Scar formation is a natural part of the wound-healing process. Scars and adhesions are formed by fibrous connective tissue aiding wound repair in the skin, underlying tissue, and internal organs. Scars can be the result of an injury, incision, trauma, or tissue infected by disease.
The damaged tissue is replaced by an inferior grade of tissue (scar tissue), so it sometimes causes chronic pain and limitations in motion.
Scars affect movement and pain by altering the way the tissue moves. Normal healthy tissue is aligned in a parallel fashion while scar tissue is laid down in a more haphazard crisscross formation. This compromises the elastic capabilities of the tissue, so movement is altered. A scar’s limited flexibility leads to a limited range of motion. In addition to being less elastic, scar tissue is weaker and is vulnerable to reinjury compared to normal tissue. Scar tissue may limit muscle layers and connective tissue, causing different degrees of discomfort and pain.
Chronic pain due to scar tissue formation may also be the result of non-traumatic injuries. This is commonly seen in post-surgical patients who experience pain in the area of their healed incisions. The University of Washington Orthopedic Department reported that post-surgical scar tissue can reduce joint range of motion and recommends treatment to improve flexibility of the injured tissue. Reduced range of motion can be avoided with manual therapy and correct motion exercises to help avoid myofascial adhesions around the affected area. Chiropractic, massage, physical therapy and acupuncture can improve these outcomes.
Early intervention generally leads to the best results. Usually two weeks post-injury or post-surgical gives the tissue enough time to heal. Prior to the tissue being ready to be manipulated, treatment for excessive inflammation can be helpful. Herbs like Boswellia, turmeric, and gotu kola as well as cold laser treatment can be helpful in decreasing inflammation and promoting healing.
After tissue has enough time to mend, manual therapy can be started. Cold laser, heat packs, and/or therapeutic ultrasound can be used first to warm the target tissue. Soft-tissue mobilization can then be performed to release myofascial adhesions. Kinesiology tape is also a useful tool to reduce adhesions.
Emphasis is also placed on stretching and strengthening exercises to restore soft tissue flexibility, strength and elasticity.
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