Scar Tissue Massage and Management

Scar massage is a common method used to help remodel scar tissue that has developed in injured tissue. It is a treatment used in physical therapy after surgery, fracture, or soft tissue injuries like sprains and strains. Scar tissue massage is also known as scar mobilization or scar tissue mobilization.

There are many instances in the body where scar tissue will develop. After surgery, scar tissue will develop where the surgical incision is in the skin. If muscles and tendons were cut or repaired, scar tissue will develop there.

After injuries like a hamstring tear or rotator cuff tear, scar tissue will develop in the muscle as it heals. Bony scar tissue, called a callus, will form on the bone after a fracture. Scar tissue itself is the body’s normal method for healing body parts that are injured. Scar tissue forms, it is remodeled over time, and the scar tissue starts behaving like your normal healthy tissue.

Scar tissue is formed by collagen. After an injury, your body lays down collagen that will become normal healthy tissue. The collagen cells are placed near the injured tissue in a random fashion, and this leads to scar tissue. (Normal healthy collagen is aligned in specific ways and directions that give your tissue strength.)

Scar tissue is not a permanent fixture in the body. After it forms and healing has taken place, the scar needs to be remodeled so that it can tolerate the stress and forces that the body may encounter throughout each day. The remodeling process is essential to ensure that normal range of motion, strength, and mobility are restored to the injured tissue. Failure for scar tissue to remodel properly can lead to loss of mobility and joint contractures.

If you have developed scar tissue after an injury or surgery, your physical therapist may perform scar massage on the injured tissue in order to help with the remodeling process. He or she may also instruct you or a family member in the proper scar massage technique.

Be sure to check with your doctor or physical therapist to ensure that proper healing has taken place and that scar tissue massage is appropriate. Massaging a scar that is not fully healed can cause damage to the developing scar tissue which can delay healing. Massaging an unhealed scar may open it and lead to bacteria and infection in your body. That's a bad thing.

In general, the scar must be fully closed and no scabbing present to begin scar massage. Again, your doctor and physical therapist should assess your scar before beginning scar massage.

Usually, a small amount of lubrication is used during scar massage. This can be baby oil, lotion, or vitamin E oil. This is used to keep the scar and skin pliable and soft during scar tissue massage. Do not use lubricants if you have any open sores or incisions. This could be an avenue where the lubricant—and an infection—may enter the body.

One effective method of scar massage is called cross friction or transverse friction massage. This involves using one or two fingers to massage your scar in a direction that is perpendicular to the line of the scar.

This technique helps to remodel the scar and ensures that the collagen fibers of the scar are aligned properly. Cross friction massage is commonly used in the treatment of tendonitis and muscle strains or ligament sprains. The technique is performed for five to 10 minutes. If instructed to do so, you may be able to perform scar tissue massage on yourself two to three times per day.

Myofascial release (MFR) is often used to manage scar tissue and the adhesions that may accompany scar tissue. The technique involves using the hands to massage the skin and underlying tissues around the scar. Motions are slow and the amount of force used is usually light. Your PT can feel for restrictions of tissue, called fascia, in various directions and work to improve movement in those restricted directions.

A relatively new technique used in physical therapy is called instrument assisted soft tissue mobilization, or ISATM. This technique involves using special stainless steel instruments of various shapes and sizes to massage and mobilize tissues. Your PT may use this technique by rubbing your scar tissue with an instrument, thus "breaking up" the tissue present. The use of IASTM is new, and thus may lack rigorous scientific study required to decide if it is worthwhile to use in the PT clinic.

Another common method to help remodel scar tissue is stretching and flexibility exercises. This can help elongate the injured tissues and improve their overall mobility. If you have had an injury or surgery, your physical therapist is likely to incorporate both scar massage and stretching into your rehabilitation program.

Stretching scar tissue may be an important component of your rehab program. Most PTs agree that long duration, low load stretching is necessary to help you fully remodel scar tissue.

The scar tissue in bone is called callus and is present for four to 12 weeks after a fracture. If you have broken a bone and have started physical therapy, your therapist may massage the overlying tissue near the callus to help restore normal mobility. If you have had surgery to repair the broken bone, scar massage over your incision may be performed.

Another way to improve callus formation in bone is by performing weight-bearing exercise. Bone grows in response to the stress that is placed upon it (Wolff’s law). Your physical therapist can choose the right exercises for you to perform to help improve the overall strength of your bone after fracture. Be sure to work with your doctor and physical therapist to ensure that your fracture is healed enough to begin weight-bearing exercise.

How long does it take to remodel scar tissue? Well, everyone is different and heals at different rates. In general, it takes about six to eight weeks to fully remodel injured tissue in the body. Just remember to take it slow and provide a nice, long duration low-load stress to your scar tissue.

Does Science Support Scar Tissue Massage?

When you PT applies any treatment to your body during rehab, you should question if the treatment is necessary and if it actually works. So what does the scientific literature indicate about scar tissue massage? A 2012 meta-analysis examined ten studies about scar tissue massage and found that techniques and applications were varied, and most studies were weak. The conclusion: "Although scar massage is anecdotally effective, there is scarce scientific data in the literature to support it."

Does this mean that scar massage won't work for you? Absolutely not. If it feels good and helps you move better then it is effective. But you must understand that it may not be the best use of your time (or healthcare dollars) if you have scar tissue that needs to be remodeled. The evidence to support scar tissue massage is largely anecdotal.

Scar tissue grows in the body as a normal response to injury. This injury may be caused by repetitive strain, fracture, or surgery. Management of your scar through scar tissue massage, stretching, and exercise is essential to ensure proper remodeling of the scar takes place and normal mobility and function are restored.