Category Archives: Scars

Everybody has them. Some people love them and others loathe them. There are many different types, from burns to punctures. Unfortunately, most people don’t realize how much they affect our daily lives beyond the stories we’re left with to tell about them. Scars are an important part of the body’s way of healing itself.

Regardless of their size, scars impact us in many ways. Sometimes the effect is felt in a completely different area of the body. They can hinder core stability, motor control, inflict pain, interfere with breathing, and more. Even the tiny scars can have a big impact and prohibit your life in many ways. This is why it’s important to have them assessed and learn about ways to release the tissue.

Tattoos causing neck pain and headaches

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The Origin of Neck Pain can be mysterious

I love a mystery. A new client complained of feeling less stability and strength over the last year. His visits to physiotherapists for a variety of small complaints hadn’t yielded any results. He found me through the www.neurokinetictherapy.com  directory. In his interview, he mentioned a lot of neck tension and frequent headaches.  I asked about tattoos in my interview and he said he had several, including some dark ones.

Tattoos CAN cause motor control dysfunctions

Dark Clavicle Tattoo

It doesn’t happen very often, but tattoos can cause motor control dysfunctions. They are in fact scars – though generally ones that don’t go very deep. Very dark tattoos like this one affect motor control more often than lighter ones or ones that aren’t colored.  This client had gotten these tattoos just previous to when he had started to notice the decrease in stability in strength. I did some testing to check the coordination of the cervical spine muscles and found it lacking. However, stimulation of the tattoos improved their function.

These tattoos were downregulating his cervical extensors, especially the ones of the right. These muscles on the back of the neck are critical for holding the head up and for performing neck movements. Underactive muscles will often get toned up, stiff and painful. In fact, I have found that they are more often painful than overactive muscles. This client was compensating in various ways to make up for their inability to function properly. The toned up muscles there were certainly contributing to his frequent headaches.

Motor Control requires a variety of stimuli

Motor control is created through a feedback loop in which information is fed from the body to the cerebellum and back again. A huge amount of this information comes from the skin. Sometimes the body needs less information from a certain part of the body to work correctly. For example, less tension in an area around a scar sends less information about tension to the cerebellum. You can read more about that in this blog entry about scars and motor control. 

However, often the body needs MORE information, more stimulation, or just different information. For example, a muscle that isn’t contracting properly might need to activate to send more information, stimulating the mechanoreceptors for stretch.  A joint that is improperly positioned might require deep pressure stimulation in a particular direction in surrounding tissues to function optimally. This might be achieved with a deep tissue massage.

There are a lot of different types of mechanoreceptors. Combinations of different stimuli types mean that there is a much larger variety of types of stimulation. For example, shallow vibration and deep vibration combine reception from several different types of receptors.

Mechanoreceptors in Hairy Skin

Stimulation is paired with motor control retraining

This particular area wanted light touch stimulation -sensed by hair follicle receptors or Merkel’s disks. Once the area had been lightly stimulated for a minute or so his cervical extensors started responding in a coordinated way again. The lack of these stimuli was downregulating the cervical extensor muscles. In order to retrain the neck to work properly, those muscles have to be consciously activated soon after the stimuli are fed into the system. Basically, this reminds the motor control center of what this information should be used for.

Homework is often a key part of changing stability issues

Sadly the effect didn’t last very long. This doesn’t mean that the retraining will be ineffective, it just means that it will take more work to make it effective.  In order to retrain this area, he will have to stimulate the area, again and again, several times a day for probably for a few weeks, maybe longer. He will also have to pair the stimulation with the retraining of his cervical extensors. The homework was simple but critical. To retain positive effects on his reflexive stability and increase motor control he will have to stick with it.

If you are having trouble tracking down the origins of your issues, think about booking an Initial Assessment with me to do some in-depth analysis and get a fresh perspective

Road Rash Scars: Scar Rehab for Invisible Scars

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Scars are sometimes invisible.  Look at the picture. Can you see the road rash scar? No, obviously, there’s nothing there. But that’s the point. The scar is there, but there is nothing to see on the surface.

This client had a spectacular fall off his long board in his late teens. It left angry road rash in many places on his body, including the right side of his ribcage. How long does it take a road rash scar to heal? In this case it looked healed just a few months later. His skin looks perfect now and there are no visible marks of this accident a decade later. However, he said he could still feel it. The scar still needs rehab. There’s a pull there, a restriction, and that restriction is contributing to his back pain and his breathing issues.

Road Rash Scars are Burn Scars.

The scars from road rash work in the same way as those caused by burns. They are contracture scars–which means that the skin around the burn area contracts into it, causing mobility problems and pain. Just like burn scars, road rash scars come in degrees. A third degree road rash scar will expose the muscle and sometimes bone beneath scraped away skin and fat. Burn contracture scars, including road rash, can often have a very high impact on motor control because they can damage the nerves more easily than scars created by cuts in the skin. Their impact can be incredibly diffuse. Last year I wrote a blog about Burn Scars where you can read more. Because this scar is on this client’s rib cage it restricts the bucket handle movement of the rib cage as it expands outwards during the inhale. This is causing breathing issues. But the area of the scar was actually much larger than what had originally been visible on his skin a decade ago.

Contracture Scars are diffuse

On this particular client the 3 inch area of the actual road rash was just the epicenter of a contracture. This scar reached all the way to his opposite hip through his abdomen’s mid line. As an assessment specialist I used Neurokinetic Therapy to establish how his motor control was being effected by his scar. I found it had created a micro diastis recti, or separation of the two sides of his rectus abdominus, and was causing a down regulation of his right internal oblique.  This motor control problem was leading to back pain, stiff hips, and a bad slumped posture. He was unable to laterally flex his rib cage more than a millimetre before the treatment.  Within a few days of the first treatment his mobility was remarkably improved and his back pain decreased.

Scar Rehab of Burn Scars is slow

The fascial release I performed on this area took about 40 minutes — I made only 3 passes from the epicenter to the mid line of his abdomen over this 40 minutes, which tells you how slow I had to go. The direction of the release was guided by NeuroKinetic Therapy testing, which showed how the scar was impacting his motor control of his core muscles as well as which direction I should release in to get the most improvement in muscle activation. While the pressure I exerted was very strong and deep, it was also so slow and comfortable that the client fell asleep during the treatment. It was relaxing for him and afterwards his body wanted to sleep. Since sleep is when bodies do most of their repair work I take it as a great sign if my treatments induce sleepiness. 

If you are in the Kitchener Waterloo area and have burn scars or road rash scars that you would like to have assessed for scar rehab, please contact me tmkachroo@gmail.com or book an appointment.

Birth Trauma and Forceps: Forceps scar causing chronic back pain more than 50 years later

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Full histories are important

I started working weekly with a new client in her mid 50s a few weeks ago. My intake sessions are long; we dug pretty deep into her history. She came to me because she saw one of my IG posts of scars. This client has a large scar on her knee, which she thought might be related to her persistent back pain.  As I asked about scars I felt the need to reiterate — “but do you have any OTHER scars?” This is when she pointed out the small scar on her left temple, as if it were unimportant. I hadn’t even gotten to asking about birth trauma yet when she told me this scar was from the use of obstetrical forceps. I knew immediately that it wasn’t something we could ignore. Why?

Face Scars can create dysfunctional movement patterns

Your face has a huge amount of proprioceptive afference. This is a technical way of saying it has a massive amount of sensory reception. It sends a ton of information to your motor control center about position, tension, temperature and A LOT of other things. The Trigeminal nerve innervates the face. This nerve is divided into three portions (named V1, V2, and V3) that correspond to different parts of the face. Disturbances in any of these areas can cause dysfunction in other structures that are mediated by that same nerve.

For example, a facial scar on the forehead might create dysfunction in the supratentorial dura mater membrane (supplied by small meningeal branches of the trigeminal nerve). What is dura mater? It’s the connective tissue that protects the brain. Issues with the dura mater can cause all kinds of problems, from migraines to low back pain. But that’s not the only reason a scar like this one from obstetrical forceps might have a huge impact.

Birth Trauma is a big deal

Trauma to cranial sutures can have a HUGE impact on neuromotor habits. Your brain’s safety is pretty much the highest priority for your unconscious neuro-motor system. If it were the highest priority consciously people wouldn’t play hockey or football. Additionally, trauma to cranial sutures in infancy means that the whole neuro-developmental process adapts to the stress of this malpositioned safety wall that is your skull. A 2004 publication by Gayle Giboney Page states that “significant and long-lasting physiological consequences may follow painful insults in the very young, including changes in the central nervous system and changes in responsiveness of the neuroendocrine and immune systems to stress at maturity.” 1 The cerebellum, where the motor control center lies, is of course, part of the central nervous system. I have seen plenty of very significant dysfunctional motor control issues stemming from birth traumas. I will have more to say on this in future posts.

Foreceps are a pretty brutal tool for birthing

trauma from forceps birth causes back pain later in life

My interest in birth trauma is not purely professional. I had a lot of birth trauma myself, which still affects my cervical movements. It’s a long story and best kept for another post.

When I heard this client mention forceps my ears pricked up. My own complicated birth trauma includes forcep use also. Foreceps are a pretty brutal tool for assisting in birthing. Infants are often bruised and sometimes left with worse injuries. I tested her reflexive stability and the neuromotor responses for her intrinsic core. There was absolutely no question that this small scar (AND the fairly largish lump directly on the other side of her skull where the other side of the forceps would have been) did affect her stability and ability to move. The scar was inhibiting much of her posterior chain.

Assessment is my focus

I spend a lot of time taking histories for a reason. Whereas some therapists might hope to treat as many clients as possible, I focus on depth.
Often my clients come to me after years of conventional treatments that didn’t get them results. They might have seen physiotherapists, chiropractors, trauma therapists, massage therapists, doctors, osteopaths and osteopathic surgeons, each with their own bias. Conventional assessments have not dug deep enough. There’s a mystery. I am keen to document all the evidence possible in order to solve it.

Of course a history on it’s own is not enough. I ask a lot of questions. But it’s also important to gather many other kinds of information. I assess global movement patterns (like a toe touch or overhead reach). Further more, I examine specific ones movement patterns related to the complaint; like the movement of the hyoid on swallowing in the case of jaw pain. Additionally I carry out careful palpation and assessment of the tone of different structures. The energy signatures of different tissues provides invaluable information. I check joint movement both passively and actively. And importantly, I use Neurokinetic Therapy to test my hypotheses. Assessment dominates theses sessions.

Correct corrections often don’t take long

Treatment and assigning homework comprise a much smaller portion of the time I spend with clients. With this client the assessment wasn’t just the most important thing, it definitely took up most of our time together. Once we had found what needed to be worked on, the work itself didn’t take long. However, it still had enormous effects. I did some simple and gentle cranial adjustments that took maybe 10 minutes.

This client’s long standing back pain disappeared after just 10 minutes of cranial adjustment. Furthermore, her movement reflected this change. Lumbar extension was smooth, with no hinge points. What’s more, her pain remained reduced by 80% when she returned to my office two weeks later. In the second session we worked on the effect of those same birth injuries on hip centration and made big progress there too. This is exciting work and I can’t wait for week three.

1 Page, Gayle Giboney. “Are there long-term consequences of pain in newborn or very young infants?.” The Journal of perinatal education vol. 13,3 (2004): 10-7. doi:10.1624/105812404X1725

Burn Scars and Scar Rehab

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Scars from burns are serious business. The skin and fascia around the burn contracts and can cause motor control problems far from the area of the burn itself. Moreover, burns often damage nerve endings. The nerves then need to be stimulated appropriately to be regrown and integrated into the vast information system that is our nervous system. Burn scars DO NOT release on their own.

My 6 year old son, like his mom, is a little bit reckless. He tries everything, sometimes with a wicked sense of enthusiasm and a lack of caution. Thus, he’s got a lot of scars. He has a big one on his belly from leaning over a frying pan. This one is recent, central and also pretty big. Cooking shirtless is now banned in our household — for all of us! This scar on his belly has been causing him pain particularly during swimming lessons. He can feel it ‘burning and itching’ with the repetitive twist and reach of his front stroke. It’s inhibiting his obliques.

There are a variety of treatments for Burn Scars

Often the first treatment used for burn scars is a silicon gel treatment. These can be purchased at the pharmacy. Carbon dioxide laser therapy is also a treatment that is being used to treat bad burns. For really bad third degree burns skin grafting is sometimes considered. There are other treatment methods too. Traditional acupuncture has very effective treatments for burns. I use manual therapy techniques that release scar tissue that is adhereing various structures together and providing misinformation to the motor control center creating movement dysfunctions and / or chronic pain.

Fascial Release Techniques for Burn Scars

Each burn scar requires individualized release techniques. The choice of technique takes into account the sensitivity of the nervous system to the release method.  Directed, slow and methodical releases are usually the ones that work best for burn scars. However, occasionally the release only takes a few moments and needs to be done quickly. The direction and type of release is also systematic and precise. How is the technique, direction and type of release chosen?

First of all, the direction of releases are based on the testing of NeuroKinetic Therapy. NKT testing shows which motor functions are inhibited by the scar. It also shows the neuromotor response to different types of release. Additionally, I pay close attention to the anatomical structures beneath the scar and surrounding it and how they have been affected by the adhesions created by scarring. Furthermore, the moment by moment physiological and emotional response of the client is really important to monitor as the release is happening. This anatomical understanding of the layering of tissue, the fiber directions of fascia and muscle, and the functional attachments of the layers of muscle and connective tissue right down to the bone is crucial is getting good results; but it’s no more important than the emotional aspect.

For more information on Burn Scars check search my blog. If you’d like to really learn the abdominal anatomy I mentioned in this blog in more depth consider taking the Immaculate Dissection courses offered by Dr. Kathy Dooley and her team. If you live in South West Ontario and have a burn scar that you haven’t had assessed or treated contact me for a scar rehab appointment by email tmkachroo@gmail.com, or book an appointment for an Initial Assessment.

Scars Interfere with Motor Control

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Scars have depth, texture, density, form and pull.  To say what we see on the surface is the tip of the iceberg is a huge understatement in many cases. I have become obsessed with scars in this last few months as I have had an influx of clients with large scars that are interfering with their motor control; and I have scars of my own that I am working with.

For some people it’s surprising that scars can interfere so much with our ability to move naturally and reflexively. So I will outline here in brief how scars can interfere with motor control. In later posts I will elaborate more on these. Scars interfere with motor control

1) through the fascial pull of the adhesions they form with the tissues around them. This creates a mechanical obstacle to motor control function. An example would be the movement of a joint being impaired by scar tissue.  Since the motor control system makes decisions based on perceived tension in the body, the distortions of around a scar can also send incorrect information about the state of tension in surrounding tissues. For example, an abdominal scar could increase tension in the internal oblique which the motor control center then interprets as an already present contraction of that muscle. The motor control center would then choose not to contract the muscle further;

2) through the increase of sensory afferance (scar tissue has more nerve endings laid down around it) that can overwhelm or confuse the motor control center of the brain;

3) through emotional trauma that can interfere with motor control through the limbic system.

 
 
 
 
 
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Scars from surgeries or scars made by sharp objects are very different from the scars created by internal fractures.  This scar is one that was self-inflicted when I was a miserable teen with no emotional resources, and no understanding about how to talk about difficult things, in the 90s. It looks flat and movable, but it has a deep root that interferes with mobility in my radial joint. I’ve done the emotional work I need to; but the scar itself still needs attention for me to have pull power through my right wrist, elbow and shoulder.

I have many clients who are having motor control problems — causing joint pain, lack of mobility — caused by scars. Some of these are recent, just 3 months ago, and many more that are decades old.  These include crush and spiral fractures that are hidden below the surface; abdominal surgeries; laproscopic scars; deep cuts made by jagged edges; and scarring caused by blunt force trauma — each of these has to be treated differently.  One client’s shoulder scar was pulling on some of his cervical nerves and giving him symptoms that he had deemed anxiety attacks. So if you have scars and pain — there is a good chance there is a connection. Discovering what this connection is and helping clients to resolve it is some of my favorite work.