Burn Physiotherapy Rehab Sunnybrook Magazine – Fall 2018

Orthopaedic rehab technique is improving quality of life for burn patients

Physiotherapist Lisa Giardino treats a burn patient in outpatient services at Sunnybrook's St. John’s Rehab.

(Photography by Kevin Van Passen)

New technique improves quality of life for burn patients in rehab

Thanks to a form of therapy typically used in orthopaedic rehabilitation, burn survivor Jerry Louvis, 46, now talks about regaining his strength. “I am much closer to where I was and what I was able to do.”

In spring 2016, Jerry was treated at the Ross Tilley Burn Centre at Sunnybrook for severe burns to most of his body from a chemical fire, receiving care as an inpatient at Sunnybrook’s St. John’s Rehab. By the summer, he was back at home but continuing to go to St. John’s Rehab for therapy appointments.

The goals of burn therapy include improving patients’ range of motion and function, minimizing contracture and supporting their social reintegration. Jerry had regained some muscle strength but felt that his movements were “wooden” and clumsy. An accomplished scientist with a very precise mind, he longed to be able to do things with more accuracy and finesse.

A year and a half later, he had surgery for heterotopic ossification – a condition that sometimes affects patients after severe burns or orthopaedic trauma – when bone grows in muscle or tendons, which can be painful and can significantly restrict movement.

During rehabilitation, Jerry received both standard manual therapy and a new approach called myofascial release technique. Standard manual procedures are helpful and effective and have been used for decades in burn rehabilitation. They involve scar massage, joint exercises, stretching, the use of pressure garments and silicone-based gels to treat scars, as well as splints to help control how a burn heals.

“More people are fortunately surviving larger burns, and there is greater need to help them improve their ability to move and carry out activities every day, [which] helps enhance their quality of life,” says Lisa Giardino, a physiotherapist in outpatient rehabilitation services at St. John’s Rehab.

Myofascial release techniques are a type of manual therapy used with orthopaedic patients – those recovering from conditions of the bones and joints. Lisa is now researching these techniques for the first time in patients with burn injury. Having worked with burn patients for 15 years, Lisa felt there was more that could be done to improve her patients’ outcomes.

It made sense to her that the same techniques used in orthopaedic recovery could be used to overcome the scarring caused by burn injuries. She set out to prove her hypothesis.

Scars can affect many aspects of the body, including muscles and fascial systems. Fascia, the layer of connective tissue under the skin that forms a network surrounding other kinds of tissues, including muscles, bones, blood vessels and organs, connects those tissues like woven fabric. Healthy fascia is relaxed and can glide easily over underlying tissues. Injuries to the body, such as burns, can restrict mobility of the fascia, causing tension and pain.

“Scars are like icebergs – what you see is only part of the story. The bigger part is how the scar has been laid down, underneath. You have to feel it to know,” says Lisa.

Myofascial release techniques involve loosening the fascia within the scar tissue, using massage. This technique frees up the scar from the underlying tissues, so those tissues can glide over each other more freely, making it more comfortable for the patient and restoring function.

“Considering the significant impact of burn injury on tissue integrity, using myofascial techniques to improve scar outcomes could be an innovative approach to burn care in patients with closed wounds,” Lisa points out. “Myofascial release techniques are a good enhancement to standard approaches. They’re another tool in a clinician’s toolbox.”

Patients often report that the techniques are gentle and comfortable. Some find it so restful they fall asleep. This new approach gave Jerry more range of motion that has since stayed with him. “I was a skeptic at first, but then I really noticed the difference. There I was, trying to move muscle that had been stuck for a year,” he recalls.

Over the next six to 12 months, Lisa will continue to measure changes in patients in terms of their range of motion, function, scar characteristics and quality of life to benchmark the use of myofascial release techniques in therapy. “Burn rehab is a team effort,” notes Lisa, who is collaborating with her colleagues and encouraging them to learn more about the technique.

“My ability to move has become a lot more refined since this type of therapy. I can now write, type and do repairs around the house,” says Jerry. “For me it’s about getting to the subtleties of range of motion – not just getting up in the morning, but instead, sitting up in bed with the confidence of knowing I can move with measure and precision.”

Below: range-of-motion outcomes for a 39-year-old patient with 11 per cent total body- surface-area burns who had myofascial release therapy for 30-minute sessions twice a week for 8 weeks.

Range-of-motion outcomes for a 39-year-old patient with 11% total body- surface-area burns who had myofascial release therapy for 30-minute sessions twice a week for 8 weeks