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More than Skin Deep: Managing Restricted Scars

Do your jeans irritate you right at the waistband, and not because of the fit? Do you stand at the sink and feel pain or irritation when you lean against the counter?

It could be the scar from that C-section or mastectomy that’s giving you trouble, even if the surgery is years or decades in the past.

Internal and external scars, even long-since healed, can cause sensitivity, pain, and reduced mobility. Knowing the proper way to manage scar tissue can help you reduce or resolve those issues, on any scar, anywhere on your body. Practicing scar massage on new incisions (once healed) can help avoid problem years in the future.

To learn more about “restricted scars” and how to handle them (har har), we turned once again to our fabulous physical therapists, Brianna Droessler-Aschliman PT, DPT, CMTPT of Four Pines Physical Therapy, and Meagan Peeters-Gebler PT, DPT, CSCS, CMTPT of Orthopedic Spine Therapy.

How do restricted scars cause problems and why does massage help?

First, it’s important to know a scar is more than just a line on your skin, says Meagan. Our bodies are made of numerous layers, and there may have been several incisions to get to whatever tissue or structure or organ the surgeon was trying to fix. So the “problem” scar may actually lie deep inside.

Second, it helps to understand how scar tissue is formed. “Think of a mud puddle,” Meagan says. “To cover it up, you throw a bunch of straw on it. It covers the hole, but the pieces of straw land every which way and end up lying in different directions. That’s how scars form.”

Plus, says Bri, the cells that form a scar matrix are often tougher and more fibrous. This makes the scar tissue less flexible than the tissue around it.

“Scars can even pull on surrounding skin and tissue and form adhesions,” says Bri. The pain, burning sensation, or restricted movement happens when you try to pull or twist against that adhesion.

Scar massage helps by realigning existing scar tissue so the fibers are neatly organized and running parallel and perpendicular to one another, making the matrix of scar tissue much more flexible and elastic. Second, massage helps break up adhesions, freeing up restricted muscles, organs, and fascia for greater range of motion. Finally, massage can help establish a framework so any new tissue that’s created becomes part of this organized pattern. No more jumbled straw!

How do I know my pain is from a scar?

Restricted scar pain can go undiagnosed for years, since people often don’t associate new pain with an old wound. A doctor or physical therapist will likely be able to feel the restricted scar by pushing on the painful area with their fingertips.

A healthy, well-healed scar should feel and move like the skin around it, according to our PTs. “I shouldn’t feel a barrier, no raised ridge, no wad of tissue or puckering. If I pull it one direction or another, it should move easily, without causing pain,” says Meagan. “If it doesn’t, a restricted scar is where I’ll start.”

“Most people aren’t told about the importance of scar massage,” Bri adds, “so we see this problem pretty often. But it’s really avoidable. People can be taught to start massaging their own scars – carefully – as soon as the incision is healed to keep adhesions from forming in the first place.”

Hands-on healing: how to massage scars

Hang on, before you go diving in: if this is a new incision, is it fully healed? As Meagan says, be sure it’s fully closed, with no draining, oozing or crusting, and no risk of eruption. If you’re not sure, consult with your doc.

Begin by desensitizing the area. Nerves may be flaring and angry from the surgery or injury; you want to calm them so the area can tolerate scar massage a little further down the road. Start the desensitization by rubbing the area lightly with a very smooth, silky fabric. Do that for a few days, then increase the sensory input by moving to cotton, then denim, then wool. Once it can tolerate that level of irritation, you can move on to massage.

According to Bri, most folks are ready for scar massage about 6 weeks after surgery. You’ll want to consult with a physical therapist to learn to do this right. Happily, once you’ve mastered the art of scar massage, you can carry on on your own.

The trick is to find areas of resistance, according to our PTs. When you find one, gently press and hold. You can continue doing this until you feel it start to release. Bri suggests finding a good topical cream to make massage easier and promote healing (oddly, a combination at frankincense and emu oil seems particularly effective, she says).

Fortunately, even very old scars respond to manipulation and massage. And no scars are “off bounds.” Had an episiotomy? Go for it.

Scars and breast cancer awareness month

We wanted to talk about this topic now, in recognition of breast cancer awareness month and the far too many women and men who wear the scars of mastectomies and biopsies.

“Scar massage is really useful for mastectomy and post-radiation healing,” Meagan says. “With mastectomy, women can have challenges with breathing, with rib-cage mobility, arm motion, even just reaching overhead. Plus superficial nerves can get entrapped in scar tissue, and that can cause lots of pain and problems. Knowing how to do scar massage can help avoid a lot of issues later on.”

Healing old wounds (and not just old scars)

For many of us, just looking at a scar is difficult, much less touching or massaging it.

This is where working with a PT can really help. “Often we’re the first to touch a new scar, even before the patient,” says Bri. “They want to know that it’s OK to touch it, that they won’t open it or cause themselves more pain. We can show them how to touch it, when it’s OK; we tell them, this is what it’s supposed to feel like, this is what you can expect, this is how it should move. Once they know all that, it’s easier to be open to the massage and to taking over their healing themselves.”

“It makes sense that it’s hard,” says Meagan. “We associate that mark on our body with a traumatic event. Even if it happened during the happy birth of a child, scars change our body and how we view it. But think of it a different way: a scar is proof that your body is healing, and that’s good. When you can’t bring yourself to touch your scar, it’s like you’re an open circuit, and all that good energy is being lost. Once you can touch it, you complete the circuit, allowing the energy to flow through your body. That’s what healing is.”

Written by: Shannon Perry

Shannon (aka “The Word Herder”) is passionate about advocating for women’s health and bringing as many voices as possible to the conversation. She will happily answer any question she can, and find an expert to do it when she can’t, so drop a comment or email her at shannon@genneve.com. She lives in Seattle with her cat, her dog, and her boyfriend, in that order.

Originally published on Genneve.com at https://genneve.com/managing-restricted-scars-scar-massage/

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