How Scar Tissue Impacts Healing and Movement
Scar tissue is a vital part of the healing process for big wounds, but did you know that it can affect your overall health and mobility? I’m Lauren Masi, Doctor of Physical Therapy and board-certified Orthopedic Clinical Specialist. I’m also the owner and Clinical Services Director of Bay Area Physical Therapy and Lafayette Physical Therapy. Today we’re going to talk about how scar tissue impacts healing and movement.
How and Where Scars Form
Scar tissue can be formed at the surface where it’s visible or deeper within our tissues, and typically is at the binding site between two tissues that have been damaged. Those tissues could be just the skin, it could be muscle interfaces, or it could even be within the fascia.
And everyone scars differently. You might know someone whose scar you can’t even see. Maybe they had a big surgery, like a knee replacement, and you have to really look hard for their scar because it healed so nice and flat with no discoloration. And then there are some people whose scar might be discolored and raised in a keloid scar effect, or a thick, raised bit of scar tissue.
Obviously, we all want to aim for that nice flush, loose skin that isn’t bound down or very tight and restricted, but sometimes we’re not so lucky. And this is where physical therapy can come into play.
What Causes Scarring?
Scar tissue can form after an actual surgery, where we’ve obviously cut the skin, but it can also occur after blunt traumas or falls. It can happen anytime that you have some bruising, which is a sign that blood vessels have broken under the skin, or just areas of swelling. Inflammation carries a lot of, in layman’s terms, sludge like broken cells and cell parts. It has the inflammatory byproducts of our body trying to heal by bringing good stuff to the area. But if we don’t flush that swelling out and we don’t get some of those bruised areas out, that thickened sludge can actually solidify and contribute to scar tissue deep under the surface that you can’t see.
Old Scars Can Contribute to New Pain
And what people might notice down the road is pain in an area that might not be related to a surgery or obvious prior injury. Sometimes I have people who come to me reporting back pain or hip pain; then when I take their medical history, I find out they had an appendectomy years ago, or a gallbladder removed. And I’ll ask, “Did you have any physical therapy after that? Did you have any visceral mobilization after that?”
And what I come to find is sometimes those surgeries, which people think are non-related to their musculoskeletal ailments, can actually be related to the pain you’re feeling now. We take that medical history so I can make sure that I get to the root cause of the pain, but I’m also going to try to help you free that scar tissue.
Scar Tissue Needs to Be Handled Quickly
If you are somebody who had a surgery years and years ago, unfortunately sometimes we’re limited in what we can do. What I tell my patients is that scar tissue at about six months, and for sure by one year, has solidified. It’s pretty much non-elastic at that time, and I can’t stretch it out or free it anymore. That’s why I want everybody to be aware of addressing their scar tissue as soon as possible.
You have to be cleared by your doctor if you have had surgery before you can come to PT. And I don’t recommend any scar mobilization or work if your wound has not completely closed. We do want to make sure that those edges of an obvious surgical scar have closed with no scabs and no signs of ongoing healing before we start to work on it. But otherwise, I’ll have patients work on that as soon as possible.
I’ll always tell my patients, “Scar tissue and range of motion is the number one thing that we need to get back after a surgery or an injury.” We can always strengthen. You can always go to the gym or work in physical therapy or at home to do exercises to get stronger; but if you don’t operate in that 6-month window before your scars have solidified, then it could have lasting effects.
How Deep Can Scars Go?
Another type of scar tissue might not be related to the skin but deeper within the tissues. For example, if you had a knee surgery, an ACL reconstruction, or a knee replacement, sometimes you can get scar tissue and adhesions down at the joint level. And you might know some people who never got their full range of motion back after those surgeries. That can have a negative effect on your life. You might not be able to get on and off the floor to play with your children or grandchildren. You might not be able to go up and down stairs or get in and out of your car easily. So, definitely please be sure to address scar tissue as soon as possible.
What if Your Doctor Doesn’t Refer You to Physical Therapy?
One thing I will say is, if your doctor has not recommended physical therapy after surgery, even if it is a visceral or abdominal surgery, please be your own advocate. Ask for physical therapy. It doesn’t mean you have to come to physical therapy for months and months on end, but we want to make sure that we teach you the right ways to handle and address those issues and to be able to prevent any future limitations.
Laser Therapy for Scar Tissue Mobilization
Another modality we are lucky enough to have here at Bay Area Physical Therapy and Lafayette Physical Therapy is the Class IV laser, which we do use to help us in treating scar tissue. The laser creates an increase in blood flow, which can help the tissue become more pliable so that we can free those adhesions and make the tissue smooth and able to glide easily. If you are not familiar with our Class IV laser, you can learn more in our prior blog post.
If you have any concerns about your scar tissue or future upcoming surgery, please reach out to us at (925) 284-3840 today to have a complimentary consultation or set up an evaluation for physical therapy.