Scar tissue mobilization using myofascial needling

This patient in the video belowpresented to me two months following his second ACL reconstruction (as he tore through the first patellar graft).  Although the patients ROM was “reasonable” (I would have wanted full ROM by this time), he complains of a feeling of tension and discomfort around the scar.  Assessment of the knee demonstrated that the scar site was adhered to the underlying connective tissue causing abnormal fascial tension with flexion, as well as axial rotation of the knee.

In addition to utilizing FUNCTIONAL RANGE RELEASE™ treatment for scar development (in this case not referring to microscopic ‘adhesions’ but actual visual scarring), I utilize the demonstrated myofascial needling technique in order to induce cytoskeletal signalling and reorganization as per the work of Dr. Helen Langevin – associate professor in the department of Neurology, McGill University.  As I posted in my blog on June 3, 2010 which demonstrated the used of myofascial needling for treatment of medial tibial stress syndrome, her work focuses on unspecialized “loose” connective tissues that forming an anatomic network throughout the body which she hypothesizes functions as a body-wide mechanosensitive signaling network that is responsive to mechanical forces over different time scales.  Her work demonstrates the potential affect of needling fascial planes to alter fascial/connective tissue composition by creating small mechanical forces with needle manipulation (rotations) (Figure 1).  Such changes are produced by creating changes in cytoskeletal organization. (Figure 2)

Figure 1: Formation of a myofascial 'whorl' with needle rotation. Numbers 0-7 represent number of needle revolutions (Langevin & Yandow, 2002)

Figure 2: Summary illustration representing proposed active fibroblast response to acupuncture needle rotation. Needle rotation (B) causes winding of collagen fibers around the needle and formation of a ‘‘whorl’’ of collagen and fibroblasts in the area immediately surrounding the needle. With small amounts of needle rotation, pulling of collagen fibers towards the needle causes fibroblasts further away from the needle to respond by changing shape, becoming large and ‘‘sheet-like’’ in marked contrasts with the small cell bodies and longbranching processes (‘‘dendritic’’ morphology) seen without needle rotation (A). After needle rotation, a new tension equilibrium is achieved between actomyosin-driven intracellular tension (intracellular white arrows) and two types of opposing forces: extracellular matrix counter-tensional forces (extracellular black arrows) and intracellular compressive forces provided by the expanded cytoskeleton (intracellular black arrows)

Here are links to some of the relevant works by Dr. Langevin:

Langevin HM, Bouffard NA, Badger GJ, Churchill DL, Howe AK. (2006.) Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction-based mechanism. J Cellular Physiol 207(3):767-774.

Langevin HM, Bouffard NA, Badger GJ, Iatridis JC, Howe AK. (2005.) Dynamic fibroblast response to subcutaneous tissue stretch ex vivo and in vivo. American Journal of Physiology-Cell Physiology 288:C747-C756.

Langevin HM, Konofagou EE, Badger GJ, Churchill DL, Fox JR, Ophir J, Garra BS. (2004.) Tissue displacements during acupuncture using ultrasound elastography techniques.Ultrasound in Medicine and Biology 30: 1173-1183.

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