Scar Tissue: Move It AND Lose It... by dealing with it
Scar tissue is THE mechanism which automatically repairs our muscle, tendons, and ligaments. A muscle contusion essentially looks like a tear, and the body eventually patches it together with cells and the building blocks that they secrete. Ligament tears, and rotator cuff tears use scar tissue to heal, and of course our bodies heal with scar tissue after a surgery. Surgeons and Physios constantly consider the scar tissue response as a fundamental basis for their care.
Before we touch on scar tissue adaptations and mobility, it is important to have a basic knowledge of wound healing.
There are four main phases of wound healing after an injury or trauma. Physiopedia: Wound Healing describes this process in detail below.
Hemostasis
Inflammatory
Proliferation
Maturation
Phase 1: Hemostasis Phase
Hemostasis is the first phase of healing and begins at the onset of injury. The goal of this phase is to stop the bleeding. During this process, platelets come into contact with collagen and essentially form a clot to stop the bleeding. Helper enzymes in the area initiate the formation of a fibrin mesh, which strengthens the platelet clumps into a stable clot.
Phase 2: Inflammatory Phase
In the Inflammation Phase, white blood cells enter the wound and destroy bacteria and remove debris. This is important because the body is preparing to grow new and healthy tissue. These cells reach their peak between 24 and 48 hours after the injury; therefore, the Inflammatory phase lasts up to three days.
As the white blood cells leave, another type of cell arrives to continue cleaning up the debris. These ‘cleaner’ cells also attract immune system cells to the site of injury in order to facilitate the repair of the damaged tissues. This phase lasts four to six days and is characterized by pain, redness, heat, and swelling.
Phase 3: Proliferative Phase
This is the phase where the wound is filled and covered. There are three events that take place in Phase Three:
Filling the wound
Contraction of the wound margins (edges)
Epithelization (covering the wound)
During these events connective tissue is added, new blood vessels are formed through the damaged area, and the wound starts to ‘pull’ towards the centre to become smaller. Epithelialization occurs when epithelial cells (skin cells) migrate across the wound bed until the wound is covered in fresh skin.
Phase 3 can last anywhere from four to twenty-four days depending on the severity of the injury.
Phase 4: Maturation Phase
During this phase, the new tissue gains strength and flexibility. Collagen fibers reorganize to run parallel with the surrounding muscle fibers, the tissue remodels, matures, and gains tensile strength. It is important to note tensile strength will only ever increase to 80% of pre-injury strength. The maturation phase takes anywhere from twenty-one days to two years.
Assuming all goes to plan, this is how a wound would heal in the best case scenario. Issues with scar tissue formation tend to occur during the Maturation Phase. If the collagen fibers aren’t gently stressed during this phase, they may not line up parallel with the surrounding muscle fibers which creates an adhesion between the tissues, as they are now not able to slide nicely past one another.
Gentle ways to stress tissue in the Maturation Phase:
Gentle massage vertically along the scar and horizontally across the scar
Gentle walks
Graded return to sport
Gentle loading at the gym: 30-40% of your one rep max
Soft tissue work with your Physiotherapist or Massage therapist (“Manual Therapy”)
Progressive home exercise program from your Physiotherapist
Being able to gently stress these tissues will help prevent the build up of scar tissue while you are in the final stages of healing.
If, however, you are past that point and you currently have scar tissue in an area of previous injury that is painful or restricting your range of motion, there are a few options to help strip that out.
Options for getting rid of Scar Tissue:
Deep tissue massage with your Registered Massage Therapist (RMT)
Manual soft tissue work with your Physiotherapist (PT)
MPS treatment with your Physiotherapist
Dry needling / IMS
If you have any questions please feel free to send us an email.
Reference Links to Wound Healing
Ashleigh Low, Registered Physiotherapist