Scar Tissue Massage and Management

Physical therapists commonly use scar tissue massage to help remodel scar tissue that has developed in injured tissue. You might have this type of physical therapy after you experience an injury that results in a buildup of scar tissue, including:

  • Surgery
  • Fracture
  • Soft tissue injuries like sprains and strains

Also Called

  • Scar massage
  • Scar mobilization
  • Scar tissue mobilization

This article explains how scar tissue develops and the techniques involved in managing it.

Physical therapist massaging patient's knee

Jan-Otto / Getty Images

What Is Scar Tissue?

Collagen (a protein found in muscles, bones, and other tissues) forms scar tissue. After an injury, your body lays down collagen that will become normal healthy tissue.

Collagen that develops under typical, healthy circumstances align to give your tissue strength. However, the collagen cells that form in response to an injury do so randomly. This sporadic layering leads to the buildup of scar tissue.

Scar tissue can develop almost anywhere in the body. Some examples of how scar tissue appear include:

  • After surgery: Scar tissue will develop where the surgical incision is. For example, if muscles and tendons were cut or repaired, scar tissue would grow there.
  • After muscle injuries: In a hamstring tear or rotator cuff tear, scar tissue will develop in the muscle as it heals.
  • After a fracture: Bony scar tissue, called a callus, will form on the bone after a fracture.

Recap

Scar tissue is the body’s usual method for healing tissues that are injured. Scar tissue is remodeled over time and starts behaving like your typical healthy tissue.

1:37

Click Play to Learn How to Break Up Scar Tissue

This video has been medically reviewed by Oluseun Olufade, MD.

Is Scar Tissue Permanent?

Scar tissue is not a permanent fixture in the body. After it forms and heals, the scar must remodel.

Remodeling is a natural part of the healing process. During remodeling, your body rebuilds the scar so that it becomes stronger and more similar to the tissue that was there before the injury. This adjustment is necessary so the new tissue can tolerate the stress and forces that the body typically experiences in a day.

Remodeling

Stretching and pulling the area helps the remodeling process. This stretching allows the collagen to align and return to normal.

Remodeling is essential to ensure that your injured tissue regains normal range of motion, strength, and mobility. When scar tissue doesn't remodel correctly, it can lead to mobility loss and joint contractures (a shortening and tightening of fibers that make movement difficult).

How Long Does Remodeling Take?

Everyone is different and heals at different rates. In general, it takes about six to eight weeks for injured tissue to remodel entirely. Just remember to take it slow.

Scar Tissue Management Techniques

If you have developed scar tissue after an injury or surgery, your physical therapist (PT) may perform a scar massage on the injured tissue to help with the remodeling process. They may also instruct you or a family member how to massage scar tissue properly.

Talk to Your Doctor

Be sure to check with your healthcare provider or physical therapist to ensure that your scar is properly healed before having a scar tissue massage. Massaging a scar that is not fully healed can damage the developing scar tissue, which can delay healing.

In addition, massaging an unhealed scar may open it and lead to bacteria and infection in your body. That's a bad thing.

Recap

In general, the scar must be fully closed, and have no scabbing to begin scar massage. Your healthcare provider and physical therapist should assess your scar before starting scar massage.

Lubrication

Usually, PTs use a small amount of lubrication during scar massage such as baby oil, lotion, or vitamin E oil. Lubrication keeps the scar and skin flexible and soft during scar tissue massage.

Do not use lubricants if you have any open sores or incisions, as it could lead to an infection.

Cross Friction Massage

One effective method of scar massage is called cross friction or transverse friction massage. This technique involves using one or two fingers to massage along the scar line.

This technique helps to remodel the scar. It also ensures that the collagen fibers of the scar are correctly aligned.

PTs commonly use cross friction massage to treat the following:

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

Myofascial release (MFR) manages scar tissue and the adhesions that may accompany it. The technique involves using the hands to massage the skin and underlying tissues around the scar.

Motions are slow, and the amount of force is usually light. Your PT can feel for tissue restrictions, called fascia, in various directions. They can then work to improve movement in those restricted directions.

Instrument Assisted Scar Tissue Massage

A relatively new technique used in physical therapy is called instrument-assisted soft tissue mobilization (IASTM). This technique uses special stainless steel instruments of various shapes and sizes to massage and move tissues.

Your PT may use this technique by rubbing your scar tissue with an instrument, thus "breaking up" the tissue. However, the use of IASTM is new. Therefore, rigorous scientific study is lacking to determine if it is beneficial.

Stretching

Another standard method to help remodel scar tissue is stretching and flexibility exercises. Stretching can help lengthen the injured tissues and improve their overall movement.

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 essential component of your recovery. Most PTs agree that prolonged, low-load stretching (slow, moderate stretching held for a long time) is necessary to help you fully remodel scar tissue.

Scar Management After Fracture

The scar tissue in the bone is called callus. It 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. This technique helps restore normal mobility. If you have had surgery to repair the broken bone, scar massage over your incision may also help.

Another way to improve callus formation in bone is by performing weight-bearing exercises. The bone grows in response to the stress that is placed on it (Wolff’s law). 

Recap

Your physical therapist can choose the correct exercises to help improve the overall bone strength after a fracture. Be sure to work with your healthcare provider and physical therapist to ensure that your fracture is healed enough to begin weight-bearing exercise.

Does Science Support Scar Tissue Massage?

A 2020 meta-analysis looked at massage as one of a few types of physical scar tissue management. Specifically, it looked at its effect on: 

  • Pain
  • Pigmentation
  • Pliability (how elastic the scar is)
  • Pruritus (itchiness)
  • Surface area
  • Scar thickness

It found that massage provided moderate-to-strong pain relief for burn scars. It also found that massage could help improve scar pigmentation, though the effect was slight.

One study included in the meta-analysis found that massage may significantly improve the pliability of burn scars. The meta-analysis also concluded that massage therapy may have a moderate effect on pruritus.

Two of the studies included in the meta-analysis found that massage could help reduce the thickness of scars, but two other studies found no such benefit. The authors noted that the length of the massage treatment (30 minutes versus 5) may account for the differences in the findings. 

It is important to keep in mind that most of the studies included in the meta-analysis were small and that there was the possibility of bias in many of them. The authors also noted the need for more research to help confirm the findings. 

Summary

Scar tissue massage is a form of rehabilitation that uses pulling and stretching to remodel scar tissue. Scar massage helps you regain mobility and strength in your damaged tissue.

PTs use a variety of techniques in scar massage. Additionally, they may instruct you how to do the exercises on your own, at home.

A Word From Verywell

Scar massage has little evidence to support it, but that doesn't mean it doesn't work. Anecdotally, plenty of people have found that scar massage helps them move better.

For safety, your wound should be closed entirely before starting scar massage. So, before you receive a scar massage, be sure to check with your doctor to see if it is appropriate in your situation.

Frequently Asked Questions

  • Can massaging scar tissue make it worse?

    It may if the tissue is fresh and inflamed, as very new scars tend to be for the first two weeks. It's best not to manipulate such tissue too aggressively as this could increase inflammation and slow routine healing and scar formation.

  • When is it too late to use massage on a scar?

    Massage is unlikely to improve the appearance of a scar, increase mobility, or soften the tissue after two years.

  • What are some alternatives to massage for treating external scar tissue?

    Treatments that are used instead of or in addition to massage for hypertrophic and keloid scars include:

Was this page helpful?
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Gonzalez AC, Costa TF, Andrade ZA, Medrado AR. Wound healing - a literature reviewAn Bras Dermatol. 2016;91(5):614-620. doi:10.1590/abd1806-4841.20164741

  2. Shin TM, Bordeaux JS. The role of massage in scar management: a literature review. Dermatol Surg. 2012;38(3):414-23. doi:10.1111/j.1524-4725.2011.02201.x

  3. Ault P, Plaza A, Paratz J. Scar massage for hypertrophic burns scarring-A systematic review. Burns. 2018;44(1):24-38. doi:10.1016/j.burns.2017.05.006

  4. Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc. 2016;60(3):200-211.

  5. Kohata K, Itoh S, Horiuchi N, Yoshioka T, Yamashita K. Influences of osteoarthritis and osteoporosis on the electrical properties of human bones as in vivo electrets produced due to Wolff's law. Biomed Mater Eng. 2017;28(1):65-74. doi:10.3233/BME-171657

  6. Deflorin C, Hohenauer E, Stoop R, van Daele U, Clijsen R, Taeymans J. Physical management of scar tissue: a systematic review and meta-analysis. J Altern Complement Med. 2020;26(10):854-65. doi:10.1089/acm.2020.0109

  7. British Skin Foundation. The benefits of scar massage.

  8. Moffitt Cancer Center. Managing Your Scar.

  9. Deflorin C, Hohenauer E, Stoop R, et al. Physical management of scar tissue: a systematic review and meta-analysisJ Altern Complement Med. 2020;26(10):854-865. doi:10.1089/acm.2020.0109

Additional Reading