Scar Tissue Management in Physical Therapy

Techniques Used to Reduce Scar Formation

Knee Injury
Yenwen Lu/E+/Getty Images

If you have surgical scar tissue or scar tissue formation from an injury, you may benefit from physical therapy to help reduce the scar. Your physical therapist can use various techniques, like massage, taping, or stretching, to decrease scar tissue adhesions and formations so you can restore normal functional mobility.

Scar tissue forms after injury to the normal collagen cells in the body. If you cut yourself, have surgery, or tear tissue in the body, scar tissue will develop.

The development of scar tissue is part of the normal healing process in the body.

What is Collagen?

Collagen is a substance that is present in all of our body parts. There is collagen in muscles, tendons, and ligaments. There is also collagen in skin and bones. The cellular makeup of collagen makes it very strong due to the alignment of collagen cells. It can resist tensile forces, such as stretching and pulling, without tearing or breaking.

How Does Scar Tissue Form?

After an injury to a muscle, tendon, skin, or ligaments in the body, the inflammatory process starts to heal the injury site. This process helps to ensure that the injured site is cleaned up and new cells are brought to the site that will soon become healthy tissue. Some of these new cells are collagen cells.

Unfortunately, the body does not know exactly how to arrange the collagen cells so that they become healthy tissue that can resist tensile and stretching forces.

The collagen cells become a balled-up clump of tissue called scar tissue. This tissue lacks the normal stretchiness of healthy, uninjured tissue.

Is Scar Tissue Permanent?

After scar tissue forms in the body, it is not permanent. The scar tissue can become stronger and better able to tolerate stretching forces through a process called remodeling.

Remodeling scar tissue is a must to ensure that the muscle, tendon, skin, bone, or ligament becomes normal, healthy tissue again. This can help you have full mobility and freedom of movement in your tissues after an injury.

Remodeling Scar Tissue

Scar tissue remodeling occurs as you start to stretch and pull on it. The stretching of the scar tissue helps to align the collagen fibers to allow them to return to normal. This realignment of the collagen fibers makes the tissue better able to tolerate the forces that are placed on it during the day.

If you strain your hamstring muscle or tendon, for example, you'd follow the R.I.C.E protocol for a few days. After some healing has taken place, gentle stretching of the hamstring muscle is indicated to help ensure that the scar tissue is remodeled properly.

After fracture or injury to bone, weight bearing with the bone helps to remodel the bone tissue to make it strong again. Wolff's Law states that bone grows and remodels in response to the specific load applied to it. Therefore, the bone becomes stronger as you place more and more stress on it. After a fracture, your physical therapist can help you learn strategies to place the correct amount of stress in the correct direction to help with the remodeling process of bone.

If you have had surgery, a scar may be present near the site of your surgery. Scar tissue massage is another way to help remodel scar tissue in the skin. This can also help loosen any adhesions between the scar and the underlying tissue and fascia. Kinesiology tape can also be used to gently stretch scar tissue.

For example, if you have knee replacement surgery, a surgical scar will be present in the front of the knee. This scar can become adhered to the underlying tissue and prevent normal range of motion from occurring. Scar massage, along with knee flexibility and strengthening exercises, can help loosen the scar tissue and ensure that proper remodeling takes place.

Remodeling of the scar tissue is an important step to achieving full range of motion in the knee.

Kinesiology Taping to Stretch a Scar

Kinesiology tape is a relatively new form of treatment used in physical therapy clinics to stretch scar tissue. Initially after your injury or surgery, the incision or scar tissue may not be ready for stretching. Before performing any scar tissue massage, kinesiology taping, or stretching for scar tissue, you should check with your doctor to be sure it is safe for you to do.

If your scar still has staples or stitches, it probably too early to mobilize the scar. Early mobilization or stretching of your open scar may cause the incision to open up. This could delay healing or could expose you to serious infection and complications.

In general, your scar should be completely closed and healed before using kinesiology tape to manage the scar tissue. Full healing of soft tissue and surgical incision usually does not occur until four to six weeks after your surgery or injury. It is always best to check in with your doctor so he or she can assess your readiness to use kinesiology tape to treat your scar tissue. You should also be sure that there are no specific contraindications to using kinesiology tape for your condition.

Getting Started with Kinesiology Tape for Scar Tissue

Before using kinesiology tape for scar tissue, you must determine the amount and direction of restriction in your scar tissue. Your physical therapist is a good person to contact to help determine the soft tissue restrictions surrounding your scar tissue, so it is best to check in with him or her.

To assess scar tissue restriction, simply pull your skin and scar is different directions to assess how much motion occurs as you pull. Do this along the entire length of your scar, and be sure to gently tug in various directions along your scar. This can help you determine where specific restrictions lie in the skin and fascia underneath your scar.

Before using kinesiology tape to treat your scar tissue, you should take a few minutes to familiarize yourself with the tape and the different types of strips that you can cut. Usually, scar tissue treatment with kinesiology tape involves using "I" strips or "Y" strips.

Kinesiology Tape Application for Scar Tissue

To use kinesiology tape to provide a gentle stretch to your scar tissue, you must cut an "I" strip about 4 to 6 inches long.

  • Anchor the tape along one side of your scar, and gently rub the tape to ensure it adheres.
  • Gently pull the tape along the side of your scar, moving in the direction of the scar restriction. The tape should have a 25 percent to 50 percent stretch to it.
  • Zig-zag the tape by pressing it into place, moving it slightly diagonally, pressing the tape, and moving it diagonally.
  • Repeat the zig-zag pattern along the side of your scar until the full "I" strip is adhered to your skin.

When you are finished applying the tape, it should be gently pulling along side of your surgical scar tissue. The tape should not cross over your scar. It should be pulled along side of your scar in a slight zig-zag pattern.

You can keep the kinesiology tape in place next to your scar tissue for three to five days. You must make sure that the tape is not irritating your skin. If you see any redness around the tape, remove it immediately.

How Does the Tape Work?

It is thought that applying kinesiology tape along the lines of restriction of scars helps to provide a low intensity, long duration stretch to the tissues around the scar tissue. This helps to slowly stretch out the collagen cells that make up the scar.

Since kinesiology tape is such a new mode of treatment in physical therapy, studies examining the effectiveness of using kinesiology tape for the treatment of scar tissue are scarce. One study published in Polish Annals of Medicine found that a significant number of patients were subjectively satisfied with the appearance of their scar after surgery or injury when using kinesiology tape.

Studies comparing the use of kinesiology tape to using no tape or using a fake taping technique have yet to be published. Therefore, you should use caution when deciding to use kinesiology tape for your specific scar tissue.

If you have a surgical incision or scar that is restricted in specific directions, you may be able to use kinesiology tape to help gently pull and stretch the scar tissue. Kinesiology tape can provide a long duration, low-intensity stretch to your scar tissue. This may help to improve overall mobility of your scar and can help you move in all directions with no limitation in motion.

Sources:

Blubaugh M. "Kinesiology taping, manual therapy, and neuromuscular re-activation." Seminar, May, 2014. Albany, NY.

Karwacińska J. et al. Effectiveness of Kinesio taping on hypertrophic scars, keloids, and scar contractures. Polish Annals of Medicine. 2012. 19 (1) 50-57.

Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. Philadelphia: F.A. Davis; 2013.

Continue Reading