar.

It is the perfect name, really. Scar is the embodiment of what it feels like to harden and stiffen in the aftermath of insult and injury. He is angry, unbending, acidic and demanding of attention. This is exactly how a scar acts in our own anatomy. No matter the injury, the basic process of wound healing applies: a painful incident, a protective reaction, and then the downward spiral of gripping tension and stifling restriction. Granted, if a wound is handled with proper care in the immediate aftermath, a lot of that anger can be avoided. But, as we know, this isn’t always how things play out. 

Whether or not an injury has healed well is complicated. There are a lot of opinions about what to do and a lot of variables dictating what actually gets done. And ultimately, what a wounded human does to self care and promote healing is entirely out of your hands. So, often times, an injury takes on a life of its own. Kind of like a nail left out in the elements. In one moment it's a nail - strong and smooth and grey. And the next moment it has grown a coat of rust and is ready for an evening of madness and mayhem. The life of the nail, and the life of an injury, faces a plethora of possibilities.

Scar, the character, has a shining moment in the movie in which he rallies his tattered hyena gang. He does this, of course, in a song. Gearing them up for the maliciousness they are about to enact, the point he drives home is to “be prepared”. And this, my fellow caretaker of scar tissue, couldn’t be more on point. Methods for approaching an injury and the havoc it has wreaked on anatomical tissue are many. But being prepared for what lies on your table - in your office - is by far the best starting point. 

What was the injury? How long ago did it occur? How severe was it? How healthy was the human when it happened? How have they managed it since? There are so many questions to ask that help you better decide your approach. But remember this: whether or not your client has clear answers to these queries is one thing. Their tissues, most likely, still don’t know what hit them. An injury, be it a sprain, a strain, a break, or any of the -itis’s, disorients the anatomy it has taken over. And it is your job to re-orient them. 

Asses the site of the injury before getting your client on the table. Use real life movements, like standing, leaning or lifting to get a greater understanding of not only range of motion, but also proprioception. Don’t hesitate to palpate as your client is moving through these actions. Get a stronger sense of what the calf feels like after an achilles strain in combination with a slight squat. Or gather information around what the rotator cuff feels like after a shoulder dislocation while it attempts to lift a water bottle. The forces and loads that shift the way muscles and fascia act are a huge piece of information you have access to. 

With your client on the table, shift your work away from breaking things up to guiding them back together. Isolate a muscle or combined muscle grouping, ask your client to fire said muscle or muscles, and move your work with the action. Use one hand to slide up the peroneals as they evert the foot and use your other hand to encourage the eversion. Or use one hand to slide along the forearm extensors toward the elbow as they extend the wrist and hand, and use your other hand to assist in the extending. Work with the flow. Not against it.

Being prepared for the work you do with clients who have been wounded is expansive. And perhaps this is fodder for another article. But don’t get overwhelmed by it. Remember this: a scar is the body’s way of protecting itself. Left unattended, though, that protection can become destructive. Don’t isolate it even more. Reintroduce it to the body it belongs to. Help it remember that it is a part of something bigger. This, after all, is a powerful tactic in preventing an uprising. 

“So prepare for the coup of the century

Be prepared for the murkiest scam

Meticulous planning

Tenacity spanning

Decades of denial

Is simply why I'll

Be king undisputed

Respected, saluted

And seen for the wonder I am

Yes, my teeth and ambitions are bared

Be prepared.”

- Jeremy Irons as Scar


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