Scar tissue and pain

Sometimes scars are visible after an injury and can clearly be seen with the naked eye such as with burn wounds or cuts from surgery. Other times scars cannot be seen but they are still there such as with pulling your hamstring muscle or spraining your ankle; some of the fibres can be torn but you won’t be able to see it through the skin. Therefore, it can be confusing sometimes when an injury remains painful months or years after it’s occurred.

When tissue is torn and starts repairing itself, it lays down collagen fibres, which are the building blocks of all types of tissue. Because the body wants to heal the tissue as quickly as possible, it lays the collagen fibres down haphazardly instead of in neat rows as with the surrounding healthy tissue. This causes the scar tissue to be thicker and less tensile than healthy tissue and often becomes a source of pain. Superficially, the scar might become raised and have slightly unusual colour. Underneath the skin, it’s not possible to see the scar tissue but it can most often be felt by palpating along the injured tissue.

Scar tissue can become tight or contracted or attach itself to surround structures such as the myofascial layer or even surrounding nerves and blood vessels. This then leads to tension and immobility on these structures that may lead to pain and dysfunction. The tight tissue can restrict circulation and lymph drainage, allowing a build-up of pain chemicals and toxins and making the tissue vulnerable to reinjury.

Scar tissue can have a local area of pain when touched or stretched or it can produce a referred pain that feel like that of a nerve which is a constant annoying burn that occasionally turns sharp. This may be due to either trapping a nerve in the tight scar tissue or by damage to the nerve endings during the initial injury after which painful and highly sensitised little nerve bundles called neuromas can form.

The formation of a scar can be guided along after an injury. This can be achieved by massaging, stretching and strengthening at the appropriate phase in the healing process. Timing of the massages, stretches and exercises is vital as starting too early may re-injure the newly formed tissue and starting too late may mean that adhesions have already formed. With new scars, the experienced massage therapist can apply appropriate tension to the scar to guide the collagen formation into more organised lines and promote circulation. In older scars, the tissue can be manipulated to break adhesions and increase the mobility in the scar and desensitise the area.
For superficial scars, home management is to apply a vitamin E rich oil and gently massage the scar daily while it is healing (following the approval of your consultant or physiotherapist). For scar tissue underneath the skin, massage may still be applied but might be difficult to determine the exact location if not instructed exactly where. Older injuries may benefit from foam rolling and stretching exercises.