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The Scar Tissue Issue

This month’s newsletter is about scar tissue.


I had one of those moments while reading up for this that I often get when studying anatomy where I kind of…trip out on existence. I mean our bodies are wild, instinctive, self-healing slabs of meat, fluid and electricity. Reflecting on scar tissue, I was in awe that our bodies just…patch themselves up. 


While we can control certain external factors that create an environment most conducive to healing, I think what’s trippiest about the whole thing is that the body restores itself on its own. Creating scar tissue is not a conscious effort. The body, in all its wisdom, just…does it. 


Scar tissue, if left unaddressed, can create imbalance, fascial tension and fluid flow disruptions that can have system-wide effects. So it’s not surprising that most people I encounter in my office view scar tissue as “bad” or want it “broken up”. But I always aim to approach the body first with reverence and appreciation before addressing the problem.


2 things can be true at once:

  1. That scar might be causing problems

  2. And it’s freaking amazing that the body was able to patch up in the first place



WHAT IS SCAR TISSUE


I tend to think about scar tissue from 2 perspectives: the tissue and the fluid in the tissue

Skin, particularly the dermis or second (and thickest) layer of skin, contains 2 major characteristic proteins: collagen and elastin. Collagen provides strength and structure while elastin gives our skin its flexibility and stretch. We need them both. 


When our skin gets damaged, the body promptly kicks into gear and tries to repair that damage. We, of course, have an initial inflammatory response to help fight off any foreign substances and clear the dead cells, cellular debris and metabolic waste. 


Then the repair part happens. The goal is to close the wound ASAP and avoid infection. We’re not going to get that delicate, finely tuned balance of collagen and elastin, it’s going to be ALL collagen to ensure the strength and integrity of the “patch”. 


Still shot from the video “Strolling Under the Skin” by Dr. Jean Claude Guimberteau which gives an incredible glimpse of fascia at a microscopic level
Still shot from the video “Strolling Under the Skin” by Dr. Jean Claude Guimberteau which gives an incredible glimpse of fascia at a microscopic level


In uninjured tissue, the collagen and elastin fibers interweave to create tensile strength in all directions (pictured above). In scar tissue, collagen fibers are laid down and begin to organize along the line of  muscular and fascial pull around them. This means that scar tissue typically has a parallel rather than basket weave alignment, making it function differently than the tissue surrounding it. Even if the scar alignment isn’t perfectly parallel, the scar tissue is going to have a different quality due to its mostly-collagen composition and alignment inconsistent with the surrounding tissue. 


All types of tissue can scar, not just skin. This is one reason why scars can cause such an issue: collagen where there wasn’t any before.


Tissue damage also disrupts blood, lymph and nerve flow. In my practice I often see changes in one or some of these around a scar, though it looks a little different in everyone. Some scars don’t cause much of an issue and can have decent flow through and around them. Other scars have been blocking tissue flow for long enough to create a lack of nutrient-rich blood flow and proper waste removal, leading to inflammation, stiffness and even fibrosis. I often see scars that are so strong and doing such a good job of keeping that tissue together that it actually starts to gather in other tissue around it and create a fascial adherence that disrupts the whole system and create imbalance in a seemingly unrelated area of the body. 


TL;DR scars differ from unscarred tissue in fiber alignment, composition & fluid flow



WHAT WE CAN DO ABOUT IT


The body is always doing what it can to restore balance


We can help it do that by creating conditions most conducive for healing. The reality is that most scars won’t go away, but they don’t necessarily have to be a problem. 

When it comes to scars, again, my approach is 2-fold: tissues & fluid. We know that scars align themselves with the tissue pull of surrounding tissue. So to make sure the area doesn’t get too used to only moving in one direction and creating an even bigger line of pull, move the surrounding tissue in different directions, even and especially as the area is still healing. 


When I work with a scar in my practice, I mobilize the scar and the tissue around it in all directions, experimenting with different pressures and lengths of holds. I often find that movement is easier in one direction than another. 


Sometimes scars, especially ones that have been around a while, need very deep pressure. Other times I have success mobilizing an area with a gentler touch. 


The light touch is especially useful when the scar is lacking or even blocking blood and lymph flow. Light movements around the scar encourage fluid to flow around the area and hopefully make their way through the scar tissue as well. Deeper pressure is used with the intention of diversifying collagen alignment and disrupting the fascial pull it may be creating as it draws in surrounding tissue.


The point isn’t to “break up” the scar, but rather to sink in and mobilize in all directions. In doing so, we change the quality of the tissue (soften), keep the scarred tissue from adhering to surrounding tissues and encourage more fluid flow (to nourish and remove waste). 


Here’s your general protocol (feel free to explore!)

  1. Start with a broad, flat hand over the area and move the tissue in all directions. Start with a light touch and experiment with differend depths

  2. Notice where it feels like the tissue could use more movement and hold it in that direction. See what changes occur

  3. Push the edges of the scar toward each other and move in all directions

  4. Pull the edges of the scar away from each other and move in all directions

  5. Move through the area with deeper pressure. You can use fingertips or tools. Try rolling the tissue between your fingertips or holding in one area and exploring specific places

  6. Gently brush over and around the area up the limb, up toward the neck if you’re working on the body or down toward the neck if you’re working on your face


Other effective methods:

Metal, stone or ceramic gua sha, scrapers of other massage tools over and around the area


Spiky balls on the scar and surrounding tissue


Red light therapy can be effective in improving scar appearance and pliability through increasing collagen production, moderating fibrosis and increasing fluid flow (1, 2)




It is said that regular topical application of honey, lemon or vitamin E can be effective in treating scar tissue, though there is no solid scientific evidence at the moment to back that up…doesn’t mean it’s not worth a try tho!




PSYCHOLOGY OF SCARS


Whenever I work with someone dealing with the effects of scar tissue, I often encourage them to work with the area at home in between sessions. Over the years I’ve encountered some resistance to this for several reasons. 


Scars can remind us of painful memories, represent a past version of ourselves or make us feel flawed in some way. Scars often represent something we’d rather just forget or dissociate from. Some scars we don’t want to sit around and pay attention to. 

But I think scar tissue work is a beautiful way to reclaim these parts of ourselves. To choose healing over dissociation, to take the power back, to move on. 


I often find resistance in the form of fear of getting it wrong, not wanting to make it worse. Honey, when it comes to scar tissue, you’re not gonna do too much damage if you’re just using your hands or using a tool mindfully. Scars are incredibly strong so as long as you aren’t dealing with an open wound, moving the tissue around isn’t gonna do any damage. Since scar tissue work moves in all directions, whichever way you go is probably gonna help in some way. As far as going “too light” or “too deep”, stay curious and open to feedback from the body. If something feels good or even little uncomfortable it’s probably working but if it hurts, stop. In my opinion, the more you can touch the scarred area the better, so just try different methods and see what feels best. The idea is to keep fluid flowing and keep the scarred tissue from adhering onto surrounding tissue. 


We’re learning to love ourselves, scars and all!!


 
 
 

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