Scar Tissue Explained

So often we hear of these things called “knots” and scar tissue falls under the umbrella of that label. But do we really know what it is?

Firstly, scar tissue is something that most commonly results from injury or surgery – which we likely understand already, but it can also form through things like inappropriate muscle activation patterns too.

The scars that we can see visually will help us to understand the process through which the first two examples result from (injury and surgery). We’ll also then go through the third example to understand how it can be present through dysfunctional movement patterns.

Injury & Surgery:

There are of course a number of differences between these two phenomenon, however they have more in common than not so we’re going to group them together for the purposes of this discussion.

When the skin is broken, the body has to first stop the bleeding and then it has to go about repairing that damage. To stop the bleeding we have these beautiful things called platelets that get “stuck” in the wound in the connective tissue lattice that is the fascia. Once stuck, they perform the function of a plug for the outflow of blood. (yay!)

From there the body has these things called “fibroblasts” that go into hyper-drive to produce more and more collagen (the main fibrous component of the fascia/connective tissue lattice). Collagen basically acts as the “scaffolding” for the construction site that is this wound. It holds everything in place so that all the other great cells in your body can perform their function and remove, repair and regenerate the tissue. It’s this scaffolding that is what we classify as scar tissue!

The idea is the generally the body puts down the scaffolding, and then when it’s no longer needed it is removed… however the workers can often forget to take some of the scaffolding away and this is what we are seeing in the visible scars that have a white colour to them. The reason it’s white is because the thicker connective tissue lattice in this spot has less vascularization (less capillaries, hence less blood flow, hence less colour).

By the way – massage (and other heating and movement methods) have demonstrated the ability to improve the healing process and reduce the whiteness/visibility of scars in the long term… just so you know 😉

Dysfunctional Movement:

So then how does scar tissue form the other way? It’s a bit convoluted but I’ll do my best to be brief.

Our muscle cells are basically suspended within the connective tissue network (fascia). The muscle cells contract, pulling on the fascia, who in turn pulls on the bones to create movement (that’s the overall view at least…a few parts of that might be changed if we wanted to delve deeper).

The two main functions of connective tissue are:

• Enable smooth movement where needed
• Create stability (no movement) where needed

The thing is, these functions are seemingly at opposite ends of the spectrum. The body determines which function to perform in which area of the body based on whether or not movement is present (the muscle cells are pulling on the connective tissue or not).

In the case of muscle cells not doing their job, the connective tissue in that area is increased in its deposition. As in, the body puts more collagen there because it believes stability is needed. Initially in this process we might classify this type of knot as “adhesions” but after a while and once the adhesions are thick enough, we can essentially classify it as scar tissue. An example is shown here of organs with scar tissue between them (where movement is now no longer possible without intervention):

We may not realize it but sometimes our muscles might be “silent” or not working when they should be. When this happens chronically we can build scar tissue.

The trick to removing this type of scar is not only the steps for surgical and injury scars, but before those things can be effective you have to re-activate the muscle correctly and integrate it into movement patterns.

On a personal note I have found electro-stimulation to be very effective at improving the recruitment of muscle fibers that have previously been dormant/silent. Electro-stim, as it’s often referred to, is where you use acupuncture needles along with a gentle electric current that ultimately induces the muscle to contract.

So there you have it. That’s the quick version of scar tissue formation.
The next time that comes up in a trivia quiz, you’ll be thanking me.

---

Scar massage techniques are discussed here: “Does Scar Massage Work?“. You might also like to read “Thai Massage vs. Swedish Massage” for a little comparison of these two great modalities of massage.