Written by Daan Lansdorp, physiotherapist and owner of FysioGrow. Trained in scar therapy and fascia massage.
Did you know that scars can cause physical problems as well as cosmetic ones? That adhesions can lead to pain and limit your movement?
At FysioGrow in Rijswijk, near The Hague, I treat people with problems caused by scar tissue. On this page I explain how a scar forms, what effects it can have and how scar therapy works.
What are scars and what problems can they cause?
A scar is the repair tissue the body makes after damage to the skin and the tissue underneath. Think of surgery, a cut, a burn, or even a deep graze. You can see the scar itself on the outside, but under the skin the tissue can also stick to deeper structures such as muscles, fascia (connective tissue) and nerves.
These adhesions can cause various problems:
- Fluid build-up around the scar
- Trapped nerves
- Mechanical blocking of nearby joints
- Pain on or around the scar
- Numbness, or the opposite, oversensitivity
- Loss of muscle strength and coordination
- Changes in posture from avoiding pain
- A higher chance of new damage in the area
You may notice these problems right after a scar forms, but they can also flare up months or even years later.
The role of fascia
Scar tissue directly affects how well the connective tissue, also called fascia, can move. Fascia holds muscles, bones, nerves and other tissues in the body together. It makes movement possible, moves fluid around and spreads the forces that act on the body.
Fascia runs through your body in chains, like a kind of spider’s web. So an adhesion or stiffness in the fascia in one place can cause problems somewhere completely different. A scar in the calf can affect neck pain, for example, and a scar after a caesarean section can cause back pain.
How does a scar form?
When the body repairs damage, we can roughly distinguish three phases:
1. The inflammatory phase
In this phase the body starts an inflammatory response to begin healing the wound. You’ll see signs such as pain, redness, warmth and swelling. The surrounding skin stiffens and becomes more sensitive to pressure. This phase lasts a few days.
2. The proliferation phase
This phase starts about 1 to 3 days after the wound appeared. The body produces healing substances that stimulate the growth of new cells. New tissue forms to close the gap.
3. The remodelling phase
In this phase the new cells are arranged more neatly in place. The connective tissue takes shape according to the pattern and direction in which the tissue needs to be used. The scar becomes less red, softer and thinner. The surrounding skin becomes more elastic. This phase can go on for a year or longer.
Once the healing process is complete, a scar is left behind. What it looks like depends on the cause and the type of tissue.
Important: drinking enough water plays a role in healthy connective tissue. Fascia is full of water. With chronic dehydration, fascia dries out and can’t function as well.
Types of scars
Not every scar is the same. At FysioGrow we recognise the following five types:
Immature scar
A scar that is red or pink and slightly raised. It can itch and be painful. This is a normal phase that often passes by itself.
Mature scar
An older scar, usually pale, flat, thin and light in colour. This is the end stage of a healthy healing process.
Hypertrophic scar
More common in young people, especially after burns, and in people with reddish or dark skin. This scar tissue is usually red and thickened and can cause itching or pain. A hypertrophic scar doesn’t grow bigger than the original wound and can develop within a few weeks of the injury. It can heal by itself, but that can take a long time.
Keloid scar
An abnormally thickened, irregularly shaped scar. It is red to dark in colour and bigger than the original wound. A keloid can occur at any age, but develops more often in younger people and people with dark skin. It can develop after any kind of skin damage: a surgical wound, burn, vaccination, tattoo, piercing or acne scar. Sometimes a keloid even develops without a clear cause, for example from an inflamed hair follicle.
Atrophic scar
A small scar that sits slightly sunken in the skin. It looks like a little pit in the skin. Well-known examples are scars from acne and chickenpox.
What is scar therapy?
Scar therapy is a targeted physiotherapy treatment to reduce or prevent problems caused by scar tissue. Scars can come from surgery or cancer treatment, among other things, and they affect the fascia. This can lead to adhesions, thickening and hardening, which in turn cause restricted movement, pain, fluid build-up, muscle weakness and loss of strength.
With scar therapy we tackle these adhesions and thickenings. In practice we often see that scar tissue is overlooked as a cause or contributing cause of pain. By treating the scar and loosening it, we can get good results, even with problems that at first sight seem to have nothing to do with the scar.
Goals of the treatment
- Support wound healing
- Prevent wound infection
- Get a scar that looks and works as well as possible
- Prevent or treat problems in the muscles and joints
Do you have a scar after surgery, an accident or giving birth, and do you recognise one or more of the problems in the list above? Then scar therapy may help. Book an appointment to discuss what we can do for you.
Approach and treatment
Treatment always starts with a thorough intake. We look at exactly where the problems come from and whether there are any serious underlying conditions (so-called red flags).
We map out all the factors that may play a role, and together we set the goals you want to reach. What do you want to be able to do again once we’ve finished the treatment?
Assessment
Next we do a physical examination. We look at how mobile all parts of the fascia are: does the tissue glide well? Are there adhesions? We check this in the superficial and deeper layers of fascia. We also assess how your body moves. If we find movements that are held back by the scar tissue, we test them again after we’ve treated the scar.
Treatment
Treatment uses several techniques. I mainly use my hands for fascia massage and mobilisations. Sometimes I add a cupping glass or kinesio tape. Applying these techniques on and around the scar tissue reduces the adhesions and thickening. The fascia glides better and there’s room to move again. This lowers the pressure and pulling tension on the surrounding tissue. It can even ease trapped nerves or make them go away completely.
Ready to start?
At FysioGrow in Rijswijk, near The Hague, I treat people with scar problems every week. Do you think scar tissue plays a part in your pain, or would you like proper care for a fresh scar (after surgery or childbirth) to prevent problems? Book an appointment and choose Daan Lansdorp as your therapist when booking. Dealing with other pain? Take a look at our pain page for the full overview.
Frequently asked questions about scar therapy
What exactly is scar therapy?
Scar therapy is a physiotherapy treatment where we use our hands, sometimes combined with cupping or kinesio tape, to treat the scar tissue and the surrounding fascia. The aim is to release adhesions, restore mobility and reduce pain or other problems.
When does scar therapy make sense?
Scar therapy makes sense if you have problems that may be caused by a scar: pain, sensitivity, restricted movement, fluid build-up or a pulling feeling. Even with old scars, for example after a caesarean section or an operation years ago, we can often still get good results. We also work preventively: by guiding a fresh scar well, we often prevent problems later on.
How long after surgery can I start scar therapy?
Only once the wound is fully closed and healed. This is usually about two to three weeks after surgery, depending on the type of procedure. Always check with your doctor or surgeon first whether the wound has healed enough. In the first phase we work gently on the surrounding tissue. In later phases we can treat the scar more directly.
How many treatments will I need?
That differs per person and per type of scar. With fresh scars we often see improvement within a few sessions. Older or larger scars (for example after major surgery or a burn) can take more sessions. During the intake we draw up a treatment plan together, with a realistic estimate.
Is scar therapy covered by my health insurance?
Scar therapy falls under physiotherapy and is covered by your supplementary insurance, depending on your policy and how many treatments you have already used. With a referral from a specialist, it is sometimes also (partly) covered by your basic insurance. Check your policy conditions or get in touch to talk it through.
Does scar therapy hurt?
The treatment can feel sensitive, especially with adhered or old scars. We always work within your pain threshold and adjust the pressure and technique to what you can handle. Right after treatment the area may be a bit sore. That usually fades within 1 to 2 days.
References
- Mustoe et al. International Clinical Recommendations on Scar Management. International Advisory Panel on Scar Management.
- Yang L, Witten TM. A biomechanical model of wound contraction and scar formation. J Theor Biol. 2013 April 4: pii: S0022-5193(13)00117-3.