Thursday, October 28, 2010

Scar Tissue & Massage

Scars are common among us.  We were wild when we were kids.  We got nicks, scrapes, cuts, jagged rips and assorted tears in the protective layer we call skin.  Did you know that skin is actually an organ? Yup.  We don't think about it much, but, sure enough, skin is actually the largest organ in your body.  It's purpose is to protect everything we are inside the skin.  And anytime we break the skin, we allow germs in.  Germs, bacteria, some viruses...  It's not good.

But we're equipped to handle it, to some degree.  We have little cells whose job it is to circulate throughout our bloodstreams, looking for damage to our organs, including our skin.  When the brain gets word that there is a break in the skin, it sends these cells directly to the site to effect repairs almost immediately! It's amazing.  One kind of cell brings patching equipment material (collagen fibrils) while another brings a gluing material to hold the fibers together.

The collagen fibers are thrown down at the placement of the wound to close it up, but this is an emergency! These cells are like a M*A*S*H unit, not like a plastic surgery clinic.  Brain says to close up the wound and there's nothing that says to do it in a pretty way.  So the cells throw the fibers down helter-skelter and the fibers end up laying in every which direction in an attempt to close up the wound.  Glue is thrown on top, followed by more fibers, followed by more glue, and on and on.

Depending on the size of the wound, the amount of inflammation in the area and the ability of the cells to actually reach and close the wound directly determines the amount of material thrown down, the length of time the cells will take to effect repairs and length of time before the scar tissue is strong enough to hold together.  Cells don't take any chances -- they pile on the collagen fibers and glue until the area is well-sealed.  Generally, scars take 5 days to 4 weeks to heal well enough.  If the wound is too big, too long or too deep, it will take far too long to close up the wound and the wound will take stitches to bring the good edges close enough together for a good repair to happen quickly.

Let's say the wound is now closed.  What you have is a discolored, usually red or pink rather bumpy or raised scar in place of the open wound.  The cells have done a great job and have continued along their way to look for trouble elsewhere.  Meanwhile, you're left with a new scar.  Now, for most of us, these scars make great conversation pieces when we're young.  We might even still boast about them when we get a bit older.  But then, it depends on personal mindsets as to whether or not we want other people to see our scars.  If they're always covered, we don't usually give them much thought.  But if they're in obvious places, the face, arms, neck, exposed areas, we may become conscientious of them as we grow into adulthood.

Here is where massage comes in.  But before I get into that, I'd like to bring into our conversation a cousin of the scar -- adhesions.  Actually, they're much the same thing -- scar tissue.  But I'm going to differentiate between them by referring to them this way: let's say "scars" are outside on the skin; "adhesions" are the inside the skin.  By "inside", I mean both actually on the inside side of the skin as well everywhere else in our bodies inside the skin -- organs, veins, muscles, other soft tissue.  Bone's don't scar because degeneration and reformation is a constant process throughout most of our lives.  That means that certain cells are constantly taking away bone material while other are constantly replacing it with new.  All that remains is for the decisions of mechanical stresses placed on the bone to determine how the replaced bone will form.

So, now to massage and how it is used where scar tissue and adhesions are concerned.

Because collagen fibrils are thrown down in no particular direction, scar tissue ends up looking more like an unstacked pile of wood instead of deck.  This is contrary to what we'd like to see.  If the fibrils would all lay in one direction, namely, the direction of the wound, the scar would be much less noticeable, smaller and much less discolored.  In essence, aesthetically pleasing if not nearly invisible to someone who doesn't know to where to look for it.

One technique of massage is cross-fiber friction (CFF).  By the way, CFF shouldn't take place on a brand new scar.  At least a week, sometimes much longer, must pass before this technique is applied.  We want to make sure the wound is closed and that our work won't reopen it.

CFF is used to break up scar tissue and align the scar fibers in the direction of the wound.  A finger or thumb is used to effect the movement and no or extremely little lubrication is applied.  The tip of the finger or thumb is placed on one side of the scar and slides across the wound, taking the skin with it.  If a lubricant is used, the skin will likely slide beneath the finger.  This is okay for a short time, but will eventually become a nuisance ache, rather like a rope or friction burn.  Once the finger reaches the other side of the wound, it is stopped and motion is reversed.  This continues as long as necessary to travel the entire length of the wound several times.  Too much aggravates the skin, so we don't want to do that.  But we DO want to reduce the amount of scar tissue.  So we may do this on a one inch scar for 2-3 minutes, perhaps longer.

You can also do this at home.  You may wish to put a natural oil on the area to help nourish the skin while you do it.  Vitamin E oil, rose hip oil or something similar is good for helping reduce the coloration of scar tissue and helps break up the fibers, too.

Adhesions are treated a little differently.  Pressure of CFF takes place only in one direction, then the finger moves without pressure back to the original position and the process starts again.  The difficulty with adhesions is actually being able to feel or palpate the adhesion.  It's key to do CFF on the adhesion and not in the general area because the collagen fiber making up scar tissue and adhesions is NOT the same material your skin (or whatever you're working on) is made of and won't take kindly to continuous CFF.

Adhesions can take place anywhere, but massage therapists generally work on ones located in muscles, tendons and ligaments including those in the spine.  Along with CFF, the therapist may use other techniques such as myofascial release, Alexander Technique or Feldenkrais Method, among others.

One additional location for adhesions, important especially for women, is the breast.  Breast tissue sits above the layer of muscle on the chest and may be damaged in lots of ways - breastfeeding, wearing too tight a bra, weight of the breast itself, sports activities or any rough handling.  The breast itself is an amazing piece of equipment.  Internally, there is adipose tissue (fat), ligaments and structures associated with the production and delivery of milk.  Adhesions can form in the connective tissue, the milk structures, ligaments or on the inside of the skin, especially when a baby breastfeeds or following surgery on the breast or nipple.

While all massage therapists are able to massage breast tissue, there are many reasonable laws, regulations and ethical boundaries in place within the profession and at the regulatory level to protect the client.  Many women get breast massage and for a number of reasons, but most are clinical in nature.  Search out a therapist who has been specially trained in this type of work before agreeing to having it done.  A written release and detailed explanation of what will take place is usually required by law before a massage session even begins when it includes breast massage.

One last bit of interestingly positive news.  It doesn't matter how old the scar is, massage can help reduce the amount of scar tissue and the redness coloration of the scar! New scars will see results much sooner, but old scars will also vastly improve over time.

In the end, massage therapy for reduction of scar tissue and adhesions is widely accepted in the medical field.  I've used it myself many times, including on myself, with terrific results! CFF for scars and adhesions can easily be integrated into a full-body massage or area-specific session.  Just let me know if you'd like to try it.

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