Cautions and Contraindications
N.B. Always work within the guidelines of your therapy profession, as defined by the professional body you are registered to in your country. The guidelines below are in addition to your standard considerations for treatment.
• Before you work with a client, make sure they are signed off by their
surgeon and are safe for work.
• We advise not working on or near inserted mesh. Mesh used in breast
reconstruction does not have the problems of abdominal/pelvic mesh
and is safe to work.
• We advise not working on anyone with active cancer. For a client within five years of their cancer surgery, we recommend requesting a letter from their oncologist to confirm that they are cancer-free and safe for work. Be sure to follow the regulations of your country.
• We advise not working on pregnant women.
• The scar should not be open, infected, inflamed, weeping fluids, or very painful. Tenderness is acceptable.
• Do not work if there is redness or swelling around the scar due to
radiation therapy.
• Do not use abrasion on keloid or hypertrophic scars; if you inflame them, they may grow larger.
• Do your best to work without causing your client pain.
Techniques
All of the work is based on countering tensional vectors. Techniques are ways of working that I have identified as having a pattern. If that pattern works for many people, it becomes a technique. Some of the techniques are more general and all-purpose; others are specific for a particular tissue arrangement. The names given to the techniques reflect the playful quality of this work.
Techniques are best learned in a classroom. Teachers help students calibrate the right kind and depth of touch. Watching a video to learn tactile techniques doesn’t give you everything, but videos are better than anything else and we have included five techniques with videos to guide you as you start to explore working with scars. The following descriptions are provided for use with the video.
FEATHER LIGHT SWEEPING
Use Feather Light Sweeping to start work on most scars. It gives you a chance for an overall exploration of the extended area and it starts to soften the texture of the scar. When in doubt, go lighter.
If you used a long flight feather, it would approximate the proper amount of pressure for Sweeping. I use a single finger because it keeps my enthusiasm in check. More fingers can be used depending on the size of the scar and the angles you need to generate. This does much more than you would expect, so do not skip it to get to the other techniques. My Sweeping finger is moving before making contact with the surface and moving as it breaks contact with the surface. There is a slight drag to the motion, much like petting a small mouse. Sweep towards the scar from all around and through the areas where there may have been swelling and bruising. Bracing or stabilizing the tissue with my other hand yields more change at a faster rate. Bracing uses a light, resting, relaxed contact without stretching or pulling.
The Sweeping is done from the Bracing hand towards the scar. Go up to the scar but do not cross the midline of the scar. You do not want to pull the scar apart; you want to put it together.
This technique may seem simple but do not underestimate it; giving plenty of time for Sweeping will improve the resilience of the skin, appears to work on the free nerve endings under the skin and will generally improve the look and texture of the area.
THE CAT
The Cat is particularly well suited for abdominal scars and adhesions. And it is useful in many other areas.
Both relaxed hands sink into the tissue, resting the weight of your arms from your shoulders. Your whole hand stays in contact while gently pushing with a fluid rolling wave. This motion resembles the Hawaiian hula dance hand gesture for “ocean”.
Alternate your hands and keep moving your contact around as you work. It does look a lot like kneading bread dough, and very much like a cat. It is easy, relaxed, and casual. Work from both sides of the body for balance. It should feel wonderful for the client. When you are not sure what to do, try the Cat.
SCRAPING
Use one hand for Scraping and one for a Brace.
Partially curl your fingers and slowly and gently Scrape through the tissue from the Brace to towards the scar. Pick up your fingers and do this again in the same direction. Go up to the edge of the incision but not over the edge or down the center of an incision.
When surgeons make a minimal incision, they must stretch or retract the tissues wide open to make enough room to work. It feels like some of the tissues get stuck in the retracted position. This leaves wrinkles under the surface. Scraping smooths and flattens wrinkles.
I use the example of making a bed, if you miss pulling a blanket layer flat in the middle of the process, it leaves a wrinkle under the top layer. You can scrape that blanket layer smooth through the top layers rather than undoing everything to make the blankets lie flat and smooth.
MATCHING LAYERS
We refer to ‘layers’ as artifacts created by surgery or damage.
Matching Layers is a complex technique and has many elements for
consideration.
Adapt your hands to the constraints of the location, size, and shape of the scar. Use both hands. For the longer scars, contact with the whole hand, using a flat contact. Your hands are a mirror image of each other with your index fingers parallel, one finger on each side of the scar. Push both hands down slightly to capture the two large sheets of tissue that form the two sides of the scar.
Start working away from the edges of the scar and push your hands together to push up two rolls of tissue, one on either side of the scar. There is an optimum distance away from each scar and finding it requires a little experimentation. Push the rolls forward and back to the comfortable excursion limit of the skin to address any displacement in the plane that is horizontal to the body surface. Move along the entire scar as you work. Push the rolls up and down to address any displacement in the vertical plane.
Along with the forward and back, and up and down motions tilt each of your hands into different angles or planes. Experiment with some wiggling as you push the two sides towards each other. This motion is similar to pushing two hairbrushes together to interdigitate the bristles.
DOWN THE RABBIT HOLE
This is used when a ‘scope’ has been inserted into the body (laparoscopy, arthroscopy), as well as for drain sites or cannula insertions. The scope or drain being inserted and removed creates local trauma and tracking adhesions. With drains, there is just a straight ‘in and out’ sensation, but where a surgeon has been investigating, you will feel yourself being pulled into the different areas
where that scope has probably gone. This technique is as much about intention as anything, so keep your focus on your fingertip.
Put your fingertip on the scar. In navel laparoscopy scars this is sometimes impossible so just put your finger in the navel. Do not apply pressure. Just stay there, very lightly, and follow the tissue; you will usually feel it moving under your finger. If there is anything to clear, you will feel the tissues drawing you in until it might feel as if your finger is fully inside the body. The client may also feel this as the intention and touch appears to transmit into the deeper fascia. When the movement eventually stops, you will feel as though you are being pushed out; that is the time to finish.
N.B. A laparoscopy may generate several scars, so go back and check them in later sessions until you no longer get any response from them and they feel complete.
Appendix I – Integration
Integration is something we as therapists do to settle, connect and ground someone, and minimize discomfort after treatment.
As we have seen, when addressing scars, we are working not only locally but body-wide. The adhesions beneath the surface may well be affecting the myofascia globally and it is important after treatment to enable the body to process the interventions as much as possible. This limits the discomfort that might otherwise be felt by the client and assists them to ‘let go’, both physically and emotionally.
You may be used to working with integration but, if you are not, you can use the following suggestion. Use a relaxed, very light touch. Put one hand very lightly over the area worked and the other further away, for example across the pelvis after working on a C-section scar, then down the legs to reconnect as women often feel “cut in two” after a Caesarean section (figs 10.15 A & B).
Ensure balance by working on both sides of the body. One technique puts one hand underneath the client and one on top, ‘sandwiching’ the area, ensuring that you can sense continuity between your hands.
Be comfortable as you stand/sit there, breathing calmly, your focus on
reconnecting the different areas of the body as you work with them. That is all you need to do. For example, if someone has had a particularly unpleasant leg injury the natural response may be anger, dislike of the scars, and of the leg.
Acceptance of the scar by the client will happen naturally when the scars are less ugly, but you can help the integration by using this technique. If the approach is somewhat alien to you, it may be tempting to dismiss it out of hand, but do try it with an open mind and get client feedback to validate what you might feel while working; the client may be able to feel more than you can and this will help you develop your awareness.
Appendix II – Occipito-sacral balancing
This is a cranio-sacral technique. It aims to restore/maintain normal
connectivity within the spine. With the client prone, supine (if lightweight), or side-lying, place one hand gently on the occiput and one on the sacrum (fig 10.16).
Rest lightly and have the intention of restoring flow. You may, after a few moments, feel as though one hand is being ‘filled’, as though something is expanding beneath it. Then the flow will move up/down the spine and the other hand will feel ‘filled’. Or you might feel a pulse at each end. The flow will be at 6-12 cycles per minute. Even if you do not feel the flow beneath your hands, if you hold the OccipitoSacral position for about five minutes the body will use the touch to its benefit. For more details on cranio-sacral methods see Parsons & Marcer (2006).
Reference:
Parsons, J. and Marcer, N., 2006. Osteopathy: models for diagnosis, treatment
and practice. Edinburgh: Churchill Livingston, Elsevier.