Do you have a scar? (Yes, I’m pretty sure the answer is “yes”). If it’s from surgery, did you know that you should have massaged it? On this one, your answer is most likely “no, I didn’t know because no one told me”! So why should I massage my surgical scar and why did no one tell me?
The science of scar massage:
A review by Shin & Bordeaux highlights the widely varying protocols, low study numbers and poor scientific rigor present in many of the studies out there. Even with a lack of standardization across studies there were some notable benefits to scar massage:
- • A significant portion (45%) of all results within this review showed improvement in post-treatment range of motion, pruritus (itching) and pain. This included scars from surgery, burns and trauma.
- • Within the post-surgical massage group specifically there was a significant increase in the clinical outcomes, with 90% of patients experiencing improvements in all outcome measures.
Beyond the noted benefits in this study there is a more substantial evidence base to support post-surgical massage purely for the aesthetic benefits it provides, decreasing redness, and the perceived surface area of the scar.
What else do we know?
One of the challenges we face with scar massage is that there isn’t really a single agreed-upon protocol or series of protocols. This may be why many surgeons and doctors don’t recommend it or educate their patients about it. (It could also be because they simply don’t know of the benefits…). To help us clarify some important elements of scar massage, here are some of the details on how massage and manipulation of the scar has an effect:
- • Mechanical disruption of scar tissue has been shown to increase its pliability, and alter the extracellular matrix environment, ultimately changing the structure and functional capacity of the tissue. Very simply, this helps release any restrictions in functional movements.
- • Consistent stretching of scar tissue has been shown to limit the production of tissue growth factor, which may prevent excess or abnormal scarring.
- • Another study also showed that mechanical loading of scar tissue reduced the levels of tumor necrosis factor-alpha, which is a key factor in apoptosis (organized cell death). This means that stretch and pressure promote the removal of excess tissue, thus reducing the overall size of the scar given long-term treatment.
Top Tips on how to do it:
Based on study recommendations, post-surgical massage treatments can begin after primary closure of the incision – typically 10-14 days after surgery, though this may vary. Also, any non-dissolvable sutures should be removed prior to beginning scar massage.
From here, any self-massage techniques should begin with the use of little to no oils to avoid risk of infection and should occur multiple times a day. There is no standardized protocol, but a suggestion would be to perform five minutes, three to four times daily. Use gentle pressure to begin and ensure that there is no pain associated with the pressure.
The main idea is to manipulate the scar and surrounding tissue. After some gradual practice you may even be able to use some more intensive fascial stretch techniques that involve drawing the scar and skin in oblique directions, creating a gentle sensation of “pulling” on the scar.
Such self-treatment should continue for weeks to months (and sometimes years) after the surgery, until the scar has completed the process of remodeling. Ultimately, the tissue that makes up your scar should feel almost exactly the same as the surrounding skin. After the scar has completed it’s healing cycle (sometimes up to 2 years), it should be as mobile as the rest of your skin, and not feel as though its “stuck to” or “pulling on” any other underlying or surrounding tissues.
Of course, you should never progress beyond a point of pain, and massage should be stopped if ever the skin breaks or swelling results from self-treatment. Know that it’s not about the “quick results” here. While you may not notice immediate improvements, the best thing you can do is stick with it for the long-term.
ALSO – if you were not told this at the time of surgery, it’s never too late! Start now – it’ll take longer to make the scar mobile again, but it’s well worth it! Scar tissue can create significant issues decades down-the-line.
Take care of yourself!
If you would like to learn more about scar tissue formation, check out our post called “Scar Tissue Explained“. We’ve also got some interesting information here on Plantar Fasciitis, as well as some important information on why you get exercises to do as homework – which emphasizes any scar massage work you do at home.