Whether you are freshly post-op an ACL repair, total hip replacement, or have suffered a serious burn, scar tissue can become a significant limiting factor in your recovery of smooth, pain-free range of motion if not treated appropriately.
Why do scars form?
A scar is how the body naturally responds to damage to the dermis, which is the deeper layer of skin under the more superficial epidermis. The body will increase its production of collagen – the building block of skin and other organ tissue – to assist in healing the damaged skin. Most of the time, this collagen is laid down in a nice and organized manner in parallel strips which eventually heal and are replaced with more mature skin cells (think about the end stages of a scab after a scraped knee), but in instances where the wound was quite deep, a hypertrophic scar will form, where the collagen is laid down in a much more disorganized manner, leading to a raised appearance of the skin and a more rough texture. They will often have a deep red or purple appearance and can be hypersensitive to temperature and touch.
Complications of untreated scar tissue
Scar tissue is much less elastic and can lead to tightness and reduced range of motion, especially when the scar crosses a joint (this is known as a contracture). Scar tissue may also lead to pain and discomfort. If scar tissue continues to build up under the original scar, it can also start to adhere to other tissue below the skin (ie. muscle or fascia), leading to further tightness and restrictions in muscle force generation.
While you are healing from your injury or operation, it is essential to treat the scar as part of the rehabilitation process for optimizing full range of motion and function.
There are several ways to treat these raised, disorganized layers of skin. Some examples include:
- Moisturizing: Applying moisturizer or oils (i.e. Vitamin E) can help keep the skin hydrated and smooth. This is a great first step prior to initiating massage or stretching
- Scar massage: This involves applying firm pressure across the scar in different directions to attempt to smooth it out, prevent adhesions, and improve collagen synthesis.
- Stretching: If the scar crosses a joint, it is important to stretch the muscles that surround that joint by passively pulling them into their end ranges of motion to improve overall flexibility of this region
- Extracorporeal Shockwave Therapy (ESWT): This is a great modality that can be used in certain cases to improve scar remodeling through fibroblast regulation
- Avoid direct sun exposure: discoloured and immature scars can burn easily, leading to further tightness. Cover these areas and use lots of SPF prior to getting in direct sunlight to avoid any complications in your scar tissue recovery
- Customized pressure garments (specific to burn rehabilitation): these can help flatten raised scars and reduce itchiness
Scar management should not be done in isolation, but instead should help round out a holistic rehabilitation program that may also include progressive strengthening, soft tissue release, manual therapy and more.
Scar tissue forms as a result of an injury or cut through the deeper layers of skin and can result in tightness, reduced range of motion, itchiness and pain. When dealt with properly, we can achieve a flexible and mobile scar that moves freely of the tissues beneath it and does not have any impact on the function of the joints or muscles it overlays.
If you have recently had an operation or injury that resulted in a scar formation, you may want to speak to a physiotherapist to discuss treatment options that include scar tissue management as part of your program.
–Kali Haydenluck, Registered Physiotherapist
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