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.
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.
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[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.