Scars. We all have them, but what are they, what happens when we get them and how does massage fit in?
Scar tissue forms as a result of (1) an inflammatory response to damage to soft tissue, (2) long-term immobilization and (3) paralysis or lost or impaired voluntary movement. They occur in all soft tissue – skin and other organs, muscles, ligaments, tendons, connective tissue and nerves. There are many kinds of scar tissue and each is defined by both individual and similar properties. Of the various kinds, today’s discussion involves adhesive scar tissue, contracture scarring and adhesions.
Scar tissue is not the same material as the original damaged tissue. Rather, it is a matrix; a mixture of collagen fibers and glue provided by cells in order to effect repairs. The matured matrix has approximately 80% of the strength of the original tissue, so cells really pile it on to make sure it holds. Unfortunately, due to the differences between the original tissue and that of the scar, restrictions and limitations are often placed on the tissue. Elasticity is reduced, discoloration occurs, range of motion may be affected particularly where scars and joints are close together, and the area becomes devoid of hair, pigment, melanin, sweat glands, blood circulation (after healing is complete) and other features.
The scars we are most familiar with occur in the skin and they are made up of adhesive scar tissue. When a break in the skin occurs (more than a minor cut), the body floods the area with all kinds of things, although all we see is inflammation. Cells throw down the collagen matrix helter skelter, rather like an unstacked wood pile. This continues until the body decides there’s enough of the new matrix to close up the injury.
Interestingly, the bright redness that occurs in the new scar appears because certain cells actually build in-roads (capillaries) to provide a route for other cells to deliver repair materials to fix you up! Like public works, when the job is done, they leave the area (including abandoning the capillaries) and the scar eventually loses pigment and becomes pale compared to the surrounding tissue.
Contracture scar tissue forms much the same way, but occurs to connective tissue at or near joints, including joint capsules. Because scar tissue is not as pliable as the original tissue (which isn’t very pliable to begin with), the surrounding original tissue becomes painful before a full range of motion can be reached.
Adhesions form between structures, whether it is between two soft tissue structures or soft tissue and bone. Adhesions further limit movement by not only being non-pliable, but by attaching to other structures than the original injury. Imagine placing your finger on the skin of the back of your hand and moving the skin surface without moving anything below it. An adhesion between skin tissue and muscle tissue beneath it would not allow you to move that so easily. It further limits the range of motion and pliability of tissue.
Many massage techniques are useful toward reducing pain and tension on structures, breaking up adhesions, remodeling and softening scar tissue, restoring mobilization of the affected tissue. These include cross-fiber friction, bowing, stretching, skin rolling, fascial spreading and massage cupping. The skilled massage therapist will use a combination of these techniques and none should create more than mild discomfort when done correctly and for the proper amount of time.
