Around ten years ago, an impromptu scar tissue treatment from a massage teacher in the UK impacted my life in a massive way. Writes scar tissue massage therapist and educator Christine Knox.
The benefits from that one treatment were so remarkable it began my learning journey and fascination with the world of scars. This gentle modality has been known to give quick, long lasting results to help client out of chronic pain and into pain free functional movement quickly.
Some scars have the ability to impact their owners’ lives in many ways. For example, Mrs M came to my treatment room to have the scars on her face treated after removal of a few skin cancers. When observing and assessing the scars, I could barely notice them but the client, a 52-year-old wife and mother of two daughters, the scars were very noticeable. She works in an educational establishment comes into contact with many people daily and outwardly she appears outgoing and happy. However, she said she felt as though everyone was staring at her scars and didn’t see her. This had lowered her self-confidence.
Upon palpation, the scars did have areas of fascial bind, which seemed to be causing a pulling sensation close to the corner of her eye. I applied some gentle scar tissue techniques on her delicate facial areas where the scars were located for no more than 15 minutes. When massaging scars, no lubrication is required, the pressure used is light similar to lymphatic work although the tissue connected is deeper and from fascial perspective. The result was that the bind and pull of the scar had gone. More impressively, Mrs M experienced a diminished perception of the scars and she said her face felt like her face again.
She also mentioned that her knee had a scar as a result of a skin cancer removal that she would like me to look at. When I asked her how this scar affected her, she said she couldn’t bend her knee because of it. When I asked her to show me how much movement she had, there was a discernible restriction in the knee flexion under 45 degrees of flexion.
I asked how long this has 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 – two years ago’.
She told me she had been unable to go to line dancing because when she tried to bend her knee it hurt.
‘I have put on weight and I miss the girls we had such a laugh, traveling to competitions together. It has really got me down’.
At this point I am thinking this scar must be huge. However, the scar was under 2cm in length, white in colour with a little pink lump on the medial aspect. It was 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. There was a positive reaction to the treatment techniques and asked her to bend her knee again. A dramatic result: more range of motion and pain free 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 they were small in size but 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.
This report shows a growing number of surgical procedures in Australia every year, making it more likely that therapists will encounter more clients with scars in the future.
Four stages of healing:
Healing has four precise stages, which overlap: Homeostasis, Inflammation, Proliferation and Re-modelling.
For success healing, a wound must go through each stage in the set order for an exact period of time. The problems occur when there is a variance in the healing process 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 aspects of the scar tissue. This means that when scars do behave atypically there is a possibility of experiencing far-reaching effects to areas distant to the scar resulting in dysfunction to the bio tensegrity of the fascia.
Think of a rabbit warren: what we see on the surface is nothing compared to the unseen below and beyond what we perceive to be the boundary of the scar.
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 some therapists are as yet unaware, yet 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.
The Australian Government reports that in 2017-18 there were over 2.3 million elective surgeries with an additional 352,000 emergency surgeries performed. Figures in this report show a growing number of surgical procedures in Australia every year, 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 many therapists don 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 – but sometimes the treatment outcomes can be disappointingly short lived with results diminishing from a few hours to a 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 undisclosed abdominal scar, possible because they have forgotten about the scar or simply do not think it has anything to do with their lower back pain.
Scar tissue massage techniques aim to impact clients by:
> reducing stress responses in the nervous system
> increasing vascular flow
> increasing lymphatic flow
> minimizing the aesthetic impact of scars
> restoring function, and
> 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 counselors or psychotherapists. Talking therapy is outside our scope of practice.
Skills essential for this work are holding the space, energetic boundaries and compassion to ourselves and others.
I have found it helpful to create a network of psychotherapists, councilors, play and music therapists to whom I refer my clients. This also opens the door of reciprocal referrals.
This is an article written by Christine Knox and was published in the Massage & Myotherapy Journal – volume 18 | Issue 1 | 2020. Christine Knox is a presenter at the Massage & Myotherapy Australia National Conference Pre-Conference workshop for Abnormal Scars on 22 May in Adelaide. Christine is a Remedial Massage Therapist with 10 years’ industry experience in the UK and Australia, who has had the opportunity to deliver massage treatments in many settings from rock concerts to hospitals and also train therapists in Australia and the UK in Remedial Hot Stone and Scar Treatments.
In our opinion, both massage and acupuncture treatments can be beneficial treatment methods in the treatment of scar tissue and their related issues.
References:
Marieb EN (2003) Human Anatomy and Physiology 5th edn. Redwood City, CA: Benjamin Cummings Publishing
Lewit K,Olasnska S (2004) clinical importance of active scars: abnormal scars cause pf Myofascial pain. Journal of Manipulative and physiological Therapeutics 27(6):399-402
Bordani B, Zanier E, (2014) Skin, fascias, scars: symptoms and systemic connections. Journal of Multidisciplinary Heathcare 7:11.
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: Chirchill Livingstone Elsever.
www.aihw.gov.au/reports/hospitals/hospitals-at-a-glance-2017-18/contents/surgery-in-australias-hospitals