Overview
Manual therapy technique used to:
Improve mobility (as scar tissue can affect ROM of joints)
Improve the appearance of scars
Improve blood circulation to the area to promote healing
Reduce hypersensitivity
Main goal is to release the restrictions/tightness caused by scar tissue formation
Scar tissue can form between tissues that normally slide freely against each other and can cause stiffness
Scar tissue near or going over a joint can cause stiffness
When to Use
Usually performed post-surgery or post-injury when there is scar tissue formation
Not performed until the incision is fully healed and closed
It is most effective when started early in the healing process
Techniques
Done by using your hands to apply pressure and movement to the tissue on and around the scar
Involves movements that are:
Along the direction of the scar
Perpendicular to the scar
Circular
The following can also be performed:
Gently pinch a small amount of the scar between the thumb and the fingers and rolling the scar back and forth
Gently stretch the scar and the surrounding skin
Can use scar massage tools
Such as instrument-assisted soft tissue massage tools that uses metal or plastic to apply more precise pressure
Vibration (such as from a massage ball) for desensitization and promote collagen remodeling
Tuning fork, which when activated and placed near or on the scar will penetrate vibrations into the scar, which can help with desensitization
The pressure applied should be tolerable and gradually increased as the scar matures
Moisturizer shoulder be used to reduce friction and to soften the scar tissue as it can be dry
Usually performed for 5-10 minutes using a combination of these techniques
Some post-surgery protocols may specify the initial directions and timing of scar mobilization
Precautions
Be gentle, especially initially
Gradually increase pressure as the scar matures and becomes more tolerant to scar mobilization
Monitor for signs of irritation or breakdown
Watch for blistering, open areas, or rashes - stop if present
Contraindications
Wound/incision is not fully healed and closed
Scar mobilization can reopen the wound if it is not fully healed and delay the healing process
Scar mobilization on an open wound can potentially cause infection
Active infection
Monitor for signs of infection such as redness, warmth, or pus
Patient Education
Patients should be educated on the use of the following (once the wound/incision is fully healed):
Silicone sheets
These aid in scar healing by creating a barrier that is protective and hydrating
Helps flatten and soften scars
Wear schedule is usually at night
The sheets can be cut to fit over the scar and be reused multiple times
Self-scar massage
Various techniques can be used that were discussed above, such as linear, perpendicular, circular, pinching/rolling, and stretching
Performed for 5-10 minute durations, 2-3 times per day
References
Garvey, P. (2024). 6 things to know about scar massage. MD Anderson Cancer Center. https://www.mdanderson.org/cancerwise/scar-massage-after-cancer-treatment--6-things-to-know.h00-159702279.html