Scar Tissue Mobilization

“Scar tissue” tends to be a general term for any type of soft tissue restriction or shortening. This term is often inappropriately applied to any type of myofascial adhesion. Authentic scar tissue demonstrates changes in the histological presentation, typically having more densely organized collagen fibers. This occurs when there is tearing, either partial or complete. This may occur due to an accident or surgery.

Normal tissue is typically arranged in lines along a given line of movement (figure 1). After an injury, the body lays down large amounts of collagen to both heal and re-enforce the damaged tissue (figure 2). The body tries to strengthen the area to prevent this type of injury from re-occurring. However, the large amount of collagen is rapidly placed and may not be placed in an orderly or viable arrangement.

Manual therapy techniques such as instrument assisted soft tissue mobilization and myofascial release are designed to prevent the formation of cross-linkages between the scar tissue and the surrounding normal tissue. If cross-linkages have already been made, these same manual therapy techniques can often reverse this process. Passive, static stretching after these treatments can also be beneficial in both lengthening the tissue and encouraging it to align into a beneficial movement pattern.

Another adjunctive therapy is kinesiology taping with RockTape. The application of this adhesive, cotton elastic tape can greatly alter scar tissue formation. The tape is typically applied with the base either medial or lateral to the incision with the application applied towards the midline with 100% tension through the end of the tape (figure 3). This applies shearing forces through the scar to pull and soften the tissues. The strips are alternated down the length of the incision. This is especially beneficial after the manual therapy techniques to encourage alignment with the least restrictions of motion (figure 4).

Typical treatment guidelines state that treatment of the scar must not begin before 6 weeks post-injury. This ensures proper integrity of the scar. However, peri-scar treatments can be utilized immediately after surgery to limit the area of keloid formation.