More Than Skin Deep: The impact of scar Tissue Massage

Article published in Massage and Myotherapy Journal 2020 Issue 1


Around 10years ago an impromptu scar tissue treatment from a massage teacher in the UK impacted my life in a massive way.

The benefits from that one treatment were so remarkable it began my learning journey and fascination with the world of scars.

As a Scar Tissue Massage Therapist and Educator with a combination of scar tissue experience and study at my fingertips I am excited to impact other people lives in a similar way.

This gentle modality has been known to give quick, long lasting results to help clients out of chronic pain and into pain free functional movement quickly.

Some scars have the ability to impact their owners’ lives in many ways let me explain by sharing the story of Mrs M. who came to my treatment room to have the scars on her face treated after the removal of a few skin cancers.

When observing and assessing the scars to be treated I could barely notice them but to the client, a 52year old female, wife, mother of two daughters, the scars were very noticeable and she told she felt as though everyone was staring at them and in so doing didn’t see her. She went onto say how much this had lowered her self-confidence.

Mrs M. works within an educational establishment providing administrative support and comes into contact with many people on daily basis outwardly she appears outgoing and happy.

Upon palpation, the scars did have areas of fascial bind, which seemed to be causing a pulling sensation close to the corner of her left eye.

I applied some gentle scar tissue techniques on the delicate facial areas where the scars were located for no more than 15minutes. When massaging scars no lubrication is required the pressure used is light similar to lymphatic work although the tissue connection is deeper and from a fascial perspective.

The result was the bind and pull of the scars had gone. Perhaps a more impressive impact was that Mrs M. experienced a diminished perception of the scars being a stand out feature of her appearance. She said her face felt like her face again.

When we were chatting she happened to mention her knee had a scar that she would like me to take a look at it.

This scar was also a result of skin cancer removal when I inquired how do you think this scar affects you?

She replied that she couldn’t bend her knee because of it. I then asked her to show me how much movement she did have, there was a discernable restriction in knee flexion under 45degrees of flexion.

When I asked how long has this been this way?

She replied since the surgical removal of the skin cancer. They bandaged me up and said just don’t bend it so I didn’t bend it and haven’t been able to from that day.

How long have you not been able to bend your knee? I asked her.

Two years.

She continued to tell me that she had been unable to go to line dancing because when tried to bend her knee it hurt.

“I have put on weight and I miss the girls we had such a laugh, travelling to competitions together. It has really got me down”

So at this point I am thinking I need to see this scar it must be huge.

Looking back at my notes this scar was under 2cm in length, white in colour with a little pink lump on the medial aspect. Situated inferior and medial to the knee.

I gently used some scar massage techniques for no more than 10 minutes and asked her to stand up and gently bend. A positive reaction to the treatment I repeat the treatment techniques and ask her to bend her knee again. A dramatic result more range of motion and pain-free knee bending!

I applied some broader work in order to integrate the scar massage.

In the follow-up treatment a week later she had returned to line dancing and was knee bending pain free. Her mood was lifted with the return to her social and exercise activity.

The scars on her face didn’t have the same tightness or pull that they once had in fact she reported that to her they were flatter and less noticeable.

It is always surprising and rewarding how transformative this gentle modality can be. In the case of Mrs. M’s scars in size they were small and large in terms of long-term effects and impact on her quality of life.

The small scars on her face had altered her body image and sense of self, the scar on her knee had affected her ability to connect with her social circle and as a direct result had negatively impacted her physical and mental wellbeing.

Interestingly just because a person has a scar does not mean it will be problematic.  In normal healthy circumstances, healing is completed and function is restored to the area.

Healing has four precise stages, which overlap: Homeostasis, Inflammation, Proliferation and Re-modelling.[i]

For successful healing a wound must go through each stage in the set order for an exact period of time. The problems occur when a variance to the healing process happens resulting in abnormal scars.

Research has demonstrated that abnormal scars can impact function within and beyond their physical borders and present considerations outside of the physical and physiological aspect of the scar tissue. [ii] [iii]

This means that when scars do behave atypically there is a possibility of experiencing far-reaching affects to areas distant to the scar resulting in dysfunction to the biotensegrity of the fascia.

Think iceberg, what we see on the surface is nothing compared to what is unseen below and beyond what we perceive to be the boundary of the scar.

Because scars have the potential to negatively affect nerves, fascia, lymph and muscles all of which are within the domain of massage and myotherapists. Scar tissue massage can offer an avenue of potential treatment that most therapists are as yet unaware of. This treatment modality could result in longer lasting results or even total resolution for clients.

There is evidence to support the claim that manual scar management techniques do positively affect the impact of pain, function and quality of life.[iv]

The Australian Government AIWH reports that in 2017–18 there were

over 2.3 million elective surgeries with an additional 352,000 emergency surgeries performed. [v]

Figures in this report show a growing number of surgical procedures occurring in Australia every year, thus making it more likely that therapists will encounter more clients with scars in the future. 

Introducing scar tissue massage into treatments would impact how therapists handle stubborn chronic pain cases. Most therapists encounter clients experiencing chronic pain or dysfunction of movement and most therapists do not consider treating scars.

The majority of the time, the treatment protocols applied do help clients to reduce their aches and pains and restore their movements – sometimes the treatment outcomes can be disappointingly short lived with results diminishing from a few hours to weeks.

This disheartening situation can have the therapist doubt their skills and refer on the client, believing another allied health practitioner will get a superior result. I suspect that in many of these cases the Client has an abdominal scar. An undisclosed abdominal scar, possibly because they have forgotten about the scar or simply do not think it has anything to do with their low back pain so don’t mention it.

Under those circumstances I have found scar tissue massage to be beneficial in resolving chronic low back pain in those with abdominal scars.

Scar Tissue Massage techniques aim to impact clients by:

  • reducing stress responses in the nervous system
  • increasing vascular flow
  • increasing lymphatic flow
  • minimising the aesthetic impact of scars
  • restoring function
  • addressing fascial restrictions

When working with clients who have experienced trauma the manual therapist does not need to know every detail of the trauma in order to provide a productive treatment.

In fact having your client give you a blow-by-blow account of the scar source and subsequent treatment can actually be detrimental to the outcome of integrating the soft tissue structures. It can bring the injury trauma whether physical or emotional to the surface. It can also affect the therapist by bringing any of their unresolved traumas to the surface too.

Which is why grounding and therapeutic boundaries are essential in this modality.

Unless otherwise trained massage therapist and myotherapists are not counsellors or psychotherapists talking therapy is out with our scope of practise.

Luckily for us being an active and empathic listener is well within our scope of practise.

Skills essential for this work are holding the space, energetic boundaries and compassion to one self and others.

I have found it helpful to create a network of psychotherapists, councillors, play and music therapists to refer my clients it also opens the door of reciprocal referrals.

Scar tissue massage can impact the practitioner emotionally. By treating scars therapists are often reminded of their own mortality, the wonderment of the human form and life itself.

This is why self grounding and instilling energetic boundaries are essential to this modality. Often the gentle techniques involved in Scar tissue massage can be applied from a seated position a welcome break for lots of therapists.

Interested in learning more about Scar Tissue Massage?

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References


[i] Marieb EN (2003) Human Anatomy and Physiology 5th edn.Redwood City, CA:Benjamin Cummings Publishing

[ii]Lewit K,Olasnska S (2004) clinical importance of active scars: abnormal scars the cause of Myofascial pain. Journal of Manipulative and physiological Therapeutics 27(6):399-402

[iii] Bordani B, Zanier E, (2014) Skin, fascias, scars: symptoms and systemic connections. Journal of Multidisciplinary Healthcare 7: 11.

[iv] Fourie W (2012) Surgery and scarring. In: Schleip R et al(eds) Fascia: The tensional network of the human body.Ch7.17,pp411-420. Edinburgh: Churchill Livingstone Elsevier.

[v] www.aihw.gov.au/reports/hospitals/hospitals-at-a-glance-2017-18/contents/surgery-in-australias-hospitals

Become the Practitioner that everyBODY loves

Become the practitioner that everyBODY loves (including your own body)

I was recently talking with one of our graduates.

A beautiful therapist with 17years experience, an incredible skillset and an overflowing jam-packed clinic.

She loved helping her loyal client base routinely treating 35+people a week. Every week. For years.

Let’s call her Michelle.

Michelle had a history with her clients; they were her people.

She had massaged them through 17years of their lives, 17 years of shared experience.

Through pregnancies, marriages, divorces, illness and injury. Through everything life gives to us. The highs, the lows, and absolutely everything in between.

Her clients had shared so much within the safety of her treatment space. A treatment space that Michelle had created through her dedication to professionalism and to helping the people of her community.

She loved treating them and they loved her and her treatments.

At first it started as just a feeling of being a little more tired than usual and then occasional niggle in her hands. As time passed Michelle began to notice a gentle decrease in her willingness to go to work. She was tired and a little sore at the start of a treatment day. Her best efforts with self-care and reducing client numbers did help a little.

Michelle started to worry that despite her love for what she did in the treatment room, her passion for massage was starting to impact her body.

The sudden shock of thinking what if I can’t treat people anymore? zipped into her brain closely followed by “if I’m not doing this what will I do and who will I be?”

It was a few months after this shock that she reached out to me and asked about which of the courses might suit her and her clients best.

Michelle and I connected over the phone. The call consisted of me listening and Michelle detailing what was happening for her. We discovered together what outcome she and her clients wanted.

It became clear that the Remedial Hot Stone Massage Course was a match for her, her practice, and her clients.

After the course we had a chat about her experience.

She said that after completing the interactive online course that a few things had happened.

Things were great! She had saved her hands no more aching and even better her energy levels were restored and climbing.

Simply put she didn’t have to work so hard to get the same results.

She said” My clients love me more than ever! I can’t believe how much they love the hot stones and you were right they really do pay more for them.”

this was such a wonderful conclusion for Michelle.

And for me -it fills me with joy to see another practitioner with a sustainable practice, avoiding injury and experiencing what we truly believe therapists who are dedicated to their craft deserve to Give with Ease™.

Save your hands, body and energy with pioneering modalities from CK Massage Training.

The Hidden Power In Your Hands That Gives You Career Control

How is the physical impact of treating clients making you feel?

Manual Therapists such as remedial massage, Bowen, or myotherapy have reported to us about their concerns surrounding the wear and tear on their bodies.

Therapists in the worst place report being physically, emotionally and mentally exhausted from the treatments they relying on to pay the bills.

This is not a happy place – next stop is it is “all too hard time to give it up” – often therapists just starting out in the industry can slip into the discomfort of being in this situation – It is a place familiar to many therapists and unfortunately therapists of many years of service under their belts can find themselves here due to injury and having no practice exit strategy for retirement or having someone to hand the reigns over to.

New Therapists and returning therapists are advised to build up their endurance to the physical outlay treatments can often inflict. “ You’ll be fine once you have built up your stamina”

Let’s imagine you are physically blessed with a strong, fit and healthy body only to find the worry of the financial responsibility is all too much –sleepless nights about paying rent, insurance, training costs, association fees – turns into stress.

You see stress all the time on your treatment tables and as you know stress when left unsupported and unaddressed has the opportunity to escalate into depression and anxiety.

What if there was a way to reduce the personal impact of treatments and running a business physically, emotionally and mentally? 

What if you knew a way – would you shout it from the roof tops so that you could help other therapists?

Of course, you would! I didn’t realize that I accidentally stumbled across a way to truly negate the physical, emotional, and mental impact of being a manual therapist until I moved to Australia and found out what I had been doing was really unusual.

I even began to feel like fraud like I wasn’t working hard enough  -my clients loved what I was doing so much they rebooked over and over – they couldn’t get enough, they told their friends and family and I was busier than ever.

Even when I put my prices up again and again until I was the most expensive therapist in my small rural town and still there was no shortage of demand –in fact, I was more popular than ever – my waitlist was huge and my staff mambers were also fully booked.

So what is this hidden power that gave such career control, saving my hands, body and mind from the impact of manual therapy.

Remedial Hot Stones.

Not just Hot Stones but Remedial Hot Stones.

This is no spa treatment. Using the stones as an extension of you has so many benefits. For those like me, who are sensitive to the energies of others it created a physical barrier between the client and myself which really helped to stop me from absorbing unwelcome energy.

The heat of the stones warming up my hands not only felt lovely but then being able to achieve a beautiful depth within the tissue with no effort and using the stones to work with the fascia and trigger points was hugely beneficial.

The approach that is used when applying remedial hot Stones permeates the whole structure of my practise.

It gives therapists mindfulness and sophisticated techniques which are delivered to give a uniquely connected experience that clients love which positions you as the only therapist to go to.

It is so important to have a sustainable practise and by sustainable I mean physcially, emoitionally, mentally and financially.

But it is not just about that, is it?

I believe it is truly about giving dedicated therapists what we believe they truly deserve; the ability to Give with Ease.

Which is why I have developed courses to help therapists be able to give with ease to themselves, their clients, the wider community and beyond.

Discover The Give With Ease approach.

The approach is applied to pioneering modalities like Remedial Hot Stones through a specific framework to deliver a sustainable practice, a connected client experience and ultimately your personal fulfilment.

Want to find out more about how the Give with Ease approach to Remedial Hot Stones can help you to personal fulfillment then download the course information here.

C- Section Scar Therapy

C-Section Scar Tissue Therapy

Having a baby is a BIG deal. 

Whether you are a first time mum or experienced it all before. All mums have countless concerns about having a baby. If you’re having a planned caesarean section, also known as a C-section, the prospect of having a surgery AND a baby at the same time can be overwhelming. 
Don’t Panic! 
You are in good company 1 in 3 women in Australia have C-sections and welcome healthy babies every day. 

A Guarantee of a C-Section is a scar
Medical science has improved and along with it better methods are now used to reduce internal scar tissue adhesions. Modern C-Sections nearly all use the Pfannenstiehl incision (horizontal just above the pubic bone). Generally, no abdominal muscle tissue is actually cut instead the surrounding fascia is and a method termed blunt entry is used. (The fascia gives the muscle it’s shape.) The incisions made are to the fascial walls of the abdominal cavity and finally to the Uterus in order to bring your baby into the world! 

Think of your scar like an iceberg – what you see on the surface is not the whole story. 

There is much that can be done to improve the health of the tissue surrounding the scar and the scar itself with massage.

In order to understand why you should massage your scar it is important to understand a little bit more about scar tissue itself. 

Scar tissue is a fiborous tissue mostly made of collegen which means it is really strong and inelastic, it is sticky stuff and ‘sticks’ the incision back together the trouble is it is indiscriminate about what it adheres to. Scar tissue adheres to skin, muscle and connective tissue also known as fascia. 

So what does that mean for you? 

It means that scar tissue has the ability to pull on all the surrounding soft tissues three dimensionally making these areas taut and tight. Thereby reducing the healthy blood flow, lymphatic flow to the scarred area.  Which really means that the tissue in that area does not receive as much oxygen, nutrients and has a reduced ability to deal with metabolic waste these reduction can effect the nerves and fascia which then can become irritated, altering their function and giving sensations pain or numbness.

Scar tissue can also be the cause of referred pain this can be experienced quite far from the sight of the incision and often the scars evolvement is overlooked.
The referred pain can be caused by myofascial trigger points, nerves and/or functional compensations in movement resulting in a myriad of problems like chronic pain, loss of sensation, increase in sensitivity, numbness and/or itchiness and disruption to organ function. 
Of particular interest to me is the commonly ignored or minimised global effects to the scar owner, the wider effects to their live and those they love. 
Scars really are like icebergs!

In order to help your recovery and reduce complications with scar tissue adhesions it is recommended that scar tissue Therapy is performed once the visible scar has healed.
You will know it has healed once it no longer has a scab.

There should be no heat, swelling, bleeding or other fluids coming from the scar if there is go back to your doctor.

All the scar therapy is done with a light touch and no ointments. 
If there is any pain stop what you are doing. 
It can be helpful to do the massage whilst looking in a mirror. 

Get to know your scar with some massage!

  • Look at your scar  – what do you think?
  • Gently touch your scar. 
  • use the same pressure as you would use when touching your eyelid.
  • Are there any areas that feel more or less sensitive than others? 
  • Are there any areas that feel hard or soft?

Scar Therapy 
How well does your scar move?

It is good to test how flexible the scar is and get to know how it moves. 

  • Place one finger at each end of your scar. Keep one hand still and let the other hand gently explore how it feels to move your scar in the directions of a compass. North, South, East and West. 
  • Are any of the directions easier than others? 
  • Revisit the directions that do not move as easily and hold then wait for a minute or two they may give a little and you might feel a subtle movement. 
  • Repeat this holding the other end of the scar still.

Help your scar

  • Using your fingertips with the eyelid level of pressure gentle stroke in towards the incision from above and blow the scar itself.
  • Notice the texture of the surface skin. Is t smooth or bumpy.
  • Then place fingers pads on the scar and gentle bright your awareness to underneath the scar your finger pads will very gently and slowly begin to sink in a little until to feel a hard ropey area. be patient
  • I invite you to explore the ‘landscape’ of the underneath ‘hardened’ area and keep fingers soft think about holding a baby bird.
  • you can choose an are to stay and be still letting the finger pads connect deeply.
  • wait and you might notice a softening happen.

DO NOT – EVEN if YOU HAVE OLD SCAR

  • Do not rub your scar vigorously – this will cause more ropey scar tissue to form.
  • Do not use circular motions all around your scar that information is out of date 
  • Do not try to break up scar tissue – it is not possible – it is a bodywork myth

Scar Tissue Therapy is a safe way to improve the appearance of your scar and the surrounding tissue – a common issue is the appearance of a ‘shelf’ below the scar. Fascial work greatly improves this and it is something you can learn to do for yourself. 
Specific work for this area is done after the the 6-8 week check up as this is when the internal uterine scar has healed.

I have experienced working with many types of Abdominal Scars. Some are 30years on from the time of incision and some are new scars of 8weeks old. In all cases there has been visual improvement and emotional and physical change for the better after the massage. 
Results are surprisingly quick. 

I like to involve clients in their Scar tissue therapy. 
By teaching them how they can reconnect with their bodies and be in control of their own treatment.

Scar tissue massage should NEVER be painful and the results are quick. Scar tissue massage can be used anywhere on the body and can give far reaching benefits.
So if you are having trouble with backache, period pain, Urinary tract infections, incontinence, bowel issues or experience pain during sex and you have an abdominal scar or pelvic scar of any age. It might be worth exploring what Scar therapy or a trained Scar Therapist can do for you. 

If you are looking for a Scar Therapist to help

CKMassage Training runs runs the longest and most comprehensive scar course available in Australia so if you look at our therapists directory you will find the top percent of Scar Therapists listed there.

If you are a therapist and you want to know more about the Scar Mastery Course

Every Scar has a Tale to Tell

Some scars like the story behind them fade within a few months and are long forgotten however it is becoming more widely known that scars have the potential to cause long term and far reaching effects for both our bodies and minds.

Body Image Risk and Reward in Massage

Body image. Almost everybody has something about their body that they don’t like.

For many people it’s a minor issue, no big deal. For some people it is a major issue which can have a wide reaching affects on every sphere of their lives in a negative way.

Most people react very positively when they find out what I do for a living – compared to other professions massage therapists have a great reputation!

However knowledge of my vocation can also illicit a less than favourable reaction.