Scar tissue management

Our bodies tell a great many stories about our lives with scars being a visual reminder of these experiences. 

What is scar tissue?

Scar tissue is thickened fibrous tissue that replaces healthy tissue that has been damaged. It is a normal part of the healing process. Scar tissue is made of collagen like normal tissue but the fibre composition and alignment can differ causing it to create tension in a singular direction.

The following information on scar tissue management is looking more specifically at scars associated with child birth but can be transferred to other areas of the body as the principles are much the same. This is of course only a guide and it is important to talk to your GP or Physiotherapist if you have any concerns or questions. 

Scar tissue massage and mobilization can usually begin after 6 weeks as long as the wound is closed and there has been no complications such as infection. The scar will be at approximately 60% of it's previous tensile strength and 6 weeks and 80% by week 12. Scar tissue will continue to remodel for 2 years so it is important to stimulate and mobilize this tissue over this time. 

Abdominal/cesarean scars can created future problems such as:

-      Reduced mobility and flexibility. This can created a feeling of tugging or pulling when standing upright, reaching over head, striding out. This may begin to affect posture.

-      Compromised or weakened abdominal muscles which can cause pelvic muscle imbalances, back pain, hip pain, and pelvic pain.

-      Pain and sensitivity around the scar.

-      Referred pain from abdominal muscle trigger points.

-      Irritation of superficial nerves around the scar.

-      Urinary incontinence or increased frequency.

Numbness around the scar is normal and may take up to 1 year to resolve. Some scars are sensitive and you may need to use a wheat bag, or apply light pressure using a Q-tip, make up brush, cotton ball, soft flannel etc. to de-sensitize it from week 6 if this does not improve on its own.​

Scar mobilization techniques are usually performed without creams so that fascial layers and the skin can be stretches and separated to avoid adhesion's to the underlying fascia and muscle. It also promotes the collagen fibers to reorganize to withstand various directions of tension that it will required to do. 

Massage technique include:​

1. Circular motion - With your index and middle finger. Press lightly down and the stretch the skin with a circular motion clockwise and anticlockwise moving through 12 - 6 o’clock and vice-versa. Repeat in each direction along the length of the scar.

2. Perpendicular – With your index and middle finger on the scar press lightly down in a direction perpendicular to the scar attempting to ‘move’ the scar 5mm down hold for 3 seconds and then repeat moving up. Repeat 2-3 times at intervals along the length of the scar.

3. Parallel – Place your index finger over the scar and stretch the skin from left to right holding for 2-3 seconds n each direction. Repeat at intervals along the length of the scar.

4. skin rolling. - Pinch the skin either side of the scar lightly between thumb and fingers, gently lift it and then roll it between your fingers for 10 seconds. Repeat at various intervals along the length of the scar.  

Repeat every 3rd day if necessary and then reduce the frequency if progressing well.

Apply a vitamin E or scar after scar tissue mobilization and 2-3 times per day every other day.

Episiotomy scars 

During childbirth there may be tearing or the perineum or it may be cut purposefully to prevent a more traumatic tear which is more difficulty to suture later.

The perineum refers to the skin between the vagina and the anus. It is associated with the surrounding pelvic floor muscles and there may also be damage in the form of muscle tears or ruptures as a result of vaginal births. This can be worse if they labor is quick, there is use of assistive devises (forceps, ventouse), high birth-weight and breech births. Perineal scar tissue following episiotomy/tearing or reconstructive surgeries can created problems such as:

-      Urinary or bowel incontinence/dysfunction

-      Painful intercourse

-      Perineal pain

-      Pelvic floor weakness or dysfunction.

-      Referred pain from pelvic floor muscle trigger points.

-      Pelvic, hip, and back pain.

Mobilization techniques can help to reduced sensitivity and make the pelvic floor more supple and flexible.

Self-perineal scar rolling:

Find a position that you are comfortable with, can relax in, and can easily reach your pelvic floor. This may be lying down propped up with pillows behind you or in the shower.

Insert your thumb inside the vagina and place a finger on the scar on the outside. Gently gripping the scar between your fingers and roll it for 2-3 minutes or as tolerated until the scar feels loose, less painful and more pliable.

Perineal trigger point therapy:

Press your finger on the body of the perineum and find a tender point. Hold pressure over this point (no more than a 5/10 pain) for 1-2 minutes or until the intensity of the pain diminished. You may need to press in at different angles to locate tender points. Do this once a day until there is no more tenderness.

Perineal thumb massage or stretching:

This can begin from 34 weeks pregnant to help with the extensibility of the tissue and is especially important if you have previous scar tissue. You may need help from a partner for this technique.

Lubricate your thumb with a water based product like KY jelly no not use Vaseline or anything with fragrances or mint which might irritate the delicate tissue.

Insert the thumb into the vagina up to the first knuckle and press straight down (toward the rectum), hold for 3-5 minutes.

Then press down to the right holding for 30-60 seconds, and the down to the left holding for 30-60 seconds. Another technique is to start from one side, press down and slowly sweep (over 30-60 seconds) in an arc across to the other side.

This may seem invasive for some and this may be something you need to discuss with your partner so that they have a better understanding of the problem. There are also relaxation, breathing exercises, and stretches that you can do to help with the mobility in this area. 

Specialized pelvic floor physiotherapist can provide internal examinations to provide a better diagnose and although we do not do internal exams at Peak Pilates we are more than happy to discuss your symptoms and any issues you are facing to help guide you through the rehabilitation process as best we can. Coupling muscle release work, stretching, and breathing exercises with pelvic floor and abdominal conditioning produces excellent outcomes for pelvic floor dysfunction.

To find out more contact the clinic 09 959 0211 and book in with one of our friendly Physiotherapist.