The Skinny on Scars

Jill Murphy, DPT, LAT, CSCS

ScarOur body is surely amazing, with abilities to respond to, survive, and recover from an astounding array of injuries and insults with maximal preservation of our overall function. There is no more direct example of the body’s ability to repair itself than scar formation and healing.

Scars start out as a conglomeration of inflammatory agents, blood cells, and phagocytes sent to the involved area as a result of the body’s inflammatory process to clean and debride the area of waste and dead cells. The next stage of scar healing involves fibroblasts that create a granular collagen tissue mesh to cover the area and pull the margins of the edges of the scar together as cells replicate and new blood vessels are formed. Starting out as a fragile bridge connecting the edges of a wound and over time building in strength and stability, the scar hardens as margins of the scar pull closer together each day. In the remodeling or maturation phase, the criss-cross haphazard scar is transformed into collagen aligned more closely with the tensile lines of the normal skin tissue around it as we move the joint or body area more and more in the days and weeks after our injury has healed.

Depending on the scar “program” contained in our DNA codes, some people scar nicely, with a flat, mobile surface that moves, slides, and glides just like ordinary skin. These scars may require slight help in that direction from the skilled hands of a manual physical therapist, but they likely don’t require a ton of attention, as the body works through the normal tissue healing process. Many other people are a bit more unlucky, and their DNA program is a little off, creating excess scar tissue that heals with some raised, firm areas that don’t move, bend, and glide with the rest of the skin. Pain, pins and needles, and restricted mobility of the scar is common. Left untreated, this scar can create layers of painful and restricted skin and soft tissue tightness that become nagging reminders of an injury that did not heal just right.

As a physical therapist, my job is to assist the body with special techniques to help speed up the healing and remodeling process and to instruct patients in movement patterns that will be helpful instead of hurtful in the long run in response to an insult to the body. The good news is that scars even decades old can and are successfully treated with scar mobilization techniques performed by a physical therapist. Because the cells in our body are constantly replenished, the scar regeneration process is available no matter how many years have passed since the initial injury.

As a physical therapist performs soft tissue techniques to mobilize and break down the scar (sometimes referred to as keloid) in specific directions of restricted movement, the body is cued to rapidly remodel the area in response. Several treatments or more may be required, depending on the severity of scar adhesions, but every patient, no matter how great the scar tissue restrictions, can be treated to the point of full scar mobility, slide and glide with adjacent tissue, leaving the area pain-free and able to move in any direction. Scar mobilization can be uncomfortable, but with treatments in the clinic by a good manual physical therapist and sound instruction on how you can mobilize your own scar at home, excellent results can be achieved. If you have lingering scar adhesions, please contact your manual physical therapist today to improve function and minimize annoying and unnecessarily painful scars.