By Dennis Petermann, Physical Therapist Assistant
How do Physical Therapy patients get scars?
It is very likely that you know someone who has a scar, whether it is from a recent injury that required surgery or from a wound that has healed from a long time ago. Whether the scar is big, little, old or new, the pain that is often felt during the healing process is at times very discomforting and intolerable. It is during these painful times that people begin to have complications during the healing process. Believe it or not, scar formation is an important component of healing. Contraction or other complication of a scar can lead to disfigurement and loss of function (especially if the scar tissue is located over a joint). After the wound is filled with collagen, the tissue must be remodeled and shaped into a finely structured and strong end product. Sounds even more painful than the injury!
What if you could find a more relaxing and less stressful way to help you recuperate as you begin the road to recovery, a way that helps improve healing utilizing massage techniques? That is why Physical Therapist and Physical Therapist Assistants are trained to practice Manual Techniques (the application of hands on the body) such as soft tissue massage to try to help ease our patient’s pain and help improve scar formation and tensile strength during the recuperative stages.
While the degree of scar formation will vary from person to person, there are some distinguishing characteristics that you often see when a scar begins to take form. Immediately after a wound heals, the scar is immature. It is during this time that the skin, typically red in appearance, will begin to tighten and shorten. Bands of fibers on or below the surface of the injured area will become hard and non-pliable. When crossing a joint, this contracture may limit range of motion, compromise function, or cause deformity. Also during this time the area may be painful, itchy or sensitive as the nerve endings within the tissue begin to heal.
While the body’s formation of scar tissue is an awesome demonstration of self-preservation, the resulting fibrous mass can set the stage for problems down the road. Composed primarily of collagen, scar tissue fibrosis (the formation of excessive tissue during the healing process) can prohibit adequate circulation throughout the area. In addition to the physical limitations of collagenous tissue, the decrease of blood flow and lymph drainage occurring in scar tissue can make it vulnerable to dysfunction and possible infection. Physical Therapists addressing scar tissue early in its development can help minimize any of the preceding scar tissue problems with the use of strategically applied soft tissue massage techniques that utilize compression, effleurage, and friction.
A current term used to describe effleurage is a gliding stroke. Effleurage is one of the most preferred manipulations to warm or prepare the tissue for more specific bodywork. It is also the preferred method of massage to facilitate circulation. Slow, superficial strokes are very soothing. During gliding stroke, light pressure remains on the skin and moderate pressure extends through the subcutaneous layer of the skin to reach muscle tissue but not so deep as to reach the bone. Strokes that use moderate pressure towards the heart following the fiber direction are excellent for mechanical and reflexive stimulation of blood flow, particularly venous and lymphatic return. Once the patient is relaxed and at ease, your Physical Therapist may move on to a compression technique.
Much of the effect of compression results from pressing tissue from two different sides causing it to spread, similar to flattening of a ball of clay or pressing pizza dough into a pan. Pressing rhythmically into the connective tissue of a scar softens it mechanically, making compression an excellent method for enhancing circulation to the healing area. The pressure against the capillary beds changes the pressure inside the vessels and encourages fluid exchange improving upon the healing process. Ultimately compression, when appropriately applied to arteries, allows back pressure to build that when the pressure is released, it encourages increased arterial flow.
Once your Physical Therapist has you ready to be molded back into shape, they will apply a technique that consists of small deep movements providing sheer force to the tissue. The application of friction massage, often referred to as cross-fiber friction (CFF), is often used by Physical Therapists with trained knowledge of the human anatomy at the site of muscle scar tissue or tendon adhesions to gain mobility and help tissue to align more properly. It also can help to mobilize ligaments and incision sites so they move more freely across the joint. The intensity and duration of the technique is progressively increased as the tissue responds. The result of this type of friction is the initiation of a small, controlled inflammatory response, which triggers chemicals to be released resulting in the activation of tissue repair mechanisms with reorganization of connective tissue.
Currently the mechanisms by which a scar can be controlled are not completely understood. While some interventions do seem to help, there is room for further investigation on how to have optimal control of scar formation. As of right now, early and adequate intervention provided by your Doctor and a Physical Therapist or Physical Therapist Assistant is the best help prevent most of the complications of scarring.
Photo Credit: Flickr/handles
