As we move through our daily lives, our muscles become binded, underactive, and dysfunctional. Many of us never pay any attention to this occurrence until pain elicits a response urging us to seek medical attention. Of course, many people will turn to traditional medicine for a solution, often receiving medication to cover the pain caused; never correcting the root cause of the pain. As time moves on surgery may be suggested by the traditional practitioner and that solution only affords a few more years before the same symptoms will return or even less time to create a new problem in a surrounding tissue, then the process comes full circle. A reason for the binded, under active, and dysfunctional muscles is the accumulation of scar tissue. By definition scar tissue, or cicatricial tissue, is the dense fibrous tissue forming a matrix, derived directly from granulation tissue. For the purpose of this paper I will use the term scar tissue throughout its length.
Scar tissue binds up and ties down tissues that need to move freely. This dense, fibrous tissue affects us all and is an underlying factor in many injuries. As scar tissue builds up, muscles become shorter and weaker, tension on tendons causes tendinosis, nerves can become trapped, and altered movement patterns result causing discomfort often pain. “All these problems can cause reduced range of motion, loss of strength as well as tingling, numbness, and weakness” [1]. Scar tissue forms two different ways: first, if a muscle, tendon, or ligament is torn or crushed, the body creates scar tissue to glue the torn pieces together. This is a necessary part of the healing process. The second is by soft tissue in the body not receiving enough oxygen- the named aspect hypoxia. Hypoxia is very common often occurring frequently in living organisms with tissue structures. Poor posture, athletic activities, repeated use, and sustained pressure as in sitting or standing, all increase muscle tension thus resulting in hypoxic conditions. When muscle tension is increased, blood supply to the area is reduced from surrounding muscles clamping the blood vessels. Healthy blood flow is important because blood carries oxygen to muscles for respiration, function, and metabolism. A reduction in blood flow means less oxygen, decrease functional capabilities, and this results in injury to tissues. Not to mention hypoxia leads to free radical accumulation in muscles. Unfortunately free radicals attract cells that produce scar tissue. These cells begin lying down scar tissue and over time, scar tissue begins affecting surrounding muscles, tendons, ligaments, fascia, and nerves.
The following are some of the common effects of scar tissue: decreased muscle length, delayed lengthening speed, decreased strength, pain, nerve entrapment, altered kinematics, future required medical attention to correct other related deficits. Scar tissue does not have the same flexibility and elasticity as healthy muscle. Since it doesn’t lengthen like normal muscle, areas with scar tissue may have limited range of motion and an altered joint axis of rotation. A muscle with scar tissue may still reach full length, but the time needed to achieve this may increase. Since muscles need to work together with precise contraction times, big problems result. For example, you kick a soccer ball. The quadriceps must shorten and the hamstrings must lengthen. If the quadriceps shorten at their normal speed, but scar tissue in the hamstrings slows down their lengthening time, a tear can result. Recall scar tissue acts like glue binding up muscles. Bound muscles have less functional muscle available to work. Fewer muscle fibers working simply mean less strength can be produced. Pain or a poorly positioned joint can also limit strength. Nociceptors can be found in scar tissue, so the scar tissue itself can be painful. Pain also can be felt in the involved tendon attachment or in a structure compensating for functional changes due to scar tissue. Nerves are supposed to slide through and around muscles, not stick to them. If a nerve happens to lie next to scar tissue, it can become entrapped. The scar tissue glues the nerve to the muscle. Then when you move, the nerve becomes tugged on or tensioned instead of sliding as it is supposed to. Typical nerve symptoms are weakness, numbness, tingling, burning, aching, and pins and needles. These are a few of the most notable implications of scar tissue.
Unfortunately the body doesn’t have a natural mechanism to remove scar tissue. Active Release Techniques (ART), Sound Assisted Soft Tissue Mobilization (S.A.S.T.M.) and Scar Tissue Massage are three highly effective methods for reducing scar tissue. After reducing scar tissue, preventing its return and further formation can help prevent injuries in the future. ART is basically a deep tissue massage performed by a highly skilled, certified practitioner. It's based on the theory that, over time, scar tissue forms within muscles, fascia, and connective tissue due to overuse. These adhesions trap nerves, causing pain, weakness, and lack of mobility. Active Release Techniques treatments address problems in individual tissues as well as in between tissues. One tissue or structure can affect another structure biomechanically and it can also affect the other structure directly. Unlike some equipment-heavy techniques like the Graston technique which uses metal instruments to break up scar tissue, an ART provider uses nothing but their hands and know-how to locate scar tissue and manually break it up.
It is theorized that S.A.S.T.M. is effective because the instruments used effectively break down fascial restrictions and scar tissue. The ergonomic design of these instruments provides the clinician with the ability to locate restrictions through sound waves. This allows the clinician to treat the affected area with the appropriate amount of pressure, due to square surface concept. The introduction of controlled micro trauma to affected soft tissue structure causes the stimulation of a local inflammatory response. Micro trauma initiates reabsorption of inappropriate fibrosis or excessive scar tissue and facilitates a cascade of healing activities resulting in remodeling of affected soft tissue structures. Adhesions within the soft tissue which may have developed as a result of surgery, immobilization, repeated strain or other mechanisms, are broken down allowing full functional restoration to occur.
Research supports the use of scar tissue massage in resolving the functional problems scar tissue creates [1]. Once collagen is stabilized its more resistant to degradation, binds less water, becomes more dense and thick, therefore movement of the tissue is impeded [2]. However, the best results are to begin to work on scar tissue eight to sixteen days after injury or surgery; at that point the scar tissue is in the maturation / remodeling phase. The advantage of treating scar tissue is that no matter how thick and tough it is it maintains some pliability [3]. Scar tissue massage allows the scars collagen fibers to increase movement in a greater and more comfortable range.
In closing scar tissue accumulation is detrimental to all those who are living and if not addressed poor posture, a lack of oxygen to tissues, injury, pain, and unnecessary surgeries will result. Receiving scar tissue massage or one of the therapies intended to reduce or remove scar tissue will ultimately result in a more mobile society not reliant on conventional medications, a physically active component in peoples live affecting the mobility of daily living activities, and a more fit environment of encouragement to remain healthy without pressures of imagery, social misconceptions, or improperly diagnosed conditions.
Footnotes
1. LaFrano, Chuck. “Scar-Tissue Massage Research”, 2012, A Unique Continuing Education in Medical Massage Therapy. (LIRN) 2. Chvapil M, Koopmann CF Jr. “Scar formation: physiology and pathological states.” Otolaryngol Clin North Am. 1984 May;17(2):265-72. (LIRN) 3. Alan J. Grodin, Robert I. Cantu. “Myofascial Manipulation: Theory and Clinical Application” 1992; Aspen Series in Physical Therapy, p.31