Conditions I Treat

On Scar Tissue

The formation of scar tissue is an important part of the body’s natural healing process.

Unfortunately, however, this protective measure can instead become an obstacle to wellness, and its mitigation via various protocols becomes necessary to both alleviate discomfort and return to full mobility.

While many people think of scar tissue as the visible indicator of a healed injury, often a laceration, the reality is that a vast majority of chronic pain and injuries are related to scar tissue.

Here’s a quick overview.

The formation of scar tissue is part of the body’s natural self defense and healing processes. In response to injuries, overuse, and even in defense of chronic use, the body produces a ‘band aid’ of sorts to protect the surrounding soft tissue – things like muscles, tendons, fascia, ligaments and even nerves. The scar tissue is, essentially, a connective tissue protein called collagen, and collagen is very strong and not easily broken down.

Often, even after the initial injury begins to feel better, some of this collagen – or scar tissue – remains in place, becoming an adhesion that restricts movement and mobility, and increases friction.

This eventually leads to the formation of additional scar tissue in response to the irritation as we continue to ‘push through’ our injuries, thus starting a cycle of entrenched and continually building scar tissue in these active areas.

With more scar tissue comes more friction, more inflammation, the creation of even more scar tissue, and increasingly restricted movement and discomfort. Over time, this can become a very painful condition that never seems to get any better.

The good news is there are ways to stop this cycle, mitigate the continual creation of scar tissue in response to the same initial injury or ailment, and get back to a largely original and healthy state.

To achieve this, and depending on the circumstance and exact nature of the injury, we can employ a variety of approaches including direct fascial manipulation and tool-assisted (e.g., Graston) techniques, Extracorporeal Pulse Activation Technologies (EPAT®) and Extracorporeal Shockwave Therapy (ESWT)  designed to effectively break up ingrained scar tissue, encourage increased blood flow and promote healing in the affected area. By doing so we can break the scar-response cycle and restore the patient to a normal and pain-free state.

Survivorship Rehabilitation

A Word From Dr. Nathanson

“It wasn’t long after I first began my studies that I started to see the enormous potential of applying my techniques to to aid, provide relief to and improve the lives of cancer survivors, especially those suffering from the effects of lymphedema. Over the years I have developed a series of proprietary treatment protocols which I believe have truly made a difference in the lives of many survivors, especially those suffering the trauma of breast-cancer related mastectomies. To be honest, it is possibly the most gratifying work I have ever done.”

The Physical Challenges of Cancer Survivorship

When a mastectomy is performed, many times both the breast and the axillary nodes (lymph nodes in the armpit area) are removed, and in many cases breast reconstruction takes place either immediately, or following a short post-recovery period. This has the potential to be both physically and psychologically traumatic.

One of the most commonly reported post-surgical occurrences is kinesiophobia – or a fear of movement. While this fear is, at the outset, often grounded in the very real physical restriction in the immediate post-surgical period. Later, as time progresses, the process of healing itself can compound this problem. This is because scar tissue inevitably begins to build up in the affected areas, which further restricts movement and can cause tension and discomfort. When this occurs, the initial psychological fear response is again triggered and movement is by choice decreased, without which the immobility is exacerbated.

“It’s kind of a Catch-22,” says Dr. Nathanson. “There’s a real initial reluctance to move after such an invasive procedure, which is understandable, but then over time, as the scar tissue begins to take hold and build up, the perceived restriction becomes a reality, the effects of which radiate into a number of related physical issues. Luckily, we can now attack the problem at its root by using the Graston technique in conjunction with the unique set of protocols I have been able to develop.”

Relief for Reconstructive Breast-Surgery Patients

Post-surgical reconstructive breast surgery is a common option for post-mastectomy patients who do not wish to wear a prosthesis, or who wish to regain symmetry or breast contour. While individual physical criteria determine when such reconstruction takes place, all of the reconstructive techniques involve considerable surgical manipulation which can lead to symptoms of discomfort and restricted movement.

Many techniques, for example, use the patient’s own tissue as material to construct the new breast. The majority of physicians feel that best way for the body to accept this newly-formed and relocated tissue is to make us of it without separating it from its blood supply. While this is a solid approach in terms of recovery, and a decrease in rejection, the tissue to be used is often harvested from either the patient’s abdomen (‘Abdominal Flap technique’) or trapezius muscle (‘Tram technique’) and ‘tunneled’ sub-dermally to the new location in the patient’s pectoral area. It is important to note that, although breasts are located above the pectoral muscles, reconstructed breasts are positioned beneath the pectoral sheath.

As such reconstructive techniques heal, scar tissue again forms not only in the pectoral area, but also along the ‘tunnels’ through which the tissue has been moved. As the scar tissue builds up and becomes less elastic once again, movement can be severely restricted, long with resulting tension, numbness and discomfort.

“While the results have been, in many cases, nothing short of remarkable, because of my experience in using the Graston® technique to address similar issues, I view applying it in this new and very specialized way as evolutionary, rather than revolutionary,” says Dr. Nathanson. “By applying soft-tissue procedures to the affected areas of breast reconstruction patients, and by restoring motion by breaking down the accumulated scar tissue, I have been fortunate in being able to provide relief for these people who have faced so many challenges. It is extremely gratifying.”

After Ten Years: A Difference and Hope Restored

Dr. Nathanson’s technique also is effective in relieving lymphedema, a condition of fluid retention that is a common side-effect of axillary dissection, and can lead to feelings of numbness, pressure and tingling in the extremities.

“I had a mastectomy over ten years ago, and had lost a great deal of mobility due to a build-up in scar tissue. I also had a persistent feeling of pressure beneath my arm, as well as numbness, which was largely a result of the lymphedema from the node removal,” says Maureen Gianni, one of Dr. Nathanson’s patients. “After ten years I figured that that was it; I was going to be that way for the rest of my life. But then Brian convinced me to try his technique and I’m pleased to report that the results were phenomenal! After only a few treatments I had regained much of my lost mobility, and I can also report greatly improved lymph flow. I really believe in what he’s doing and can honestly say that his techniques have made a tremendous difference in my life!”

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