Swelling is expected after surgery. But swelling is supposed to be temporary. That expectation gets repeated after nearly every surgery. Patients hear it after cosmetic procedures, orthopedic repairs, abdominal operations, and cancer-related interventions. Early inflammation makes sense. Tissue trauma triggers fluid movement as part of healing.

Problems begin when swelling does not fade.

Weeks pass. Months follow. The area still feels heavy or tight. Clothing fits differently. Skin appears puffy or uneven. Scars feel bound down. Movement feels restricted. In some situations, swelling spreads or hardens rather than settling.

Across Long Island and New York City, many people quietly live with this outcome, assuming it is simply something they must accept. In reality, unresolved swelling usually points to lymphatic dysfunction rather than failed healing.

Understanding that distinction can shift the entire recovery process.

The Lymphatic System’s Role in Healing Is Often Overlooked

The lymphatic system regulates fluid balance, immune activity, and tissue health. Unlike the circulatory system, it does not rely on a central pump. Movement, breathing, tissue glide, and subtle pressure changes keep lymph moving.

Surgery disrupts all of those mechanisms.

Incisions interrupt lymphatic vessels. Scar tissue limits motion between layers. Protective muscle guarding alters posture. Pain changes breathing patterns. Even prolonged rest can slow lymph flow when it becomes excessive.

Once lymphatic movement slows, fluid accumulates. Proteins remain trapped in tissue. Inflammation persists. Over time, this environment contributes to fibrosis, discomfort, and structural change.

That process explains why swelling sometimes becomes chronic rather than temporary.

When Swelling Is a Sign of Lymphedema

Lymphedema develops when lymphatic pathways are damaged or overwhelmed beyond their capacity. It frequently follows cancer treatment, lymph node removal, radiation exposure, or repeated surgical trauma.

Early symptoms are often subtle and misunderstood:

• A heavy or full sensation rather than sharp pain
• Mild size differences between limbs or body regions
• Tightness that worsens as the day goes on
• Skin that feels thickened or less pliable
• Swelling that improves overnight but quickly returns

Without proper lymphatic support, lymphedema can progress. Tissue may become firmer. Mobility can decline. Skin health may change.

Gentle lymphatic stimulation, particularly approaches that lift tissue rather than compress it, plays a critical role in managing this condition safely and effectively.

Lipedema: When Swelling Is Not About Weight

Lipedema is frequently misdiagnosed or dismissed. This condition involves abnormal fat and fluid distribution, most commonly affecting the hips, thighs, legs, and sometimes arms. Pain, tenderness, easy bruising, and swelling are common features.

Unlike weight-related changes, lipedema does not respond predictably to diet or exercise. Swelling often worsens with heat, hormonal shifts, or prolonged standing. Many individuals are told to simply try harder, which only adds frustration and confusion.

Lymphatic congestion often overlaps with lipedema. Supporting lymph flow can reduce pressure, heaviness, and discomfort even when fat distribution remains unchanged.

A thoughtful approach focuses on tissue health, circulation, and nervous system regulation rather than aggressive manipulation.

Plastic Surgery Recovery and Lingering Edema

Cosmetic procedures place significant demands on the lymphatic system. Liposuction, tummy tucks, breast surgery, body contouring, and reconstructive work all involve extensive tissue disruption.

While swelling is expected initially, problems arise when:

• Edema persists months after surgery
• Skin feels firm, uneven, or hardened
• Scars restrict movement or sensation
• Fluid pockets remain despite compression
• Healing appears stalled or incomplete

Compression garments alone rarely address scar behavior or deeper tissue restriction. Without restoring lymphatic pathways and tissue glide, swelling may linger far longer than anticipated.

Targeted lymphatic therapy helps guide fluid out of compromised areas while supporting scar integration. When done correctly, it improves comfort and helps surgical results settle more naturally over time.

Scar Tissue: A Common Denominator Across Conditions

Scar tissue influences far more than appearance. Adhesions limit glide between tissue layers, compress lymph vessels, and alter movement patterns.

Even small scars can disrupt drainage pathways. Abdominal scars may influence pelvic or leg swelling. Breast scars can affect chest and arm circulation. Orthopedic scars often change mechanics well beyond the joint involved.

When scar mobility remains unaddressed, lymphatic congestion frequently follows.

Supporting scar tissue health is essential for long-term comfort and fluid balance.

Why Aggressive Techniques Often Backfire

Swollen or compromised tissue does not respond well to force. Deep pressure may irritate lymph vessels, trigger protective nervous system responses, and push fluid into areas unable to drain efficiently.

Gentle negative pressure approaches work differently. By lifting tissue rather than compressing it, space returns between layers. Lymphatic channels reopen. Fluid movement improves without overstimulation.

This distinction is especially important for individuals with lymphedema, lipedema, or post-surgical sensitivity.

How LymphaTouch® Supports Lymphatic and Scar Recovery

LymphaTouch® uses controlled negative pressure combined with subtle vibration to stimulate lymphatic flow and improve tissue mobility. Instead of pushing downward, it gently lifts tissue layers.

That lifting action helps:

• Encourage lymphatic drainage
• Reduce edema without pain
• Soften fibrotic or restricted tissue
• Support scar integration
• Improve circulation and tissue glide

When integrated with skilled hands-on therapy, this approach supports healing without overwhelming sensitive systems.

Advanced LymphaTouch® therapy is often used when gentle lymphatic stimulation is required to support recovery from surgery, cancer treatment, or chronic swelling patterns.

Specialized Lymphatic Care in Long Island and NYC

Access to experienced lymphatic care is not evenly distributed. Many Nassau County and Suffolk County residents report difficulty finding providers who specialize in complex swelling, scar-related restriction, or post-cancer recovery.

As a result, individuals from New York City often travel to Long Island seeking more specialized, individualized care. Consistency matters with lymphatic work, and having local expertise allows treatment to progress thoughtfully rather than sporadically.

On Long Island, Marjorie Brook works with clients managing lymphedema, lipedema, plastic surgery recovery, and unresolved post-surgical swelling. Her approach integrates LymphaTouch® therapy with hands-on scar and fascial techniques, always guided by tissue response.

Sessions are unhurried. Treatment plans evolve over time. Nothing is forced.

Many clients arrive after being told swelling is simply something they must live with. For them, understanding lymphatic function becomes the turning point.

What Progress Often Looks Like

Improvement rarely happens overnight, yet meaningful changes tend to emerge gradually:

• Reduced heaviness or pressure
• Softer tissue texture
• Improved range of motion
• Better tolerance for daily activity
• A sense that healing is finally moving forward

These shifts often occur without flare-ups or setbacks when therapy respects the body’s capacity.

When to Seek Lymphatic-Focused Support

Specialized lymphatic care may be appropriate if you notice:

• Swelling lasting months after surgery
• Diagnosed or suspected lymphedema
• Painful swelling associated with lipedema
• Plastic surgery recovery that feels incomplete
• Scars that feel tight, painful, or restrictive

Early intervention can prevent progression, although improvement remains possible even years later.

Healing Does Not Always End When You Are Discharged

Medical clearance does not always equal complete recovery. Many people exist in the space between “everything looks fine” and “something still feels wrong.”

That gap often reflects unmet lymphatic needs.

With proper support, fluid can move again. Tissue can soften. Comfort can return. Healing can continue long after the expected timeline has passed.

For individuals across Long Island and New York City dealing with unresolved swelling, lymphedema, lipedema, or post-surgical recovery challenges, a lymphatic-focused approach may be the missing piece that allows healing to finally make sense. Call today to book your appointment with Majorie Brook, LMT.

The post Why Post-Surgical Swelling, Lymphedema, and Lipedema Often Don’t Resolve on Their Own appeared first on Marjorie Brook, LMT.

Essentials for Your Health

Guest on Dr. Mitchell’s The Smartest Doctor in the Room Podcast

I recently had the pleasure of joining Dr. Dean Mitchell on his podcast The Smartest Doctor in the Room to discuss how scar tissue treatment and proper stretching can improve your life.

DR. DEAN MITCHELL

So we have all experienced the cuts and bruises in our lives, and many of us have actually gone under the knife, you know, for a surgical procedure. Afterward, we are left with a scar that over time will fade, but just sometimes doesn’t feel like our original skin in medical school. One of my first pathology lectures was all about, inflammation and healing and actually how scar tissue forms with the connective tissue coming in. But I have to tell you, for the rest of my medical training, I never heard another word about scar tissue or how it affects us.

My guest today, Marjorie Brook, is an internationally known educator and medical massage therapist who has spent over 30 years in her career caring for and teaching healthcare practitioners about her expertise. You know, as I’ve mentioned before, to patients, I’m pretty open-minded, and obviously, though I have a medical degree and I’m a conventional doctor and I do a lot of holistic medicine, I’m always searching to find people doing unusual things that I think could benefit my patients that I wanna learn more about. And I was really fortunate cause I had a really smart patient that is a mutual patient of Marjorie’s and myself. And when I heard what Marjorie was doing, I was very curious. And we got to meet up. And I’ve actually come to her as a patient and I think she does great work. And I just really wanted her on the podcast to talk about her work with scar tissue and some of the other things she does. So it’s my pleasure to welcome Marjorie Brook to the podcast.

Okay, so the first thing we will get into is scar tissue. Cause that’s what actually got me interested in meeting you. This was all right before COVID broke. I dunno if you remember we got to finally meet at a conference you came to, I was speaking and you came to attend, which was, you know, really nice. As  I mentioned in the introduction, you know, scars tend to remind us of an injury or an operation. And sometimes also even psychologically kind of tells us that we’re no longer perfect. But maybe you could give sort of a broad overview of what, how, what you see, you know, how you look at scar tissue and if you could even explain to some degree what a scar is.

What’s the Issue with Scar Tissue?

MARJORIE BROOK

Well, basically when people think of scars, they think mainly of the aesthetic look of how it altered the way they look. But what people really don’t understand is that scar tissue can affect every single system in the body.

I’m not saying that every single scar is an issue, but every single scar has the potential to be an issue. And people don’t even realize that the scar tissue is actually causing a problem because the doctors don’t talk about it. All the pains that people have or things that people say, oh, it’ll, it’ll fade in time, or it’s just going to be that way can actually usually be traced back to the scar tissue. Scar tissue is actually the tissue that replaces the tissue that’s been injured. All right. And a lot of people hear things about breaking up scar tissue and taking scar tissue away.

Well, you really can’t do that. Scar tissue literally has to be there. Every wound heals with some form of scarring and it’s meant to be there. And the point is, you just have to understand that it’s not as effectively able to behave and perform as well as normal tissue. It’s only about 80% as functional as normal tissue at its best. But scar tissue left on its own can have multiple issues and multiple problems. It can run rampant, it can spread through the body, it can cause restrictions, it can cause poles, it can interfere with the, uh, circulatory system. It can interfere with the electromagnetic system in our body. It interferes with the energy. If you’re gonna go with traditional Chinese medicine, it actually can block and interfere with everything in this, in the, in this in our body with every single system.

DR. DEAN MITCHELL

Okay. I’m going to stop you there because that’s a lot to swallow.

You always provide a lot of information. But I want to try to take a little bit simpler and then No, and then we’re gonna go deeper. So again, the way I visualize it, and you know, what’s interesting is because scar tissue could be on the skin, as you know, on the tendons, on muscles, internal organs, I guess. And I tend to think of, again, from my medical training as scar tissue being, see this is where the problem is almost like glue or, you know, that’s like a layman’s term, but the, the collagen coming in, which is not the original tissue. Right. So just for example, I mean, if you get a scar on your face, I mean, you have what we call dermal cell epidermal and dermal cells. And then where that cut is, whether it’s, you know, done by a doctor or if you got an injury, that tissue comes in and heals and it’s collagen tissue, which is not the exact same tissue. Am I saying this correctly as the original skin tissue? So it’s like almost like a filler?

MARJORIE BROOK

Well, no, a part of it actually. It’s pretty much formed out of the same materials. Only it gets excessive collagen. Too much collagen. Cause you have collagen in your regular tissues. What it is, is, is the way the tissue, uh, re-knits itself together, if you think of the collagen fibers as threads that are all getting basket weaved in to fill in the the scar where formally the tissue went like this. Right now the tissues are like this and this is the problem.

DR. DEAN MITCHELL

It’s almost like essentially sewing up the tissue so it gets stronger because scar tissue is not as strong as the original tissue. Is that correct?

MARJORIE BROOK

Correct. So at its best left, if it’s healed as best as it can, scar tissue is about 70 to 80% as functional as normal tissue, which means it’s not as stronger. It’s actually weaker. And it can interfere with the tension like your skin is meant to, has tension to pull in a certain way. But if you have a cross now, it can’t do that. Now it’s pulling.

DR. DEAN MITCHELL

Now there are some limitations.

MARJORIE BROOK

Yeah. It’s not, it’s not moving the way it was designed, it’s limited and those poles can end up  pulling throughout the whole body. It’s like one big chain. Right. And you can have a scar on your shoulder and it could be pulling and end up causing a problem down by your ankle on the other side of the body.

Does the Scars Age Make a Difference in Its Impact on the Body?

DR. DEAN MITCHELL

Wow. Does it matter also how old a scar is? Especially like when you see patients, I mean, obviously maybe till somebody finds out about you, their scar is 10 years old or, you know, or, um, maybe someone’s fortunate and they’ve seen you in the last six months when they noticed a scar either wasn’t healing right. Or was giving them problems. So does that matter to you when you’re caring for them?

MARJORIE BROOK

It doesn’t matter how old a scar is. I’ve worked on scars as old as 80 years old and made a difference. Our tissue is very elastic and we can alter and change our tissue. That’s not an issue. The connective tissue, the fascia is. The best thing is you wanna start working with the body as soon as you have the injury and not necessarily working, you won’t allow the first three months to allow the body to actually scar. It’s supposed to scar. Right. That’s how. Right, right. Unfortunately, people go after the scar way to the injury too soon to avoid a scar. Like they actually make a worse scar because they don’t allow the body time to heal.

DR. DEAN MITCHELL

The post Scar Tissue Treatment and Proper Stretching: Essentials for Your Health appeared first on Marjorie Brook, LMT.

What is Scar Tissue?

So what is a scar? We all hear about scars. We think about a scar as what we can see – the mark on our face, chest, legs, or a cut from surgery. But the truth is, what you see on the top is just the beginning. It’s just the surface.

Now every scar you see is not necessarily a problem but more often than not, it does relate to issues because that little scar you’re seeing on the surface is actually just the tip of the iceberg. You ever see that picture where you see the very tip of the iceberg and then they show you below the surface and it’s spread to beyond gigantic in size. That’s what can happen with scars within your body. The scar tissue can spread.

Scar tissue causes your tissue to stick together instead of allowing it to slip and slide and move the way it’s supposed to move. Take a c-section scar for example, when you feel that scar on the surface, that top layer actually moves and doesn’t seem to be a problem. But if you’ve reached down a little bit below or a little bit above the scar, you feel a thick, ropey stuck area within your abdomen and pelvis. That’s actually the scar tissue.

What Most People Don’t Realize About Scar Tissue

What most people don’t even realize is that scar tissue can spread – that it doesn’t just stay right underneath that incision line that you see or where you have the road rash from where you fell off your bike during some type of extreme sport on your motorcycle.

The scar tissue gets stuck and ends up spreading throughout your body three-dimensionally. Very common with c-sections is having scar tissue that sticks down to your flexor muscles or down towards your pubic bone which is limiting your ability for your hip and pelvis to move. It pulls you down in front and it can go straight three-dimensionally all the way to your back attached to the muscles and the bones in the back of your sacrum and spine.

It can even travel all the way up to your diaphragm making it hard for you to breathe and hard for you to fully extend. And you’re totally unaware of it being the cause of your pain and issues because on the surface you look healed.

You have the scar and think it can’t be affecting me now. Not true. It can be.

Anytime you have an alteration in your tissue and your connected tissue that holds you together, you’re going to have a problem at some point in time. If not immediately in the future. Somewhere in your body, there will be a problem as a result of your scar tissue.

Here’s another crazy example. When someone has breast augmentation. Believe it or not, that pull from having the scar from augmentation can eventually cause issues in your feet. That’s right – one end to the other.

Your tissue is one big piece and any kind of disruption, kink, or problem within that tissue is going to cause an issue – and not necessarily where the scar is but somewhere else in your body.

》A B O U T   M A R J O R I E   B R O O K

Marjorie Brook, LMT is a massage therapist, author, and international educator. For over 21 years, she has specialized in scar tissue release and massage therapy. She works from the fundamental belief that your body is intuitively aligned with the thoughts you think, the emotions that you feel, and the things that you do. She founded Brooks Seminars in 2007 after working as a decade as a nationally recognized massage therapist with a private practice on Long Island. She is the creator of the Scar Tissue Release and Integrated Therapies (S.T.R.A.I.T Method) and offers continuing education courses on this method all over the world. Her articles have appeared in magazines such as Massage Today, American Fitness and Massage World. She’s approved by the National Certification Board for Therapeutic Massage and Bodywork, the Massage Therapy Association of Alberta and the College of Massage Therapists of British Columbia.

The post What is Scar Tissue appeared first on Marjorie Brook, LMT.

And for others, they are something they have already forgotten and are unaware of how it is affecting their body. For these people, the scars are so forgotten they don’t even get listed on medical history forms. Six out of ten women who come into my practice who had a c-section do not consider their c-section a surgical procedure.

Scar Tissue 101

Most people are aware of how scars impact the physical appearance of the body but most fail to recognize how scars impact their body internally. The truth of the matter is scars, and the restrictions they cause can affect every system of the body.

Recognizing this is the key to unlocking mysterious pain and other issues that have been interfering with the body’s ability to function and balance.

Historically scar tissue has been ignored or even viewed as having no consequence by the medical world. So long as there’s no infection and they didn’t leave anything inside of you during surgery, the doctor’s job is done. Doctors are not thinking about scar tissue and its impact before, during or after surgical procedures. If you are having any type of abdominal or pelvic surgery, you have a 95-100% chance of having adhesions and scar tissue. But nothing is done about it. It’s no different than breast cancer and mastectomy patients not learning about lymphatic massage until lymphedema occurs instead of being proactive and preventative and getting these massages before and after the surgery.

With all the current, ongoing research and information compiling on the importance of fascia, the medical world is starting to recognize the significance of scar tissue on the body. But there are still too many doctors who don’t recommend scar tissue therapies immediately following surgery and instead only recommend it when the scar tissue is causing noticeable pain for their patients.

Scar Treatment Concerns – What to Look Out For

As with most new fields of interest, there have been many new versions of therapy popping up, which for the most part is a very good thing. Unfortunately, the negative side of new frontiers is that many therapies are being administered without a proper understanding of the subject matter.

• The internet is now flooded with inaccurate information about scar tissue and ways to cure it. There is even a guy out there who tells people in his book that they can stick themselves with pins to help with their scar tissue.
• Therapies are being applied with total lack of understanding of the physiology of scar tissue.
• There is little, or worse, no knowledge behind the events that caused the scars (i.e. surgeries, accidents, and what the corrective procedures actually did to the body). For example, there is a big difference between an emergency c-section and a planned c-section and the impact it has on the body.
• No attention is paid to the psychological and emotional trauma surrounding the event(s) which caused the scarring. This is important because touching or manipulating the scar could trigger PTSD. There are many people who have never even touched their scar due to the trauma associated with it.
• Few look for the possible compensations the body may have compiled in response to restrictions and what releasing those restrictions without proper rehab would do.

In other words when it comes to the compensations, if someone has a c-section, that c-section may be pulling this person down or turning their pelvic or not allowing their pelvis to reset after the pregnancy. Or someone who had a mastectomy not being able to pull their arms open all the way or they can’t lift their arms overhead – all as a result of the surgery. Or people who have had foot or ankle surgery whose body has shifted because it changed their gait. Or women who have breast implants (not reconstruction) with foot pain. This is common as the fascia lines runs down the body from the breast to the feet and as a result of the implants there is now a pull that impacts the feet. About 60% or more of women who increase their breast size by a cup or more with implants experience feet pain.

This lack of understanding and people just jumping at attempting to treat scar tissue without an understanding is honestly terrifying. 

In order to treat scar tissue, you need to find someone who understands scar tissue, what caused the scar, and all the events that lead up to the scar formation. 

Scar Tissue Misinformation

Here is some common misinformation regarding scar tissue.

• Scar tissue cannot be broken down nor can it be removed. Anyone who claims to breakdown scar tissue does not understand what scar tissue is.
• Scar tissue (not to be confused with adhesions) replaces normal tissue that is damaged. If you break down you are essentially saying that you are causing a new wound. At its best scar tissue is only 70% as functional as normal tissue. But scar tissue could be functioning at less than 10% of normal tissue. The goal with scar tissue therapy is to get it functioning as optimally as possible.
• The only person who can remove scar tissue is a surgeon who is literally cutting it out – only for new scar tissue to form. You want to avoid this whenever possible as it simply creates new scar tissue formation and it is very traumatizing to the body.
• Scar tissue is dead fibrous tissue – this is not true. Scar tissue composition and structure are different than that of the normal tissue it replaces. Because of changes in the relative amounts, type and structure of collagen, it is inferior to function.
• Anyone can treat a scar
• Scars only affect the tissue
• Scar tissue is only an esthetic issue

Most people are only concerned with how the scars alter their appearance and have no idea how the scars and adhesions are affecting their bodies on so many different levels or that scars can be a trigger for PTSD. For example, individuals who are getting angry or sad for no apparent reason but it’s really stemming from pressure on their scar tissue such as their bra or pants putting pressure on the scar. Or an action such as reaching for a can of peas causes a flashback or triggers an emotion because that action puts a strain on the scar tissue.

Misinformation: Scars only affect the tissue

Scar tissue affects every system of the body including

• Integumentary
• Muscular-skeletal
• Nervous
• Circulatory
• Lymphatic
• Respiratory
• Endocrine
• Urinary / Excretory
• Reproductive
• Digestive

Understanding how each of these systems can be affected by scar tissue can lead you to unravel the mysteries of the pain and frustration you have been suffering, in some cases for years.

How Scar Tissue is Different Than Other Tissue

• Scar tissue has less elasticity
• Scar tissue is not as strong as normal tissue (in fact it’s only 70% as strong at best)
• Scar tissue does not oxygenate well, creating a low (acidic) PH environment
• Scar tissue is different neurologically – it can transmit pain faster and more intensely than normal tissue
• Scar tissue does not contract – it moves through tension force
• Scars are less resistant to ultraviolet radiation (this means you have to wear sunblock on the scar)
• Scar tissue does not contain sweat glands and hair follicles
• Scar tissue is prone to injury

Because of the chaotic ways that the fibers are forming and the cross-tension pulls that scar tissue causes, it is not as strong as normal tissue and is more likely to tear and cause a problem. Additionally, it does not oxygenate well because the circulation is limited which limits the oxygen through the area. This causes a low (acidic) PH environment which is never good as it allows bad things like cancer to thrive.

Many patients experience a loss of feeling or sensation or pain where their scar is located. About 50% of women who have c-sections or hysterectomies are numb where their scar is due to the tissue not reconnecting properly after the surgery or they are bound up in the scar tissue. But during scar tissue release massage you can get the sensation of feeling back by releasing the bound-up nerves in the area.

The Goal of Working with Scar Tissue

The goal of working with scar tissue is to:

• release the adhered layers – get it separated and moving (not break them apart)
• attempt to re-establish homeostasis – or try to get the body to function the way it was designed to function
• release and correct the compensations from fascial restrictions
• be acutely aware of possible emotional release during this process

It’s about rehabbing the body and getting it as close as possible back to the “factory” settings.

Acknowledging that scar tissue may be at the root of the problem is the first step in any therapy. After that simply massaging the affected area can bring about change. Your therapist needs to thoroughly understand the event which caused the scar and everything that goes with it in order to truly treat the scar tissue.

There are so many wonderful forms of therapy available today to help people on their journey to balance health and wellness. One of the ways to achieve that health and balance are recognizing the effects scars are having on a person.

》A B O U T   M A R J O R I E   B R O O K

Marjorie Brook, LMT is a massage therapist, author and international educator. For over 21 years, she has specialized in scar tissue release and massage therapy. She works from the fundamental belief that your body is intuitively aligned with the thoughts you think, the emotions that you feel and the things that you do. She founded Brooks Seminars in 2007 after working as a decade as a nationally recognized massage therapist with a private practice on Long Island. She is the creator of the Scar Tissue Release and Integrated Therapies (S.T.R.A.I.T Method) and offers continuing education courses on this method all over the world. Her articles have appeared in magazines such as Massage Today, American Fitness, and Massage World. She’s approved by the National Certification Board for Therapeutic Massage and Bodywork, the Massage Therapy Association of Alberta, and the College of Massage Therapists of British Columbia.

The post Scar Tissue 101 – How Scar Tissue Affects the Body appeared first on Marjorie Brook, LMT.

Marjorie Brook, creator of the Scar Tissue Release and Integrated Therapies (S.T.R.A.I.T Method), speaking at the Polish Fascia Symposium on scar tissue.

I have been a massage therapist for over 20 years. In this time I have seen:

• Complications from scar tissue be dismissed by doctors – leaving their patients in pain and frustration
• A general population completely in the dark as to what is the root of their pain and suffering (i.e. they don’t realize that their back pain or shoulder pain is coming from the fall they had at the age of 15 that left a scar across their abdomen
• To current considerations by the medical profession that it may be a problem to some

Are Scars Really a Problem

This is a question I hear over and over and over again. And the answer is simply – while not every scar presents a problem, they all have the potential to become one.

Scars have been documented for over 3,700 years, yet they are still not entirely preventable. Despite advancement in the management of several diseases during the last centuries, scarring remains a tremendous clinical challenge to patients and clinicians.

Scar formation, although evolutionarily beneficial in wound healing, can create a substantial aesthetic and functional burden. And yet it is still the ugly step sister of the medical field. Never given the respect and understanding it deserves.

We are the only species that heals with a pathological scar. No other species has keloids or hypertrophic scars. Humans are a tight-skinned species unlike animals where the skin is loose for example a mother picking up her cub by the scrub of her neck. Our skin is very tight around our bodies. Scarring is a late evolutionary event that probably arose in response to a need, as hunter-gatherers, to heal quickly to avoid infection or detection by predators. We’ve evolved for speedy repair. And speedy repair is not necessarily quality repair.

Scar Statistics

• There are an estimated 12 million traumatic lacerations treated in the United States emergency rooms each year
• 250 million surgical incisions created worldwide every year
• 11 million burns severe enough to warrant medical treatment worldwide
• Every year 300,000 to 400,000 Americans approach their doctors to get their scars reduced
• Over $20 billion dollars are spent every year on the treatment and management of scars (this includes creams, lotions and therapies)

Scar Tissues Impact on the Body

Scar tissue forms after an injury, trauma, surgery, and, in some cases, disease. It can develop on the skin’s surface or internally. And, unfortunately, it’s the superficial scars or surface scars that concern people the most. They are concerned with how it looks and what it is doing to their appearance while they fail to focus on what the scar is doing to their body internally.

Scars are often considered trivial, but they can be disfiguring and aesthetically unpleasant and cause:

• severe itching
• tenderness
• pain
• sleep disturbance
• anxiety
• depression
• disruption of daily activities

The list of long-term complications is hefty and include:

PHYSIOLOGICAL

• nerve impingement
• pain
• numbness
• limited range of motion and flexibility
• postural misalignment
• muscle atrophy
• tissue hypoxia
• an increase in potential for future injury

PSYCHOSOCIAL

• development of post-traumatic stress reactions
• loss of self-esteem
• stigmatization

Depending on the way in which the scar tissue matures over time, these symptoms may not occur until years after the injury which is why the person at 40 years old with neck pain or back pain doesn’t relate it to the scar from when they were 15.

Scar tissue has the potential to affect every system in the body.

• Integumentary
• Muscular-skeletal
• Nervous
• Circulatory
• Lymphatic
• Respiratory
• Endocrine
• Urinary / Excretory
• Reproductive
• Digestive
• Polarity

Understanding how each of these systems can be affected by scar tissue can you unravel the mysteries of the pain and frustration you’re suffering, in some cases for years.

Emotional Impact of Scar Tissue

Physical scars cannot and do not show how much pain or suffering a person has experienced.

• Shock
• Guilt
• Failure
• Loss
• Detachment
• Trauma
• Anger and resentment
• Fear
• Low self-esteem
• Hopelessness/depression
• Disgust when seeing or touching the scar
• Sadness about the limits the scar places on everyday life
• Humor – yes, there can be funny stories behind accidents

The emotions surrounding the physicals scars can and do have a direct emotional and psychological effect. It can bring about significant self-image issues and lower self-confidence.

Research on the aftercare of burn survivors or those with severe facial scarring has proven this. The cases of patients with severe scarring suffering from depression (between 13-23% of cases) or post-traumatic stress disorder (between 13-45% of cases) have been documented.

Helping scar tissue mature and heal in conjunction with the body’s original state gives you the best chance to minimize and/or avoid these symptoms altogether. 

Scar Tissue Awareness

The potential for scar tissue related complications, in general, has been ignored or viewed as having no consequence. It is time to bring scar tissue into the light.

Recognition of potential to disrupt the natural order of the body.

• It is very common that people with scars are frustrated and confused by the complications they experience
• People with scars have no idea that the pain, stiffness, decreased mobility, lack of sensation, and weakness are resulting from their scars
• Without an understanding of what is happening to them, they do not know to seek therapy. They are left to face a lifetime of pain and limitations
• The medical world needs to start recommending actual scar therapy not just hand out creams or lotions to deal with scar tissue

Preventing scar development at the onset of wound healing is the ultimate goal.

The external shape of human body is determined by the underlying bony skeletal framework, which the skin must cover. To conform to this complex shape, the skin must be both viscous and elastic to deform and return to its original shape. Mechanically, it needs to be both strong and flexible and scar tissue interferes with this. Scar tissue is only 70% as functional as normal tissue. So, it is not as strong as normal tissue, it is not as elastic as normal tissue and it will impede in the skin’s ability to reshape and reform around the skeleton which limits the range of motion, flexibility and causing other issues.

Scar Formation & Tension

It is a well-known surgical dictum that if wounds are closed under tension, scars stretch and worsen according to the magnitude and direction of the forces acting on them. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice or incision design.

This brings us to the Langer’s lines, relaxed skin tension lines and biodynamic excisional skin tension or BEST lines. Most people do not consider these lines with scar tissue and how it affects it but it’s exactly what needs to be considered in both when it comes time to close the wound and for therapy thereafter.

LANGER’S LINES
Langer’s lines which are skin tension lines, or cleavage lines, are named after the Austrian anatomist Karl Langer who first depicted them.

• They are topological lines drawn on a map of the human body.
• They correspond to the natural orientation of collagen fibers in the dermis, and are generally perpendicular to the orientation of the underlying muscle fibers.
• Skin lines are important when making and closing wounds.
• Ideally all wounds should be made parallel to Langer’s lines to optimize the cosmetic outcome.
• Wounds made across the lines of skin tension promote hypertrophic scarring and by wounds we’re talking incisions made by doctors.

The photo illustrates an example to show you that an incision perpendicular to cleavage lines may deep and delay the healing due to the pull from the tension in that area as opposed to the lower one where the incision line is parallel to the cleavage lines and is more likely to heal quickly because it doesn’t have the same amount of opposing force or tension on it.

RELAXED SKIN TENSION LINES (RSTL)

Relaxed skin tension line (RSTL) is a furrow created when the skin is pinched and relaxed in the absence of local tension. Relaxed skin tension lines (RSTL) versus other skin lines. This is why we don’t have as much scarring with the elderly as the tissue is losing its elasticity and there’s not much tension on it. However, as we know because of the lack of collagen that we have the elderly bruising more.

When Langer’s lines and RSTL lines run in the same direction over many parts of the body they are significantly different in mechanically complex areas such as the mouth corner and the temple.

BIODYNAMIC EXCISIONAL SKIN TENSION (BEST) LINES

Biodynamic excisional skin tension (BEST) lines have been derived by using tensiometer data (measure of muscle force) from patients undergoing skin excision. These show the optimal orientation of a skin excision to minimize tension across its closure.

While Langer’s lines run in a sagittal direction on the scalp, BEST lines run in a coronal direction. While RSTL/wrinkle lines run in a horizontal-oblique directions or on the limbs. On the lower limbs, BEST lines run in a vertical direction. So we need to keep in mind what type of wound, how the wound was formed, what the shape of the wound is and where the location of the wound is.

When it comes to closing the wounds and when it comes to treating the wounds, BEST lines appear to have a remarkable anatomical consistency of pattern across the human body. Following BEST lines can therefore be expected to reduce wound tension and improve both cosmetic results and surgical outcomes.

Plastic surgeons follow these principles in order to minize scarring. Whenever possible the patient would be given the option to request a plastic surgeon to close the wounds and they need to be educated in regards to how to take care of the wounds after the surgery.

Post Injury Management of Surgical Incisions

The management of a surgical incisions does not end when the sutures are removed. Surgical scar care should be continued for one year. Scar tissue is continued to be produced for up to 18 months after the initial wound so just taking the sutures out because the surface is closed is not where the care should stop. We need to continue to treat and look after the area.

When an incision, cutting, ripping, or puncturing injury occurs the tension from the adjacent intact skin pulls the free edges of the wound apart. In places where the wounded skin is under greater tension, the wound gapes more widely and heals more slowly, and the resulting scar is relatively large.

Also, another consideration is that a new scar is weaker than the adjacent tissue. Scar tissue does not function the same as normal skin and if we have the newest scars or are the weakest in other words if you multiple scars you have one scar you go back for more surgery or you fall again in the same area. This new scar is not as strong and it’s weaker than the original tissue so you have multiple lines of tension being set up with different poles and different forces going against the original orientation and function of the skin. Pushes and pulls that would have no effect on healthy parts of the body can reopen a healing wound, even when it is protected by a well-made dressing.

Similarly, if there is significant skin tension surrounding the wound (e.g. over a bent knee), the healing wound will not be able to seal tightly. This is a big consideration for rehab for things like a knee or a joint. It’s usually common practice in physical therapy, at least old school, to force flexion on the knee very early into the healing process which doesn’t give the knee enough time to heal the area in order to avoid scar tissue. Unfortunately, force flexion causes more scar tissue because pulls and it helps pull the wound open during the flexion.

Phases of Wound Healing

You can’t talk about scar tissue and not talk about the phases of wound tissue.

Inflammatory Response

Occurs approximately 1 week to 30 days after surgery, when reparative cells gather at the incision, creating the structure on which future scar tissue will grow. It is perhaps the most vulnerable phase of scar formation.

Proliferative Phase

Cells divide rapidly to produce collagen, which fills gaps made by the incision, and worsened by everyday management and other stresses on the wound. It’s the time of greatest scar tissue growth, occurring until about 45 days after surgery.

Remodeling Phase

The critical end-phase of tissue healing, when the wound closes and fills with dry scar tissue. Gaps caused by tension on the skin may continue to be filled by collagen, leading to wider, thicker, darker scars, setting the stage for complete healing that may take up to a year.

Wound Healing Best Practices

Wound healing phases are not discrete. The proliferation phase begins even before the inflammation phase has completed and continues even as remodeling has begun. The remodeling phase itself continues long after the sutures have been removed and the dressing abandoned. Because of this, the care of an incisional wound should be considered as a continual process, and minimizing scar formation should be a long-term goal.

There are important aspects of wound management that must be emphasized to encourage patient participation.

Wounds should be dressed/taped following Langer’s to off load the tension. This would significantly reduce the scar.

• Gentle Movement: We have a tendency not to move to stabilize and isolate the area and leave it alone until the wound is closed and this is not the greatest thing in the world. As the wound heals slow gentle movement with intent to prevent restriction should be included in the therapy in order to encourage the collagen to lay down in the proper direction.
• Proper Nutrition: the vitamins and minerals that play roles typically associated with wound healing include vitamin A, vitamin C, zinc, copper and iron. Proteolytic enzymes can effectively “digest” scar tissue

Therapy for Existing Scars

Let’s talk about therapy for existing scars whether they’ve been around for 3 months or 80 years. The biggest and most important thing about treating scars is proper education.

I can’t stress this enough. The internet is now flooded with inaccurate information about scar tissue and ways to cure it. For example, that scar tissue cannot be broken down nor can it be removed. Anyone who claims to breakdown scar tissue, we’re not talking about adhesions, does NOT understand what scar tissue is. Scar tissue replaces normal tissue that is damaged. I you break it down or if your intent is to break it down you’re essentially saying that you’re going to cause a new wound. The only person who can actually remove scar tissue is a surgeon with a procedure such as scar revision. While scar revision removes the tissue usually results in the same or worse scar within a year after the procedure.

Once again we must return to the issue at hand – understanding and respecting scar tissue. Therapies are being applied with a total lack of understanding of the physiology of scar tissue. Many therapies look to interrupt and/or stop the formation of scar tissue before it has had time to complete its job – to repair and stabilize the wound.

Instead of trying to impede the formation we should be assisting and guiding it. Helping the collagen to laydown in a cohesive pattern. In order to do this, we once again must take the lines of tension into consideration. If it is a recent surgery all procedures should be looking at how the tensions have been altered from the wound and the client’s everyday living movement.

If it is an older wound, how has the formation of the scar tissue altered the tension in the body and how has the body compensated for it?

There is little, or worse, no knowledge behind the events that caused the scars (i.e. surgeries, accidents, and what the corrective procedures actually did to the body). I see this all the time. Scar tissue is very popular. We have all the tools such as cupping, instrument assisted blades, all types of therapies now but you can not just focus on the scar as an individual thing and go to release the scar.

You need to know the surgery behind it and everything that has occurred to that person via that surgery/accident, what was the rehab before you start to release that scar. For example, if you have someone who has had a mastectomy and reconstructive surgery, you need to know all the different types of reconstructive surgery, and the specific surgery that person has undergone. If they’ve had a piece of their lat removed, a piece of their glutes removed, if they’ve had the deep procedure. Any of those things and how all of those things have resulted in effects on the body both physically and emotionally. And remember the majority of people who get something like a reconstruction after a mastectomy do not receive rehab. And this is a very big problem.

We need to know how will releasing the scar affect the body – physically and emotionally. Little or no attention is paid to the physiological and emotional trauma surrounding the events which have caused the scar. So while working on the scar a person can have any possible emotional reaction during the treatment, after the treatment, within a week of the treatment, and not understand what is going on. So you need to make them aware of the fact and you need to be aware of the fact that this is a possibility so they are prepared to cope with it. Remember it’s not the issue in the tissue, the issue is in the brain. The tissue with the scar is the trigger.

What rehab has to be done after the release to aid the body to return to optimal function?
Few look for the possible compensations the body may have complied in response to the restrictions and what releasing those restrictions without proper rehab would do. You can not just release the scar and alter the tension that the body’s been working under and say “have a nice day.” We have to consider what has been altered and we have to figure out and work with the body to bring it back, as close as possible, to its original settings so the body can function in the manner in which it was designed. Otherwise, it’s going to go right back to what it knows which is the compensations that are in place.

As with all diseases, disorders, and dysfunctions (yes, scar tissue is/can be a cause of dysfunction), the therapist needs to understand all the aspects of what they are working with before they lay hands on someone.

There are so many wonderful forms of therapy available today to help people on their journey to balance health and wellness. No one is better than the other, rather we have to find the right one, or combination thereof, that works for each individual. That being said, there is nothing more important than recognizing the effect scars are having on a person. Knowing what those scars are doing physically, mentally and emotionally is key to helping a person heal.

In order for any therapy to be fully effective, you have to clear and release any and all scars that are impeding the body’s function. In other words, scar tissue release is the first step then you may proceed with any and all therapies that resonate with the patient. 

Scars should not only be viewed as a symptom or end result of a wound/injury but as a cause/major factor in disease, disorders and pain.

》A B O U T   M A R J O R I E   B R O O K

Marjorie Brook, LMT is a massage therapist, author and international educator. She works from the fundamental belief that your body is intuitively aligned with the thoughts you think, the emotions that you feel and the things that you do. She founded Brooks Seminars in 2007 after working as a decade as a nationally recognized massage therapist with a private practice on Long Island. She is the creator of the Scar Tissue Release and Integrated Therapies (S.T.R.A.I.T Method) and offers continuing education courses on this method all over the world. Her articles have appeared in magazines such as Massage Today, American Fitness and Massage World. She’s approved by the National Certification Board for Therapeutic Massage and Bodywork, the Massage Therapy Association of Alberta and the College of Massage Therapists of British Columbia.

The post Scars: In the Line of Tension appeared first on Marjorie Brook, LMT.

One of the most important things you can do to prepare for surgery would be to boost and clear out your immune system by receiving Manual Lymphatic Drainage massage (MLD). MLD aids in cleansing the blood which allows greater circulation of oxygen and nutrients throughout the body. This will greatly aid in the process of recovery after surgery. Ideally, you should try and have at least one session weekly for 4 weeks prior to your surgery. Healthy immune systems also protect you from infection.

Proper nutrition and supplementation are also essential to the healing process. In addition, herbs and supplements are well known for assisting the body to heal following surgery or trauma.

• When taken prior to surgery, zinc reduces wound healing time, rapidly reduces wound size, and bolsters immune function to help ward off infection.
• Vitamin C is an important component for full post-operative recovery. According to the Australasian College of Nutritional and Environmental Medicine, vitamin C levels actually decrease in burn victims, post-op patients, and other victims of physical trauma. This vitamin is essential for the growth and mending of tissue throughout your body. It’s required to manufacture collagen, repair wounds, and make scar tissue.
• Vitamin A stimulates collagen synthesis and increases the strength of scar tissue so that it doesn’t tear.
• A deficiency in the B-complex vitamins can hinder your ability to heal from injury or surgery because these nutrients link collagen and deliver oxygen and nutrients to the site of injury. The University of Maryland Medical Center specifically indicates that thiamine and pantothenic acid, or vitamins B1 and B5, can heal wounds and promote skin health.

Always ask your naturopath or physician about which herbs or supplements may work best with your particular health circumstances. 

Increasing the intake of anti-inflammatory foods, spices, and alkaline water may help immensely. Foods such as dark green vegetables, garlic, onions, mushrooms, peppers, berries, seeds, nuts, metal-free fish, grass feed beef, organic eggs and chicken. Like vegetables, herbs and spices have anti-oxidant and anti-inflammatory abilities. Cinnamon, curcumin, turmeric, oregano, rosemary, olive, ginger, and green tea also help to reduce inflammation.

Immediately after surgery, the standard protocol is basically bed rest and nothing else. However, this is exactly when light massage therapy techniques such as MLD, myofascial release and visceral manipulation should be administered (never apply deep pressure techniques directly after surgery).

Compression bindings can aid in holding the collagen fibers together at the incision. It can reduce and prevent the incision from tearing.

Avoid excessive but not all movement. Gentle appropriate movement helps to prevent excessive scar tissue and keep scar tissue from limiting future movement. You need to introduce a simple tissue oriented range of motion while avoiding severe pulls or stretching of the wound as it heals. Tension (actions that separate or pull the area apart) on the wound, while it is healing, can impede the healing process can cause excessive scar growth.

It can take up to 18 months for wounds to completely heal. Once out of the initial healing phase (first 3 months) scar tissue release therapy should be sought out to help release and excessive scar tissue/adhesion build-up. Scar Tissue release therapies such as The S.T.R.A.I.T Method.

The Scar Tissue Release and Integrated Therapies Method is a progressive therapeutic approach to healing that recognizes the complexity of each individual. Utilizing a whole-person perspective, The S.T.R.A.I.T Method is a multi-disciplinary approach combining the therapeutic and rehabilitative modalities of fascial scar work, mind-body interactions, body mechanics, therapeutic stretching/strengthening and proprioceptive support to create a balanced treatment session designed to meet each clients’ goals and needs. Every person is different and therefore there can not be a one-modality-fits-all mentality.

Utilization of therapeutic stretching/strengthening can prevent fibrosis by stretching and loosening the injured areas, once any abrasions have healed. It helps to keep the tissue loose and prevents scar tissue from forming.

It is always important after there has been a restriction inactivity to correct any and compensations that may have formed. Body mechanics retraining from simply how to get out of bed to stand up from a sitting position is crucial to avoid any future adhesion formation through the entire body.

》A B O U T   M A R J O R I E   B R O O K

Marjorie Brook, LMT is a massage therapist, author and international educator. She works from the fundamental belief that your body is intuitively aligned with the thoughts you think, the emotions that you feel and the things that you do. She founded Brooks Seminars in 2007 after working as a decade as a nationally recognized massage therapist with a private practice on Long Island. She is the creator of the Scar Tissue Release and Integrated Therapies (S.T.R.A.I.T Method) and offers continuing education courses on this method all over the world. Her articles have appeared in magazines such as Massage Today, American Fitness and Massage World. She’s approved by the National Certification Board for Therapeutic Massage and Bodywork, the Massage Therapy Association of Alberta and the College of Massage Therapists of British Columbia.

The post The Best Way to Prevent and Reduce the Risk of Adhesions appeared first on Marjorie Brook, LMT.

You’ve had scars since you were little. Perhaps you fell off your bike when you were three. Maybe you got an injury playing football in high school. Perhaps you’ve constantly banged your hip into the desk and now you have a bruise that won’t go away. But these scars don’t impact you. They are no big deal – right? 

WRONG.

In fact, scar tissue is a majorly big deal. It’s something that most people including doctors, trainers, and coaches ignore. And yet it is a problem with the essential thing that keeps us together and makes us what we are – your connective tissue.

Your connective tissue is your skin and all the tissues three-dimensionally – front to back, top to bottom, inside and outside – all the way around your body is one giant piece of the issue. If anything is caught or kinked in that tissue then you have an issue because that tissue is supposed to move, slide, twist and bend in every possible direction. And even pull apart and come back together if you want to get really technical about it.

A Scars Impact Goes Beyond the Visible Scars

The problem is that if you have a scar then it is impacting your body. And this doesn’t just mean the visible surface scars you don’t like aesthetically on your body – it means any scar tissue that runs all the way through your body. The scar that you can see is just the tip of the iceberg. And we’re not even talking about just scars we’re talking about adhesions or anything that causes the tissue to stick together and not move the way it was meant to move. And we think – what’s the big deal. It’s a huge deal. And no one really addresses it.

The impact of scar tissue on the body is starting to garner some attention now but it’s still not enough. How often when you or someone you know has had surgery do you get information prior to the surgery regarding prepping for scar tissue or boosting the immune system. When you or the person you know are still at the medical facility or hospital following the surgery what type of information do you then get regarding scar tissue – none. And when they send you home what information do you get, aside from how to keep the wound clean and covered, – none. Do the doctors, nurses, or any of the medical practitioners speak with you about the build-up of scar tissue and all the steps you can take – no.

Sports Injuries and Adhesions

Let’s talk about if you have any injury. Say you play a sport or are a runner and you have tight hamstrings. Odds are you are going to still play the sport or go for a run. As long as you continue you’re building up adhesions and stuck tissue. And these adhesions impact the way you move. If you’re a runner, it impacts how fast you can run. If you’re a football player, it affects the way you are able to move down the field. If you’re a weightlifter or bodybuilder it impacts the way you work out and how your body builds muscle.

Scars, Adhesions & Everyday Life

For kids, they build up adhesions falling off their tricycle, playing sports, or even carrying their backpack to school. As adults or teenagers, we build up adhesions through everyday repetitive or static positions that lock up our tissues such as looking down at cellphones, laptops and tablets for extended periods of time.

All of these things come together to cause problems throughout every single system in our body. And that’s why it’s extremely important to work with scar tissue.

There are all types of things you can do for scar tissue such as hands-on techniques with a massage therapist. At my private practice, I created the Scar Tissue Release and Integrated Therapies method or S.T.R.A.I.T Method which focuses on healing scar tissue and adhesions in the body.

Unless we take the time to learn about it and actively do something, we’re just going to be stuck. Not only are we not changing but we’re going to go downhill from where we are currently.

》A B O U T   M A R J O R I E   B R O O K

Marjorie Brook, LMT is a massage therapist, author and international educator. She works from the fundamental belief that your body is intuitively aligned with the thoughts you think, the emotions that you feel and the things that you do. She founded Brooks Seminars in 2007 after working as a decade as a nationally recognized massage therapist with a private practice on Long Island. She is the creator of the Scar Tissue Release and Integrated Therapies (S.T.R.A.I.T Method) and offers continuing education courses on this method all over the world. Her articles have appeared in magazines such as Massage Today, American Fitness and Massage World. She’s approved by the National Certification Board for Therapeutic Massage and Bodywork, the Massage Therapy Association of Alberta and the College of Massage Therapists of British Columbia.

The post What is the Big Deal About Scars appeared first on Marjorie Brook, LMT.

The fact is, stretching is something that we do naturally. The question you really should be asking is “how should you consciously stretch?”

The first step in healing, exercise, and life is awareness. People tend to be disconnected from their bodies. They know they are in pain, tired or just not “as young as they used to be.” There is that feeling of something is not right or “off” with their body and they see the choice is either doctor visits and pills, or worse acceptance and coping. The truth is that these feelings are calls for help from the body and that is not getting through. For healing to begin the connection between mind and body needs to be reestablished.

What is Integrated Therapeutic Stretching

Integrated Therapeutic Stretching (or I.T.S) is an extremely effective stretching therapy that works with the body to figure out and correct what’s gone awry. The objective of ITS is to aid and empower the client with the tools to re-educate and maintain a balanced physiological and emotional system.

Whether you are rehabbing, training or just going through daily routines of life the body needs balance, it needs to be both flexible and strong. Unfortunately, in both rehab and life flexibility tends to be an afterthought, or it is the last step when it should be the first. One should never strength train a joint that does not have full ROM. If a muscle and surrounding fascia are restricted strength training can cause more of a restriction and possible damage to occur. On the flip side, one should never open up a restricted/adhered joint/muscle without understanding the reasons why it is tight. Is it compensating? If so why? Is there an injury? A disorder? Simply releasing a tightly restricted area without this knowledge can lead to the body’s stability being compromised.

Benefits of Integrated Therapeutic Stretching

Integrated Therapeutic Stretching is a system designed to help an individual achieve and maintain balance and well-being. It’s not strain/counter-strain, PNF (proprioceptive neuromuscular facilitation), or any of the other popular systems claiming increased flexibility and function by simply exhausting muscle fibers into laxity. Integrated Therapeutic Stretching teaches the individual how to stretch each muscle and the surrounding fascia distinctly (in non-loading positions), releasing the connective tissue while re-training each muscle to perform correctly, individually and cohesively within its muscle group.

Let’s face it; we all have times when our daily actions are less than beneficial for our health & wellbeing, whether due to trauma, exhaustion, improper training, or boredom. When that imbalance exists, our muscles learn to function incorrectly or to compensate. Without corrective stimulus, the compensation cycle continues to force the muscles into working inaccurately and inefficiently. We all need a simple and effective practice that helps our body to return to maximum performance, efficiency and wellness.

Another hindrance to balance and recovery is that what a person perceives as normal posture and movement is usually a skewed perception. When in pain or injured the body compensates in order to function. If these compensations are not corrected, then the compensation pattern is eventually perceived as the normal state of being by the brain. Since the body needs to continue to function, a person’s perception of straight is altered to believe the chronic restriction/misalignment is the norm and the norm is incorrect.

How many times have you straightened out a client who is laying crooked on your table only to have them say “Well now I feel crooked”? If we do not make our clients aware of how they are improperly moving then we will never truly be able to restore them to balance. The average person has no idea how to get out of bed, up out of a chair or how to bend over and pick up their keys. When you combine this with the body’s predilection for compensation the end result is pain and injury. I am not impressed by the perfect kettlebell swing if that same person cannot stand up straight and walk across the room without strain.

Therapists are just as guilty of these misperceptions. They tend to use muscle when they work instead of proper body mechanics which allows them to move with less effort, more efficiency. To become an extension of their clients rather than working on them.

When I teach the ITS, I literally find myself wrapping around the practitioner in order to retrain them on how to move. They have no clue that they are moving in cross forces from the client causing the client’s body to react, fighting against, instead of releasing with them. If the practitioner is unaware of what proper body mechanics are and that they themselves are incorrectly using their bodies, then how can they properly assist their clients on their journey back to health? For this reason alone, I decided to make the Integrated Therapeutic Stretching courses a pre-requisite for the advanced S.T.R.A.I.T Method Scar courses. Not only does it open the practitioner’s eyes to the importance of proprioception and body mechanics for themselves, but it also gives them the tools to educated and rehabs their clients once the tension of the scar tissue is released.

Once the connection between mind and body is reestablished through awareness the next step is empowerment.

Through specific, focused active stretching and strengthening, ITS helps re-educate the body on how to move the way it was designed, leading to increased joint range of motion (ROM), lymphatic and venous circulation. The emphasis is placed on building and maintaining muscular flexibility, strength, and endurance throughout the body. Since it is an active modality the client is given the power to aid in their own recovery. For some, it gives them back control over their bodies.

Massage/Physical therapists are expected to alleviate stress, help with relaxation, and relieve pain caused by injuries, repetitive use, and physical limitations. A therapist’s success in doing so often leads clients to view their therapist as a “cure-all.” Sooner or later, however, a therapist might be faced with questions from their clients such as: “Why does the pain keep coming back?” or “I feel better, but I am afraid to do anything that might start the pain again.”

If you would like to empower your clients to take an active part in their own health, consider incorporating Integrated Therapeutic Stretching into your practice.

How I.T.S Works

There are two primary principles that provide the basis for how ITS works.

The first is the mechanism of reciprocal inhibition and innervations working together. If you want to lift your arm, your nervous system has to shut off the muscles that bring your arm down (inhibition) while turning on the ones that lift it up (innervation). ITS works with your nervous system and in the process re-educate the muscles on how to function properly and how to utilize and maintain full ROM.

The second principle is to hold the stretch for 2 seconds. Holding a stretch for longer than 2.5 to 3 seconds triggers a protective stretch reflex in the muscle fibers, and the muscle you are trying to stretch contracts. By not tripping the stretch reflex, you are able to get a gentle stretch without having the bodywork against itself. The stretch is repeated multiple times in a set(s). The repeated “pumping” action of the muscle allows for increased circulation to the area. By targeting very specific angles of the muscle and promoting full ROM of the joint, the results are a highly efficient and effective stretch, affecting the muscles from origin to insertion. It reaches areas a therapist’s fingers and hands cannot go. With ITS, you can address injuries such as sprained ankles and pulled muscles as well as physical issues/disorders such as sciatica, multiple sclerosis, scleroderma, scoliosis, and paralysis. Most importantly, you give your clients the ability to fend off the multitude of physiological and psychological effects their disease or recurring injury is causing.

Client Success Stories

I have used ITS with success for clients ranging from children to seniors and presenting a broad range of problems. Below are the stories of two clients who experienced dramatic results with ITS.

Client Story 1: “Tom,” 49, suffers from multiple sclerosis (MS). When physical therapy and pain management no longer yielded results, his insurance company stopped coverage, leaving him house-bound without any means of therapy or aid. As a former college athlete, Tom was utterly frustrated at his loss of control over his own body.

When I met Tom, he was 60lbs overweight, wheelchair-bound, and depressed. I explained how ITS works and that I needed his help if the therapy was going to be successful. He looked doubtful but said he would do whatever he could. Since Tom was starting to experience drop foot and his ankles were very swollen, I started there. After showing Tom how to use the stretching strap to assist himself, I asked him to concentrate on lifting up his foot and giving a light pull on the strap at the end of the movie. While we worked together, his edema went down, and Tom started to get excited. The motor functionality in his feet started to improve, and Tom’s enthusiasm increased. As we progressed on to other areas of his body, I explained how he could perform the stretch on his own, and I also showed his wife how she could assist him. After two sessions, Tom insisted on coming to my office instead of having house calls. After six visits, Tom amazed and thrilled me by coming up the walkway to my office using his walker. His wife informed me with a big smile that he had been doing his exercises every day and his whole attitude had changed. Today, Tom has lost 40lbs, goes out with friends again and seems to have a new lease on life. He still has bad days and setbacks because of the MS, but with the help of ITS, he has the ability to slow down its progression and take some control back over his life.

Client Story 2: “Brad,” 13, has pectus excavatum (also known as sunken or funnel chest). Brad’s mother is a scar tissue release therapy client who sought relief from her c-section restriction and lower back pain. She asked if I thought I could do something for her son’s fingers, which had been broken two years prior and had not healed properly. As soon as I met Brad, I knew that his fingers were the least of his problems. Despite standing slouched forward, typical of many 13-year-old boys, I could clearly see that his right shoulder was internally rotated and basically stuck to his chest. The left side was rounded forward in compensation with the right. His arms were rotated outward, giving him the appearance of normal function. His head also jutted forward. As far as his fingers were concerned, the phalanges of the two middle fingers were truly sticking out. The fingers had never received any rehabilitation. After a few stretches, I showed Brad specific ITS stretching exercises and gave him a hand-exercise ball to take home.

Once his fingers were taken care of, I asked his mother to explain what was going on with his shoulder. Apparently, Brad had broken his collarbone coming through the birth canal. He was put in a sling and that was it. Over the years, she had asked the doctors if there was a problem with the way Brad’s shoulder was developing and the reply was always the same: “No that is just the way he is growing.” With her and Brad’s permission, I started to work on his shoulder. I gently went through the protocols for the shoulder and neck while explaining to him what I was doing and why. I made sure that he was actively involved in every aspect of the session. Within 20 minutes, Brad’s shoulder was no longer pressed against his chest and was already gravitating to its proper functional position. I gave him a homework assignment of stretch and strength exercises and went to work on his mom. While I was working on her, I could see Brad moving his shoulders around. When I asked him how they felt, he replied: “Weird, but in a good way.”

On Brad’s second visit, he told me that baseball practice was awkward at first because he kept overthrowing the ball until he got used to the way his shoulder was moving. On his third visit, he told me that his endurance was better. I asked him if he was able to take deeper breaths and get more oxygen into his lungs, and he said yes. His mother was happy that she no longer had to tell Brad to stand up straight. On his fourth visit, his mother told me with tears in her eyes how Brad was doing so well in basketball now that the other night he and his father would not come in out of the rain; they just kept shooting basket after basket. Brad continues to come once a week for stretching and strength training. All of his atrophied/undeveloped muscles are coming back to life, and he is learning how to use his body more effectively. Recently, he asked if we could start stretching his legs since the soccer season was starting up.

Incorporating ITS in Your Practice

It is always a challenge to introduce any new technique to your clients. People usually prefer the security of your established routine and are wary of anything new. It is slightly more so with ITS since it requires the patient to be an active participant. If a client is hesitant, you can start by introducing small sets of stretching at the beginning of the session before you start to massage. The cervical and wrist stretches can be performed with the client already undressed and on the table. You can also offer to stretch an area of injury or discomfort, like sciatica, before the client gets undressed as a free demonstration. Eventually, you can offer a half-and-half session where the client can be stretched first and then receive a massage. Once your clients experience the results of the stretching, they will be more inclined to book whole stretching sessions.

ITS is a simple and effective technique that helps to enhance performance, decrease the likelihood of injury and reduce muscle soreness. It helps to increase blood supply and lymphatic flow and the delivery of nutrients on a cellular level. ITS improves ROM of the joints and aids in neuromuscular re-education. Used therapeutically, ITS works with the body, not against it, and empowers clients to take an active role in their own well-being. Furthermore, it works hand-in-hand with scar tissue release, massage, and other bodywork techniques. Inspiring your clients to be active participants in their own healing process and maintaining their health is the most powerful effect of all.

》A B O U T   M A R J O R I E   B R O O K

Marjorie Brook, LMT is a massage therapist, author and international educator with a private practice located on Long Island, NY. She works from the fundamental belief that your body is intuitively aligned with the thoughts you think, the emotions that you feel and the things that you do. She founded Brooks Seminars in 2007 after working as a decade as a nationally recognized massage therapist with a private practice on Long Island. She is the creator of the Scar Tissue Release and Integrated Therapies (S.T.R.A.I.T Method) and offers continuing education courses on this method all over the world. Her articles have appeared in magazines such as Massage Today, American Fitness and Massage World. She’s approved by the National Certification Board for Therapeutic Massage and Bodywork, the Massage Therapy Association of Alberta and the College of Massage Therapists of British Columbia.

[updated august 2020]

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