Many people have scars as a result of accidents, injuries and surgeries. While scar tissue is extremely helpful at repairing the body quickly to prevent further damage and/or injury, scars and their presence in the body can cause pain and restrict movement. This can lead to musculoskeletal imbalances and ultimately impede athletic performance.

What Is Scar Tissue?

Scar tissue is made from the same matter as every other soft tissue in the body (i.e., collagen). Scars form in the body to replace injured tissue any time skin, muscles, fascia, ligaments and/or tendons have been damaged. When healthy tissue is injured, the body responds to the problem by first stopping the bleeding (with a blood clot). It then starts producing collagen quickly to heal the wound as fast as possible.6 During this rapid repair process, the body prioritizes mending the injury ahead of making sure the newly formed collagen fibers are neatly lined up and organized in the same fashion as the original tissue before it was damaged. As a result of the process scar tissue is not as flexible as healthy tissue, not structured in the same way and does not have a normal blood supply, sweat glands, or hair.2

Scar Tissue and Its Effect on Pain and Movement

Since the configuration of scar tissue is not the same as the surrounding muscle fibers it can alter the way these structures work.4 For example, the muscle fibers of the rectus abdominis are striated in a longitudinal fashion running up and down the torso (see Figure 1).

Rectus Abdominus

Figure 1: Direction of Fibers of Rectus Abdominis

They are organized in this direction because this muscle helps bend the spine forward during movements such as abdominal crunches and lifting the spine up to get out of bed. Similarly, these muscle fibers also need to lengthen to help slow down the spine as it arches backwards during movements such reaching over your head to wash your hair, hit a volleyball spike or perform a tennis serve.

Alternatively, the external obliques wrap around the torso and the fibers are almost perpendicular in relation to the spine (see Figure 2).

Figure 2: Direction of Fibers of  External Obliques

They are organized as such because these muscles are primarily involved with rotation of the trunk. They help with movements such as swinging the arms when walking, the backswing and follow-through in golf and reaching behind you to grab something out of the backseat in the car.4

Many people undergo surgeries in the abdominal region that require cutting through the rectus abdominis, external obliques, and other muscle tissue and fascia of the abdominal wall (i.e., hysterectomies, gallbladder and appendix removal, hernia repairs, etc.). While these procedures may be life-saving and/or absolutely necessary, unfortunately they produce a lot of scar tissue that affects the function of both the rectus abdominis and external oblique muscles.11

There are many other common-place surgeries that can also affect the way the body moves and functions. Hip replacement surgeries typically result in extensive scarring to the gluteal complex of muscles. Similarly, knee replacement surgeries (and the associated scarring) affect the function of the quadriceps muscles. As a result, the function of these muscles is compromised along with the joints these muscles help control (i.e., lumbar spine, sacroiliac joint, hip, knee and ankle). The interconnected nature of the body also means that not only these joints are affected by scarring from such procedures, but so too is movement and performance of the body as a whole.8

Healing and Treating Scar Tissue

There are many techniques and strategies that can be used to decrease the buildup of scar tissue.

Protection of the Wounded Area

When tissues are injured they must initially be protected from further harm. Depending on the severity and type of wound, bandages/dressings are recommended (as well as antibiotics in some cases) for maintaining cleanliness of the area and to prevent infection. Most wounds are best kept clean with a saline solution as chemicals and other harsh soaps can dry out the skin, prevent healing and worsen scarring.

Nutrition

Vitamin C is used throughout the body for cell repair and is generally recommended to help the body recover from injury. Furthermore, a vitamin B complex may also help speed up the recovery process and promote healing.5 However, it is recommended that you consult with a licensed dietitian/nutritionist before making any nutritional changes to help diminish/treat scar tissue.

Massage

After a scar has healed initially, a person can increase flexibility in the scar tissue and surrounding tissue by massaging the area with a doctor/surgeon recommended gel or ointment. As the scar heals further, self-myofascial release and/or trigger point therapy may be used to improve the elasticity of the surrounding myofascial structures as well as bring new blood supply to the affected area. Always obtain medical clearance before employing any type of self-myofascial release or trigger point technique to ensure you do not reinjure the area. 9,10

Laser/Light Therapy

Many people are familiar with the use of laser treatment and dermabrasion to improve the surface of the skin and remove superficial scars. However, it has also been demonstrated that low-level laser therapy can improve cellular function and help with the treatment of deep scars. Moreover, the exposure to sunshine (and ultraviolet light) has also been shown to improve cellular function to damaged tissue and scars. However, it is important to consult with a physician first to make sure the initial wound has completely healed before exposing to sunlight as that can make scarring worse in some cases.3

Vibration

The formation of scar tissue can sometimes affect the activation of a muscle or surrounding muscle groups by interfering with the neural pathways that activate those tissues. Recent research has demonstrated that when high-frequency vibration is applied to adhesions, scar tissue, and the surrounding muscle, that nerves can be stimulated to help improve the function of muscle tissue that has been affected by the formation of scar tissue.1

Recognizing the far-reaching effects of scar tissue, identifying those areas of the body that are affected by it and applying appropriate strategies to treat scar tissue can help you limit their potential to cause pain, dysfunction and inhibit performance.

To learn more from Justin Price about the causes and cures for both your own and your clients’ aches and pains, check out The BioMechanics Method Corrective Exercise Specialist course.

References

1Cochrane DJ. 2011. The Potential Neural Mechanisms of Acute Indirect Vibration. Journal of Sports Science and Medicine, 10, 19-30.

2Corr, D., and Hart, D. 2013. Biomechanics of Scar Tissue and Uninjured Skin. Advanced Wound Care. Mar; 2(2): 37–43.

3Doidge, N. 2015. The Brains Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity. Penguin, USA.

4Gray, H. 1995. Gray’s Anatomy. New York: Barnes & Noble Books.

5Harker, Malcolm. 2005. Health and Healing. New Zealand: Wings of Waitaha Books.

6IDEA. 2013. IDEA Fitness Programs and Equipment Trends Report. IDEA Health & Fitness Association.

7Kraft, J. 2014. How to Heal Scar Tissue: How to Heal Your Own Scar Tissue and Get Rid of It! Jonathan Kraft, CMT.

8Myers, T. 2001. Anatomy Trains. Myofascial Meridians for Manual and Movement Therapists.  Edinburgh: Churchill Livingstone.

9Price, J., and M. Bratcher. 2018. The BioMechanics Method Corrective Exercise Specialist Certification Program. 2nd Ed. San Diego, CA: The BioMechanics Press.

10Price, J. 2018. The BioMechanics Method for Corrective Exercise. Champaign, IL: Human Kinetics.

11Rolf, I. P. 1989. Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well-Being (revised edition). Rochester, VT: Healing Arts Press.