What is Scar Tissue?

Scar tissue replaces normal skin tissue after the skin is damaged. Though scar tissue is made up of the same substance as undamaged skin, it looks different because of the way the fibers in the tissue are arranged. Scars form every time the skin is damaged beyond its first layer, whether that damage comes from a cut, burn, or a skin condition like acne or a fungal infection. Though there are ways to minimize the appearance of scars, there is no way to remove them entirely.

How it Forms

Human skin is made up of three main layers, the epidermis, dermis, and hypodermis. When the dermis — the pink middle layer in the cross-section of skin — is injured, the body first responds by making blood clot in the area to close off the wound. After the blood clots, the body then sends in fibroblasts, a type of cell that helps rebuild skin tissue. These cells break down the clot and start replacing it with proteins, primarily collagen, that make up scar tissue.

Though both scar tissue and normal skin are made with these collagen proteins, they look different because of the way the collagen is arranged. In regular skin, the collagen proteins overlap in many random directions, but in scar tissue, they generally align in one direction. This makes the scar have a different texture than the surrounding skin. Scar tissue is also not as flexible as normal skin, and does not have a normal blood supply, sweat glands, or hair.

Types of Scar Tissue

How an individual scar looks depends on a few things, including the circumstances of the injury and a person's skin tone. For instance, a puncture wound causes a different looking scar than a burn wound, and whether the wound gets infected or not can also influence the appearance of the scar. A wound in a place where the skin is stretched tight, like the chest, often causes a thicker scar, since the body has to make more tissue to keep the wound from pulling open. Skin tone plays a role too. Though scars in general tend to turn white over time, those with dark skin may get scars that get darker with time. Those with darker skin may also be more prone to keloid scars.

There are five main types of scars:

Atrophic scars: These scars are sunken down into the skin. This type of scarring is often seen with acne scars or with wounds where skin or muscle is removed by an injury. This type of scarring can also happen when the body produces so much scar tissue in one area that it prevents new cells from growing where the wound took place.
Hypertrophic scars: These are usually red or purple and are slightly raised above the skin. They tend to fade and get flat over time.
Contracture scars: These types of scars often happen with burns, and end up pulling the skin in towards the site of the injury. This can make the skin look puckered around the wound.
Keloid scars: These are very elevated, red or dark scars that form when the body produces a lot of extra collagen in a scar. Keloid scars are actually a benign type of tumor, and often grow bigger than the area of the original injury. Those with darker pigmented skin are thought to be more prone to keloid scarring, but it's not clear why.
Stretch marks: Also called striae, these are considered a unique type of scar since they don't happen in response to an injury, but because of the skin being stretched rapidly, often during pregnancy or adolescence. The tissue here is often sunken a little into the skin, and tends to fade with time.

Preventing and Treating Scar Tissue

Though there is no way to entirely get rid of scar tissue aside from avoiding a skin injury, there are ways to minimize its appearance both while the wound is healing and after a scar has formed. Except for keloid scars, most scars will fade on their own even without treatment.

While the wound is healing:

Covering the wound with a bandage — This is particularly important before going out in the sun, since UV rays can cause the newly formed tissue to get discolored and may slow down the healing process.
Cleaning wounds properly — Doctors recommend cleaning a wound with a gentle soap and lukewarm water. Cleaning with hydrogen peroxide, alcohol, or iodine can all damage the newly forming cells and lead to a more noticeable scar.
Soothing gels — Rubbing aloe vera gel on the skin after the wound has closed can help lessen redness. Vitamin E gels are not recommended, since studies show that they are not very effective are minimizing scars.
Anti-itch cream — This can help with the urge to scratch or touch the healing wound, which could irritate it and make a more noticeable scar.
Pressure bandages — Some doctors say that putting a specific type of pressure bandage on a wound can help prevent the appearance of elevated scars since it pushes the collagen down. There are several different brand name versions of these bandages, which are often called scar therapy bandages or scar sheets.

Ways to minimize scars after they form:

Massage — Massaging a scar with lotion or a doctor-recommended gel can help fade many types of scars. This is particularly recommended for keloid scars, since this can keep them from getting sensitive and painful, and can help break down some of the built-up collagen.
Injections — Steroid injections may help with hypertrophic or keloid scars, and atrophic scars can sometimes be filled in with collagen injections. One downside to this type of treatment is that it is almost always temporary, and has to be repeated regularly.
Skin resurfacing — This can be done with lasers or with equipment that works like very fine sandpaper in a procedure called dermabrasion.
Cryotherapy — This is a technique of freezing the scar, and can reduce the appearance of keloid and hypertrophic scars.

In extreme cases, a doctor might recommend surgery. Though surgery can't get rid of a scar, it can make it less noticeable. Surgery is not recommended for hypertrophic or keloid scars though, since it can make them worse. Another type of treatment for severe scars is radiation therapy, which can sometimes reduce keloid and hypertrophic scars.

This article originally appeared on wisegeekhealth.com

Brachial Plexus Injury: A Nerve Injury You Shouldn't Ignore.

The brachial plexus is the network of nerves that sends signals from your spine to your shoulder, arm and hand. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord.

Minor brachial plexus injuries, known as stingers or burners, are common in contact sports, such as football. Babies sometimes sustain brachial plexus injuries during birth. Other conditions, such as inflammation or tumors, may affect the brachial plexus.

The most severe brachial plexus injuries usually result from auto or motorcycle accidents. Severe brachial plexus injuries can leave your arm paralyzed, with a loss of function and sensation. Surgical procedures such as nerve grafts, nerve transfers or muscle transfers can help restore function.
 

Symptoms

Signs and symptoms of a brachial plexus injury can vary greatly, depending on the severity and location of your injury. Usually only one arm is affected.

Less severe injuries

Minor damage often occurs during contact sports, such as football or wrestling, when the brachial plexus nerves get stretched or compressed. These are called stingers or burners, and can produce the following symptoms:

• A feeling like an electric shock or a burning sensation shooting down your arm
• Numbness and weakness in your arm

These symptoms usually last only a few seconds or minutes, but in some people may linger for days or longer.

More-severe injuries

More-severe symptoms result from injuries that seriously injure or even tear or rupture the nerves. The most serious brachial plexus injury (avulsion) occurs when the nerve root is torn from the spinal cord.

Signs and symptoms of more-severe injuries can include:

• Weakness or inability to use certain muscles in your hand, arm or shoulder
• Complete lack of movement and feeling in your arm, including your shoulder and hand
• Severe pain

When to see a doctor

Brachial plexus injuries can cause permanent weakness or disability. Even if yours seems minor, you may need medical care. See your doctor if you have:

• Recurrent burners and stingers
• Weakness in your hand or arm
• Weakness in any part of the arm following trauma
• Complete paralysis of the upper extremity following trauma
• Neck pain
• Symptoms in both arms
• Symptoms in upper and lower limbs

It's important to be evaluated and treated within six to seven months after the injury. Delays in treatment may compromise outcomes of nerve surgeries.

Causes

Damage to the upper nerves that make up the brachial plexus tends to occur when your shoulder is forced down while your neck stretches up and away from the injured shoulder. The lower nerves are more likely to be injured when your arm is forced above your head. These injuries can occur in several ways, including:

• Contact sports. Many football players experience burners or stingers, which can occur when the nerves in the brachial plexus get stretched beyond their limit during collisions with other players.
• Difficult births. Newborns can sustain brachial plexus injuries when there are problems during birth, such as a breech presentation or prolonged labor. If an infant's shoulders get wedged within the birth canal, there is an increased risk of a brachial plexus palsy. Most often, the upper nerves are injured, a condition called Erb's palsy. Total brachial plexus birth palsy occurs when both the upper and lower nerves are damaged.
• Trauma. Several types of trauma — including motor vehicle accidents, motorcycle accidents, falls or bullet wounds — can result in brachial plexus injuries.
• Inflammation. Inflammation may cause damage to the brachial plexus. A rare condition known as Parsonage-Turner syndrome (brachial plexitis) causes brachial plexus inflammation with no trauma and results in paralysis of some muscles of the arm.
• Tumors. Noncancerous (benign) or cancerous tumors can grow in the brachial plexus or put pressure on the brachial plexus or spread to the nerves, causing damage to the brachial plexus.
• Radiation treatment. Radiation treatment may cause damage to the brachial plexus.

Risk factors

Participating in contact sports, particularly football and wrestling, or being involved in high-speed accidents increases your risk of brachial plexus injury.

Complications

Given enough time, many brachial plexus injuries in both children and adults heal with no lasting damage. But some injuries can cause temporary or permanent problems:

• Stiff joints. If you experience paralysis of your hand or arm, your joints can stiffen, making movement difficult, even if you regain use of your limb. For that reason, your doctor is likely to recommend ongoing physical therapy during your recovery.
• Pain. This results from nerve damage and may become chronic.
• Loss of feeling. If you lose feeling in your arm or hand, you run the risk of burning or injuring yourself without knowing it.
• Muscle atrophy. Slow-growing nerves can take several years to heal after injury. During that time, lack of use may cause the affected muscles to break down (degenerate).
• Permanent disability. How well you recover from a serious brachial plexus injury depends on a number of factors, including your age and the type, location and severity of the injury. Even with surgery, some people experience permanent disability, ranging from weakness in the hand, shoulder or arm to paralysis.

To diagnose your condition, your doctor will review your symptoms and conduct a physical examination.

To help diagnose the extent and severity of a brachial plexus injury, you may have one or more of the following tests:

• Electromyography (EMG). During an EMG, your doctor inserts a needle electrode through your skin into various muscles. The test evaluates the electrical activity of your muscles when they contract and when they're at rest. You may feel a little pain when the electrodes are inserted, but most people can complete the test without much discomfort.
• Nerve conduction studies. These tests are usually performed as part of the EMG, and measure the speed of conduction in your nerve when a small current passes through the nerve. This provides information about how well the nerve is functioning.
• Magnetic resonance imaging (MRI). This test uses powerful magnets and radio waves to produce detailed views of your body in multiple planes. It often can show the extent of the damage caused by a brachial plexus injury and can help assess the status of arteries that are important for the limb or for reconstruction of it. New methods of high-resolution MRI, known as magnetic resonance neurography, may be used.
• Computerized tomography (CT) myelography. Computerized tomography uses a series of X-rays to obtain cross-sectional images of your body. CT myelography adds a contrast material, injected during a spinal tap, to produce a detailed picture of your spinal cord and nerve roots during a CT scan. This test is sometimes performed when MRIs don't provide adequate information.
• Angiogram. If your doctor suspects that the blood vessels feeding your arm might be injured, he or she might suggest an angiogram — an imaging test where contrast material is injected into an artery or vein to check the condition of your blood vessels. This information is important in planning your surgical procedure.
  
  This article originally appeared on mayoclinic.org

If We Can't Stretch Fascia, What Are We Doing?

When Ida Rolf (developer of the profound therapy, Rolfing) began putting her hands and elbows on people’s skin and applying pressure, creating a slow, sustained stretch, she imagined that she was stretching fascial sheets. Generations of manual therapists have followed her thinking, accepting this explanation to account for the changes felt in tissue tension beneath their hands and the sensations experienced by those who receive this type of therapy.

Ideas change over time

Much of manual therapy has grown largely out of anecdotal experience and tradition. Without the means to directly observe or measure what happened inside of the body, explanations for results had to be created from the “outside” and have largely been guesswork. As manual therapy has moved forward, an interest in understanding exactly how touch affects the body has led to a growing interest in research. With research has come the realization that many explanations of the past are not supported by evidence and are sometimes contradicted by evidence. Science-minded manual therapists have learned to adapt to this information, dropping outdated hypotheses and unsupported claims. While some have found it disconcerting to have cherished notions disproved, others have embraced knowledge and have adapted their conceptual models to fit what is known. They may continue to use modalities that have produced desired results but their understanding of how that comes about changes to fit the evidence.

Such a change is happening in the field of “fascial” therapy. 

When Rolf began her groundbreaking work in manual therapy, she devised a hypothesis in an attempt to explain how changes created by her contact came about. However, in recent years, evidence has challenged those explanations. Robert Schleip, Ph.D., was one of the key organizers of the first Fascia Research Congress and is a highly respected researcher. He is credited with discovering minute contractile fibers in fascia, a discovery whose clinical relevance has not yet been demonstrated but still excited many in the world of fascial therapy just the same. In his two-part article, “Fascial Plasticity: a new neurobiological explanation,” published in 2003 in the Journal of Bodywork and Movement Therapies, Schleip points to studies which contradict the notion that we can change the shape of fascia with our hands. One study found that collagen fibers would only begin to stretch shortly before they reached the breaking point, something that would not be desirable in a living human being. In other studies, Schleip, Trager, and others have done Rolfing under anesthesia and found that it produced no results. If the application of manual pressure had the ability to stretch fascia, there should have been a change in spite of anesthesia blocking any neural response. Why, then, was there no change when anesthesia took the nervous system out of the picture?

A neurobiological explanation

If we aren’t stretching fascia, then how do we account for the “release” felt by both the practitioner and the subject? Schleip and others have suggested that the change in tonus is not achieved by an alteration in the shape of fascia but is instead controlled by the nervous system. Schleip suggests that one possible mechanism of change brought about by sustained manual pressure could be the Ruffini corpuscles.

Why Ruffini corpuscles? Clinically, we observe that applying a slow, extended stretch to the skin can create desirable changes both locally and centrally, decreasing tension in the area where the hands are applied as well as creating an overall sense of relaxation. Ruffini corpuscles respond to lateral skin stretch, that is, stretching the skin tangentially or along the same plane as the tissue below. They are slow-adapting, meaning that they continue firing for as long as the stretch is sustained, unlike some mechanoreceptors which respond briefly to new stimulation and then stop responding if it continues.

We know that when we apply our hands to the skin of the body, we stimulate mechanoreceptors. Impulses are sent through the sensory nerves to the brain. The brain evaluates and responds, sending out impulses of its own through nerves to various parts of the body, causing changes to occur in the diameter of blood vessels, breathing, muscle tonus. If it likes our touch, it can create the changes we associate with relaxation, release of tension, and can decrease the sensation of pain. If it feels threatened by our touch, it will do the opposite. As manual therapists, we are always trying to create changes that make the body feel at ease. We can achieve this through the nervous system.

The nervous system is constantly monitoring its environment, responding to a complex array of input. It would be naive and simplistic to think that response to our touch could be reduced to one set of mechanoreceptors or to ignore all the other countless factors. However, when examining the kind of manual therapy we have come to think of as "fascial," understanding the role of Ruffini corpuscles is a good place to start.

Why does it matter?

Does it matter whether we believe we are stretching fascia or not? It matters that we think accurate thoughts about how the body works and what effect our touch has on the body. Understanding how the body actually works will help us work more effectively.

We may still use our hands in ways that we have before. If those methods work to achieve the client's goal, there is no need to abandon them. However, we want to know that how we think about what we are doing is accurate and we want to be able to communicate honestly with our clients. If we discover that our conceptual model is contradicted by what is known about how the body works, then it is time to adapt our model so that our thinking is in agreement with evidence.

Manual therapists need not feel threatened by the news that we cannot stretch fascia. A growing number of Rolfers, practitioners of myofascial release, and related modalities are continuing to use their hands in the ways that have worked for them in the past while adapting their thinking to an updated neurobiological explanation. Many have found that this shift to thinking about the role of the nervous system in manual therapy has led to new, even more effective approaches.
 

A thought experiment

Schleip proposes an interesting thought experiment. During the time it took to read this article, one’s bottom, if seated, is subjected to more pressure over a longer period of time than most therapists will apply to the hips of a client. Yet most of us are not all stretched out and droopy from daily sitting for extended periods of time. Think about it.

This article originally appeared on www.massage-stlouis.com and was written by Alice Sanvito, LMT

Headaches: Causes, Diagnosis and Treatments

Headaches are one of the most common complaints, and most people experience them at some point in their life. They can affect anyone regardless of age, race, and gender.

The World Health Organization (WHO) reports that almost half of all adults worldwide will have experienced a headache within the last year.

A headache can be a sign of stress or emotional distress, or it can result from a medical disorder, such as migraine or high blood pressure, anxiety or depression. It can lead to other problems. People with chronic migraine headaches, for example, may find it hard to attend work or school regularly.

Migraines, cluster headaches, and hangovers are some of the causes of headaches.

Contents of this article:

1. What causes a headache?
2. Types of headache
3. Diagnosis
4. Treatment

What causes a headache?

Headache is a common complaint worldwide.

A headache can occur in any part of the head, on both sides of the head, or just in one location.

A headaches can radiate across the head from a central point or have a vise-like quality. They can be sharp, throbbing or dull, appear gradually or suddenly. They can last from less than an hour up to several days.

There are different ways to define headaches. The International Headache Society (IHS) categorize headaches as primary, when they are not caused by another condition, or secondary, when there is a further underlying cause.

Primary headaches

Primary headaches are stand-alone illnesses caused directly by the overactivity of, or problems with, structures in the head that are pain-sensitive.

This includes the blood vessels, muscles, and nerves of the head and neck. They may also result from changes in chemical activity in the brain.

Common primary headaches include migraines, cluster headaches, and tension headaches.

Secondary headaches

Secondary headaches are symptoms that happen when another condition stimulates the pain-sensitive nerves of the head.

A wide range of different conditions can cause secondary headaches.

These include:

Eating something very cold can lead to a "brain freeze."

• An alcohol-induced hangover
• Brain tumor
• Blood clots
• "Brain freeze," or ice-cream headaches
• Carbon monoxide poisoning
• Concussion
• Dehydration
• Glaucoma
• Influenza
• Overuse of pain medication, known as rebound headaches
• Panic attacks
• Stroke

As headaches can be a symptom of a serious condition, it is important to seek medical advice if they become more severe, regular, or persistent.

For example, if the headache is more painful and disruptive than previous headaches, worsens, or fails to improve with medication or is accompanied by other symptoms such as confusion, fever, sensory changes, and stiffness in the neck, a doctor should be contacted immediately.

Types of headache

The symptoms of a headache can depend on the type.

Tension-type headaches

Tension-type headaches are a common form of primary headache.

The person can feel as if they have a tight band around the head, with a constant, dull ache on both sides. The pain may spread to or from the neck. Such headaches normally begin slowly and gradually in the middle of the day.

Tension-type headaches can be either episodic or chronic. Episodic attacks are normally a few hours in duration, but can last for several days. Chronic headaches occur for 15 or more days a month for a period of at least 3 months.

Migraines

Migraine is the second most common form of primary headache and can have a major impact on the life of an individual. According to the WHO, migraine is the sixth highest cause of days lost due to disability worldwide. A migraine can last from a few hours to between 2 and 3 days.

A migraine headache may cause a pulsating, throbbing pain on one or both sides of the head. The aching may be accompanied by blurred vision, light-headedness, nausea, and sensory disturbances.

Rebound headaches

Rebound or medication-overuse headaches are the most common secondary headache.

They stem from an excessive use of medication to treat headache symptoms. They usually begin early in the day and persist throughout the day. They may improve with pain medication, but worsen when its effects wear off.

Rebound headaches can cause a range of symptoms, and the pain can be different each day. Along with the headache itself, rebound headaches can cause neck pain, restlessness, a feeling of nasal congestion, and reduced sleep quality.

Cluster headaches

Cluster headaches are a less common form of primary headache. They strike quickly, one or more times daily around the same time each day and often without warning.

They usually last between 15 minutes and 3 hours, and they persist for the duration of what is known as a cluster period, which normally lasts 6 to 12 weeks.

The pain caused by cluster headaches is severe, often described as sharp or burning, and it is normally located in or around one eye.

The affected area may become red and swollen, the eyelid may droop and the nasal passage on the affected side may become stuffy and runny.

Diagnosis

A doctor will usually be able to diagnose a particular type of headache through a description of the condition, the type of pain and the timing and pattern of attacks.

It may be a good idea to keep a diary detailing the symptoms of regular headaches and any possible triggers. This can help both the patient and the doctor in identifying the exact nature and possible cause of the headaches.

If the nature of the headache appears to be complex, tests may be carried out to eliminate more serious causes.

Further testing could include blood tests, X-rays, and brain scans, such as CT and MRI.

Treatment

The most common ways of treating headaches are rest and pain relief medication.

Generic pain relief medication is available over the counter (OTC), or doctors can prescribe preventative medication, such as tricyclic antidepressants, anti-epileptic drugs, and beta blockers.

It is important to follow the doctor's advice because overusing pain relief medication can lead to rebound headaches.

The treatment of rebound headaches involves the reducing or stopping pain relief medication.

In extreme cases, a short hospital stay may be needed to manage withdrawal safely and effectively.

Self-care

A number of steps can be taken to reduce the risk of headaches and to ease the pain if they do occur:

• Apply a heat pack or ice pack to your head or neck, but avoid extreme temperatures
• Avoid stressors, where possible, and develop healthy coping strategies for unavoidable stress
• Eat regular meals, taking care to maintain stable blood sugar

A hot shower can help, although in one rare condition hot water exposure can trigger headaches.

Exercising regularly and getting enough rest and regular sleep contribute to overall health and stress reduction.

Several alternative forms of treatment for headaches are also available, but it is important to consult a doctor before making any major changes or beginning any alternative forms of treatment.

Acupuncture is an alternative therapy that may help relieve headaches.

Alternative approaches include:

• Acupuncture
• Cognitive behavior therapy
• Herbal and nutritional health products
• Hypnosis
• Meditation

(Research: Acupuncture and Migraine)

Sometimes, a headache may result from a deficiency of a particular nutrient or nutrients, especially magnesium and certain B vitamins.

Nutrient deficiencies can be due to a poor quality diet, underlying malabsorption issues, or other medical conditions.

Anyone with a suspected nutrient deficiency should work with a qualified health professional to diagnose and correct the deficiency in a sustainable and holistic way, rather than relying on an isolated supplement.

The WHO points out that headaches are often not taken seriously because they are sporadic, most headaches do not lead to death, and they are not contagious.

They call for more resources to be allocated for the treatment of headache disorders, because of the huge health burden they represent.

This article originally appeared on medicalnewstoday.com Written by James McIntosh