Scar tissue prevention, reduction and management through massage

massage
Written By Skylar Haven

Scars are visible manifestations of the amazing self-healing capacity of our body and aspects of our stories. Unfortunately, scar tissue can have a range of unwanted functional or cosmetic impacts. This post will share information about the impacts of scar tissue and the benefits of massage as a support for successful scar tissue formation and for reducing unwanted cosmetic and functional side effects in old scar tissue.

What is scar tissue?

Scar tissue itself is the result of the body forming new collagen fibers to knit together tissues which have been damaged. This can occur as part of a planned surgery or an unplanned. The resulting tissue is less elastic than the original tissue and generally has a different texture and appearance than the surrounding tissue. 

There are different types of scars including

  • Hypertrophic scars
    generally thick, raised, red scars that tend to regress over time

  • Keloid scars
    thick raised smooth and often shiny scars that grow bigger than the original wound

  • Atrophic scars
    form an indentation and thinner area of skin

  • Contracture scars
    often formed as a result of injuries at joints or in skin folds, the tissues pull together, tightening and restricting movement

  • Adhesions / fibrosis
    internal scar tissue that joins tissues in the body together that were not originally directly connected. This can occur as the result of surgery, liposuction, infections, inflammation, joint overuse, and more. It is sometimes palpable as hard spots under the skin and can visibly impact skin texture such as in the case of liposuction.

  • Stria
    otherwise known as stretch marks, these are breaks in the connective tissue which occur as the skin rapidly shrinks or grows such as during adolescence, pregnancy, or bodybuilding.

Physical and psychological effects of scar tissue

Scars have numerous physical and psychological impacts. The cosmetic appearance of a scar is just one of many aspects of the physical impact of scars. The impacts may be felt in the area of the scar or much further away. Scar tissue may be numb or have an increased sensitivity to pain. It can lead to disruptions in the flow of communication in the nervous system which may impact sensation, blood circulation, temperature, pain, nearby muscle tone or strength and even disruptions in parts of other body systems such as organ functioning, digestive functioning, and sexual functioning. The reduced elasticity and joining of tissues together may lead to areas of chronic tension, palpable hardening, reduced mobility and more. 

Scars can also have complex psychological impacts often related to the story behind the scar, how we feel about the appearance of the scar and potential unwanted physical side effects of the scarring. Each person forms a different relationship with their body and scars. A rage of reactions from gratitude or joy at being alive to shame, grief, or even indifference are all common responses.

Benefits of scar tissue massage

Massage therapy can offer valuable support throughout the lifecycle of wound healing and scar tissue formation. The exact approach will differ depending on the health of the person, the planned intervention and any advice from the person’s medical team. It is important to consult your doctor prior to starting with any type of massage therapy.

Prior to looking at how scar tissue massage can help before and after an operation, procedure or unplanned event, it’s useful to have a basic understanding of the stages of wound healing in order to better understand the benefits of scar tissue massage.

4 stages of wound healing

There are 4 recognized stages of wound healing:

  • Homeostasis (in the first seconds and minutes)
    Begins immediately and the focus is on stopping blood loss through clotting 

  • Initial Inflammation (1-4 days)
    Occurs as the body's immune response works to prevent infection

  • Proliferation (beings 2-3 days after injury, lasting up to 6 weeks)
    New tissue begins to form to bridge the wound

  • Remodeling (months to years)
    The tissue continues to adapt and in healthy scar formation moves from being red and prominent to thin and pale. During this period nerve growth and vascular functioning in the tissue continues to adapt. During the first year, scars are classified as immature and will have a different texture and color than a scar which is older than a year and classified as mature.

Preparing for surgery with massage and Manual Lymphatic Drainage (MLD)

Prior to a planned surgical intervention, massage therapy is used to stimulate relaxation and to improve the flow of the lymphatic system which optimises recovery time and healthy scar tissue formation. Ideally, 2-3 sessions will occur in the week of the planned intervention. 

How Manual Lymphatic Drainage reduces pain and speeds healing

Manual Lymphatic Drainage is an incredibly gentle technique that is relaxing and improves and speeds the flow of lymphatic drainage and reduces risk of infections. This reduces the swelling associated with fluid buildup as the body is able to clear out toxins and waste products more efficiently. Reduced fluid buildup reduces inflammation which is critical for healthy wound healing and scar formation. The reduction in inflammation also results in less pain which also helps to decrease stress and tension levels and makes it easier to move which supports the needed blood flow to speed tissue repair. MLD before and after an operation helps to optimize recovery time and can have a significant influence on the speed of recovery as well as on the healthy formation of scar tissue.

Post-operative massage therapy in the first weeks after an operation

In the first month after an operation, it is advisable to continue with manual lymphatic drainage between 1 and 3x per week. In between sessions it is possible to use lymphatic taping to continue to support the healing process. Additionally, your massage therapist may teach you some gentle self-massage techniques that you can use at home. 

Massage therapy after the first month after surgery

As soon as the scabs from a wound have fallen off, connective tissue massage (bindgewebsmassage) and myofascial techniques including cupping therapy can be used to prevent and reduce build up of adhesions and fibrosis. The techniques will begin gently and may build in intensity over time to best support the desired outcomes. Additionally, MLD, taping gentle movement exercises and silicone gel pads may be indicated to support optimal healing and scar tissue formation.

The functional and cosmetic impact of Connective Tissue Massage (CTM) / Bindgewebsmassage for scar tissue

Connective tissue massage and myofascial release offer a range of specialised massage techniques that focuses on releasing tension and adhesions within the connective tissue. It ranges from gentle superficial techniques to deeper and more intense techniques. The nervous system runs through connective tissue and keeping this tissue as supple as possible helps healthy nerve formation which supports functioning of internal communication. This results in better outcomes related to sensation, pain, and circulation. Through preventing or breaking up adhesions, stimulating healthy collagen formation, improving blood supply and stimulating the body's natural healing mechanisms, healthy tissue formation is optimized, pain is reduced and muscle tone, mobility and cosmetic appearance of skin can be positively impacted. 

Massage therapy and mature scars

Many people do not know about or have access to the resources needed for massage therapy during the initial healing period. They may come for treatment after months or years to address cosmetic or functional concerns related to scarring. In these cases, connective tissue massage, myofascial release, cupping therapy and in some cases needling can offer significant improvements in the appearance and texture of a scar and surrounding tissues as well as reduce pain or numbness, improve mobility and restore a degree of nervous system functioning. 

Pre and post-operative scar treatment
at Collaborative Motion

In my practice, I offer support for navigating planned and unplanned scars. This can be physical or psychological / emotional support throughout a whole journey from pre-operative to post-operative support or only for a specific part of it. A few examples of types of scars that can be treated:

  • Scars from surgical interventions
    including c-sections, top surgery, liposuction and more

  • Scars impacting intimate regions
    For scars, areas of reduced sensation or lost pleasure around perineum, genitals, or anus such as those related to giving birth, haemorrhoids, gender confirming surgeries, sexual trauma or other surgical interventions, sexological bodywork can offer wonderful outcomes by combining massage therapy, body mapping, de-armoring and coaching techniques in an ethical way for intimate regions. This topic deserves a further blog post.

Summary

It’s nearly impossible to make it through life without scars. Thanks to the body’s amazing healing capacity, scar tissue knits our body back together when it gets wounded. Unfortunately, this can lead to unwanted functional and cosmetic impacts. Massage therapy helps to prepare for and speed recovery leading to reduced discomfort and optimal healing and formation of scar tissue.

References

Skylar Haven
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