Jill Murphy, DPT, LAT, CSCS
In last month’s article, The Skinny on Scars, you learned that scars don’t have to be annoying. While we prefer that you seek a medical professionals’ instructions on how to address your scar, we can provide some basics on scar treatment that you can attempt at home.
First, know what the red flags are before you begin. Red flag signs are the signs and symptoms that tell you that you should NOT treat at all, but instead seek medical advice from your physician or physical therapist without delay:
- Your scar is red, open, and painful: this could indicate a likely infection
- Your scar has yellow, pussy, drainage: this is another sign of a likely infection
- Your scar has been open for months: this scar is not healing, and may need professional wound care
- There is swelling in or around the area of your scar that is not explainable (no trauma created the swelling)
- Because of your scar, you are unable to move, walk, or breathe fully
- You are unsure about the source of your scar, i.e. you don’t remember being injured there: this could be a cancerous lesion and not a scar at all
Also, before you begin any kind of work on an incision, get clearance from your doctor or physical therapist if this is an incision from a recent surgery, to make sure you are at the correct stage of healing to begin working your scar. If you incision has any openings or scabs remaining, DO NOT DISTURB IT! This will keep you from messing with a scar before it is ready.
If you haven’t read last month’s article, The Skinny on Scars, be sure to do so to review the stages of wound healing before beginning any scar treatment. Patients often ask if there is an ointment or cream that can help improve healing of an incision after surgery. Yes, but again, get the okay from your surgeon before using one of these. For facial or neck scars where appearance is at a premium, Mederma can help reduce the visibility of your scar. For basic scar healing, cream or ointment with Vitamin E, aloe, cocoa butter, or other healing ingredient based concoctions can be of benefit as well. Also remember to keep your incision/scar covered to stay out of the sun for the first year of the new scar to allow it to heal without increased discoloration/pigmentation that occurs when the incision/scar is placed in direct sunlight for any amount of time.
The goal of scar mobilization is to address a scar with tissue that is haphazardly organized by stimulating the body’s own healing process to assist in the re-alignment of scar tissue more in line with the angles of tissue pull and stretch in and around the scar area. While the scar may be randomly oriented, the secret to scar mobilization is to take a very organized approach.
1. Parallel scar mobilization: Start working the scar by placing pressure with small massage strokes in parallel on each side of the incision or scar but not on top of the scar itself. This process can start relatively early, because you are not actually touching the scar itself, so you will not be disturbing any scabs.
2. Circle scar mobilization: Using your fingertips (after approval from your MD or physical therapist), work the well-healed and scab free areas of the scars with superficial circular motions in clockwise, and then counter-clockwise directions. Start superficially, working each area slowly and gently, and pausing with some deep breathing to work any particularly tense areas of scar. Over time, you can work the same way with your fingers utilizing deeper angles working deeper into the scar.
3. Cross-friction massage: Once you have worked the scar in the methods described above, and no apparent adhesions remain, go ahead and use the most aggressive technique, the cross friction massage directly over the scar. Again start superficially with a more flat hand technique, and progressing to a deeper massage, holding in areas of scar restriction (areas you will note as painful) and deep breathing until the pain subsides, then move onto the next area of restriction.
4. Directions of the clock double-check: If you still feel there are tiny areas of restriction that the above methods did not address, place your finger-tips over and to the side of the scar and push gently in all directions of the clock to find any remaining restrictions to hold pressure and deep breathe through. Move up and down the scar with these techniques to clear out any remaining adhesions.
- Remember to start with superficial angles and then work deeper into the tissue by changing the angle of your fingers from a flat angle to closer to a 90 degree perpendicular to the tissue over days and weeks.
- Start with light pressure, and work to more substantial pressure.
- Deep breathing with sustained pressure is critical to releasing restrictions.
- Your goal is to make your scar tissue slide and glide in all directions with the same amount of movement as the skin around it and to create a pain-free scar.
- Your body continues to re-organize scars throughout your lifetime, with the most remodeling done in the first 3 months, then 6 months, and the first year. Even if your scar is fine now, don’t be surprised if you need to re-address your scar anytime in the future, as adhesions may return.
- Never spend more than 5 minutes per inch of scar, as you can create damage with excessively intense soft tissue work.
- Work on your scar every other day to allow the tissue to adequately respond to your work.
- If you have any of the red flag signs or if anything about your scar is causing you to be concerned, please share these concerns with your healthcare provider or physical therapist!