Scars Change How We Move
The human body is incredibly resilient. It knows how to heal itself, and automatically takes steps to further reinforce an area after injury. Scars are a perfect example of this. Think back to an event that caused you to need stitches. Maybe it happened while you were playing sports, having a baby (C-section or episiotomy), or after having a surgery? At first the injured tissues are highly sensitive. This helps remind us to slow down and take extra care during this more fragile phase of healing. Then over time our tissues grow back together and eventually form a strong seal that keeps our skin from re-opening. Such reinforcement is provided primarily by type I and III collagen (1). These collagen fibers (and their supporting cells) create what we know as scar tissue.
Scar tissue is extremely important. It strengthens and supports previously injured tissues in order to promote optimal healing and decreases risk for future re-injury. Such remodeling begins within 1-3 months, reaching its fullest maturation period within 6-12 months, and continues on for another 18-24 months from the initial onset (1,2). The way in which these collagen fibers are laid down by the body is haphazard. Collagen and supporting cells don’t take into account how the injured tissue will eventually need to restore its former extensibility for optimal movement and range of motion once healed. Scar tissue’s only focus is to prevent the injured tissue from weakening and/or re-opening in the future. Thus, other interventions must be taken into account to help with remodeling of the scar tissue in order to achieve optimal reinforcement AND mobility post scar tissue maturation. Without adequate interventions, immobile scar tissue results in pain, loss of range of motion, and suboptimal movement patterns that can lead to other injuries (1-3). Most people have no idea how important scar tissue mobilization is for long term healing. This is where physical therapy comes in 😉
Research shows that scar tissue management, especially manual therapy interventions, dramatically improve scar tissue maturation, remodeling, and tissue extensibility (1-3). Soft tissue massage directly to the scar and bordering tissues significantly improves mobility and decreases sensitivity of the scar tissue over time (1-4). I find scar tissue massage techniques to be especially important for my post surgical patients and also for my mammas to assist with pain management and movement re-education. When scars are left untreated pain and movement restrictions often persist, which directly impacts the body’s ability to restore efficient movement patterns. Restricted scar tissue inhibits proper fascial gliding of surrounding tissues, which leads to the development of compensatory movement patterns as a result. Scar tissue massage is something that I do with my patients and also educate them on how to do this at home as part of their rehab program when needed.
I’m often asked, “When is the most ideal time to perform scar tissue massage?” My answer: as soon as your wounds are fully closed, and often throughout the first 6months, but note that there’s no expiration date on scars. The younger they are, the more malleable they are to interventions, but that doesn’t mean older scars can’t benefit from treatment. I’ve seen dramatic results with patients who have had injuries that were 10+ years old, and were amazed at how much scar tissue massage education helped improve their symptoms. It’s never too late to start!
If you’ve got a scar, and the surrounding tissues don’t seem to move very well, you’d likely benefit from some scar tissue work. I recommend patients start at one end of their scar, applying a firm amount of pressure while rubbing in line down the full length of the scar. You can do this with our without lotion. Then repeat by going perpendicular to the scar. When you find areas of the scar that are especially “sticky” or less elastic, focus more of your efforts on those locations (this is often the case at either end of the scar). This routine should take about 5-10min, 1-2x/day, depending on the length and stickiness of your scar. Try this for one month, and you’ll likely be surprised by how quickly you start to notice a difference in your tissues!
- Cho, Yoon Soo, et al. “The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial.” Burns8 (2014): 1513-1520.
- Arno, Anna I., et al. “Up-to-date approach to manage keloids and hypertrophic scars: a useful guide.” Burns7 (2014): 1255-1266.
- Hammer, Warren I. “The effect of mechanical load on degenerated soft tissue.” Journal of Bodywork and Movement Therapies3 (2008): 246-256.
- Laudner, Kevin, et al. “Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players.” International journal of sports physical therapy1 (2014): 1.