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Scars can impact your life in many ways. The look and feel of a scar can affect your self-perception and the way a scar binds to surrounding tissue can cause mobility issues and pain. New or old scars can benefit from these treatments. Read more about the types of scars and the treatments below or skip to Benefits of Scar Work.
Surgery and Wound Scars
From C-sections and episiotomy to joint replacements and keyhole surgery to falls and impact scars.
Many surgery scars can benefit from massage 6 weeks after the surgery, such as c-sections. The type of massage depends on when you had the surgery or accident and what type of scar it is. You will be shown how to self-massage in between appointments and as the scar progresses so too will the treatments.
Burns or joint injuries
Contracture scars usually form due to significant tissue loss. The skin and underlying tissue pull together for healing, often restricting movement. Starting with a 30-minute consultation and then three 45-60 minute sessions you will see how rapidly change can occur. Depending upon the extent of tissue loss and contracture, more than three sessions may be needed.
Chickenpox & Acne
Atrophic scars develop below the skin surface, producing a sunken appearance. They become more prominent with time due to aging. The most common causes of atrophic scars are chickenpox and severe acne. Monthly appointments and facial creams to encourage new skin growth will help this type of scarring.
Stretch marks are indented streaks that appear on the body.
Stretch Marks (striae) are formed due to breaks in the connective tissue, caused by rapid shrinking or growing of the skin. It is common with rapid weight loss, adolescence, pregnancy, and bodybuilding. The newer the mark, the easier it is to treat.
Keloid and Hypertrophic Scars
Excessive collogen production leading to tissue overgrowth
Both Keloid and Hypertrophic scars need more clinical work such as surgical excision, or cryotherapy. If you have scars of this type that are concerning you then approach your doctor for advice.
The Benefits of Scar Massage
Scar massage is one of the most commonly recommended treatments in scar management.
What scar features indicate that massage may be beneficial?
Tethering – scar mobilisation may loosen scars, which are firmly attached to underlying or surrounding tissues
Pain, hypersensitivity and itch– scar massage may improve such troublesome symptoms
Tightness – soft tissue manipulation may soften scars and increase pliability
Bulk– scar massage may help flatten certain bulky scars; nevertheless, keloid scars are unlikely to benefit.
What is the rationale for massaging scars?
By applying mechanical forces to the skin, a number of biological events are triggered including:
increased blood flow
hormonal release e.g. oxytocin
induction of mechanotransduction (i.e. activation of molecular signaling within the scar) aiding remodeling of the scar structure.
What is the evidence behind massaging scars?
There are a few high-quality studies supporting massage techniques in scar management. For example:
There is good evidence that massage can help reduce symptoms of pain, itch as well as anxiety and depression in burns victims (Field, 2000, Roh YS, 2007)
One study has indicated that massage may improve colour as well as elasticity in burn scars (Cho YS, 2014)
Is massage good practice for all types of scars?
Although massage has traditionally been considered a universally beneficial component of scar management, recent ideas support the use of vigorous techniques for mature scars only. An immature scar is one that has been created recently from trauma or surgery and appears to be red/inflamed with a quick refill time (i.e. if pressed with the tip of the finger, a rapid return of colour is seen). Scars, generally speaking, tend to be red and inflamed for the first 3-9 months. On the contrary, a mature scar has colour similar to neighbouring skin, shows no signs of inflammatory activity (i.e. the refill time is slow) and represents an older injury to the skin.
What is the best way to massage my scar?
There are a variety of methods proposed in the literature; in clinical practice, these vary extensively depending on the exact type and maturity of the scar they are applied to.
For younger immature scars, movements of low intensity and frequency are recommended, whereas older mature scars can be treated with more aggressive soft tissue mobilisation techniques.
It is important to avoid friction on the skin; circular movements with local pressure appear to be safer and are generally preferred. Other useful techniques involve creating a skin fold (i.e. lifting the scar) gently and carefully mobilising it.
Traditionally, scar massage is done with a cream medium, but this makes some techniques (e.g. skin fold) difficult because the skin cannot be easily grasped; cream can increase the tendency to move over the skin and create friction rather than mobilise the scar.
There is no evidence to support the best frequency or duration of scar massage. Common advice is to massage a scar of 10cm2 for 5 minutes 3-4 times a day.
Moisturisation / hydration is very important for every scar irrespective of whether massage is indicated and should be encouraged four times a day or as needed to prevent any dryness.
A scar specialist can help guide on the type of massage although often the massage once demonstrated can be done independently by patients/carers.
Key messages for scar massage
Moisturisation is universally recommended for all scars as opposed to massage, which needs to be tailored to the type of scar and degree of scar maturity/age.
Scar massage can ameliorate a number of scar characteristics including tethering, tightness, pain itch, and hypersensitivity.
Special attention needs to be given to fresh, inflammatory scars, since aggressive soft tissue techniques may worsen inflammation and associated scar characteristics.
Certain scar types should only be massaged under the supervision of a professional.
Always take expert advice to ascertain if your scar is suitable for scar massage, and what the most appropriate techniques are.