Scar Tissue Management in Physical Therapy

From the Graston Technique to Kinesiology Tape

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If you have surgical scar tissue or scar tissue formation from an injury, you may benefit from physical therapy to help reduce the scar. Your physical therapist can use various techniques, like massage, taping, or stretching, to decrease scar tissue adhesions and formations so you can restore normal functional mobility.

Role of Collagen

Scar tissue forms after an injury to the normal collagen cells in the body. If you cut yourself, have surgery, or tear tissue in the body, scar tissue will develop. The development of scar tissue is part of the normal healing process in the body.

Collagen is a substance that is present in all of our body parts. There is collagen in muscles, tendons, and ligaments. There is also collagen in skin and bones. The cellular makeup of collagen makes it very strong due to the alignment of collagen cells. It can resist tensile forces, such as stretching and pulling, without tearing or breaking.

Causes of Scarring

After an injury to a muscle, tendon, skin, or ligaments in the body, the inflammatory process starts to heal the injury site. This process helps to ensure that the injured site is cleaned up and new cells are brought to the site that will soon become healthy tissue. Some of these new cells are collagen cells.

Unfortunately, the body does not know exactly how to arrange the collagen cells so that they become healthy tissue that can resist tensile and stretching forces. The collagen cells can begin to ball up and clump, losing their natural flexibility and structure.

Scar tissue is not inherently permanent. The tissue can undergo a process known as remodeling in which abnormal clumps of cells, called adhesions, are gradually loosened and replaced with normally aligned cells.

Depending on the extent of the injury, remodeling may take weeks, months, or even years. In some cases, such as deep abdominal incisions, the scar tissue will never completely disappear.

Promoting Tissue Remodeling

Scar tissue remodeling occurs as you start to stretch and pull on it. The stretching of the scar tissue helps to align the collagen fibers to allow them to return to normal. This realignment of the collagen fibers makes the tissue better able to tolerate the forces that are placed on it during the day.

If you strain your hamstring muscle or tendon, for example, you'd follow the R.I.C.E protocol for a few days. After some healing has taken place, gentle stretching of the hamstring muscle is indicated to help ensure that the scar tissue is remodeled properly.

The same general principles apply to scar tissue management.

Physical therapists will often use a form of massage, known as the Graston technique, in which metal tools gradually release adhesions by manually stretching and mobilizing soft tissues, including the muscles and fascia where adhesions form.

For example, if you have knee replacement surgery, a surgical scar will be present in the front of the knee. This scar can become adhered to the underlying tissue and impede the normal range of motion. Scar massage, along with knee flexibility and strengthening exercises, can help loosen the adhesion and ensure that proper remodeling takes place.

Kinesiology Tape

Kinesiology tape is a newer tool used by physical therapists to stretch scar tissue in the remodeling process.

When the kinesiology tape is applied correctly, it holds the skin a stretched position to create a space between the dermis, fascia, and muscle. This increases blood flow between the layers which, in turn, promotes healing and remodeling.

Care needs to be taken to ensure the tape is not applied too early. After an injury or surgery, the tissue may not be ready for stretching. Before performing any tissue massage, kinesiology taping, or stretching for scar tissue, you should check with your doctor to be sure it is safe for you to do.

If your scar still has staples or stitches, it probably too early to mobilize the scar. Early mobilization or stretching of your open scar may cause the incision to open up. This could delay healing or could expose you to serious infection and complications.

In general, your scar should be completely closed and healed before using kinesiology tape to manage the scar tissue. Full healing of soft tissue and surgical incision usually does not occur until four to six weeks after your surgery or injury.

It is always best to check in with your doctor so he or she can assess your readiness to use kinesiology tape to treat your scar tissue.

How Kinesiology Tape Is Applied

Before using kinesiology tape, you must determine the amount and direction of restriction in your scar tissue. Ideally, you should do this with your physical therapist.

To assess the scar restriction, simply pull your skin in different directions to see how much movement there is. Areas of restriction are those in which there is a feeling of resistance. Kinesiology tape would be used to counter this resistance.

To apply kinesiology tape correctly:

  • Cut a strip about 4 to 6 inches long.
  • Anchor the tape along one side of your scar.
  • Gently pull the tape along the side of your scar, moving in the direction of the restriction. Don't apply it too tightly; the tape should have a 25 percent to 50 percent stretch to it.
  • Zig-zag the tape by pressing it into place, moving it back diagonally, pressing the tape again, and moving it diagonally.
  • Repeat the zig-zag pattern along the entire your scar.

When you are finished applying the tape, it should be gently pulling along side of your surgical scar tissue. The tape should not cross over your scar.

You can keep the kinesiology tape in place next to your scar tissue for three to five days. You must make sure that the tape is not irritating your skin. If you see any redness around the tape, remove it immediately.

Benefits of Treatment

It is thought that applying kinesiology tape along the lines of restriction of scars helps to provide a low intensity, long duration stretch to the tissues around the scar tissue. This helps to slowly stretch out the collagen cells that make up the scar.

Since kinesiology tape is such a new mode of treatment in physical therapy, studies examining the effectiveness of the technique are scarce. One study published in Polish Annals of Medicine found that a significant number of patients expressed satisfaction with the appearance of a surgical scar or wound after using kinesiology tape.

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