I recently had an email conversation with a HawkGrips course attendee that I thought could be of interest to many readers. With the permission of the attendee, who is a physical therapist, I’ve reproduced our discussion below.
Hello, I completed the HawkGrips course in Minneapolis on Jan. 21, 2017, which was instructed by Ted Forcum, DC, DACBSP, CES, PES, CSCS. I have a question pertaining to use of the tools post-operatively. I’ve been using the “framing technique” with a patient nearly right after surgery, treating around the incision to work on the scar tissue. However, I’ve had colleagues completely stay away from using the tools after surgeries out of fear. Are my colleagues right? Should I be staying away from the surgical site with the tools? Also, when is it safe to do some light work over the incision on post-op patients? Thank You!
Dr. Aaron Wickboldt, PT, DPT, OCS, Courage Kenny Rehabilitation Institute, Part of Allina Health
Hi Aaron, I’m a big proponent of starting cross-friction massage very soon after surgery! As long as you are staying pretty far away from any open wounds to avoid infection, it’s perfectly safe to perform light massage using instruments to help limit and prevent scar tissue. Are your colleagues doing cross-friction massage that early, just not with tools? Anytime you are using your fingers, you can use instruments instead. You would just vary your treatment angle and pressure to keep the treatment light and superficial, and therefore less intense for the post-op patient.
Once that incision is closed with no fear of it opening up, go ahead and start the cross-friction massage using instruments. I might start out with my fingers first, just to test that it’s fully healed (about 6-8 weeks). The tools are a little bit more intense so the incision, and your patient, will thank you for getting them comfortable with your fingers before introducing instruments.
I hope that helped answer your questions! When in doubt, you can consult with the operating physician. However, I’ve come across physicians who say that I can do cross-friction massage but that instruments would be too much. I personally disagree since I can vary the pressure and treatment goals with instruments, just like my hands! I recommend educating the physician on this fact. The only limitation I’d mention is to not do this over internal sutures or surgical hardware. The former needs time to set and heal, while the latter doesn’t present much of a target for soft tissue massage and can be quite painful to the patient. Let me know if you have further questions!
Dr. Wickboldt’s Reply:
Thanks for the quick response. I love the way you think. I’ve been using the tools with most of my post-op patients since the course and all of them love it. I’ve also been working over the incision, very lightly, and have had no complications, just reduced scar tissue! I only questioned myself because a few of my colleagues have been pretty conservative post-op and I was worried about being too aggressive. But I always work within patient comfort and response. Like you said, if you’re doing it with your hands post-op, why not with the tools? Thanks again!
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