Scar tissue massage can often help if you have excess scar tissue or adhesions that cause pain or limited mobility or if you want to improve the appearance of a scar. Injury, surgery, or repetitive motion can lead to excess scar tissue and adhesions. This tissue is weaker, less elastic, more likely to be re-injured, and more sensitive to pain than healthy tissue.
An adhesion is an internal band of scar tissue that binds together tissue fibers, preventing them from moving properly. When adhesions develop on muscles, fascia, or other connective tissue, they can limit the movement ability of a muscle or joint. Adhesions on the fascia surrounding nerve cells can lead to problems such as carpal tunnel syndrome. Adhesions on organs (a common problem after surgery) can also cause pain.
When you have a soft-tissue (muscle, tendon, ligament, etc.) injury, the injury heals in three stages called the inflammatory response.
Acute phase (lasts two to four days): Initially, acute inflammation, redness, swelling, heat, and pain occur. The fluids from torn blood and lymph vessels coagulate to seal off the injured area, while uninjured vessels bring in extra fluids and chemicals that create a gel-like substance around the injured tissue. This gel contains binding factors that help hold together the injured tissues.
Also during the acute phase, white blood cells called macrophages come in to eat the dead tissue and bacteria that might cause infection. The macrophages also let the body know how many repair cells called fibroblasts to send in. If infection or prolonged inflammation does occur, the macrophages request too many fibroblasts, contributing to the formation of excess scar tissue.
During the acute phase, gentle massage to surrounding areas can help reduce swelling by assisting fluid movement, but direct massage to the injury can cause damage.
Repair or rebuilding phase (lasts three to four weeks): As inflammation decreases, fibroblasts begin to repair the injured tissue by producing collagen and lubricating fluids. The collagen fibers line up within the fluid and bond, forming scar tissue over the injury. During this phase, gentle movement, range of motion, and gentle massage can help the collagen fibers move, line up, and bond normally.
Some sources recommend starting to massage scar tissue eight to 16 days after the initial injury for the best results, though your individual situation may vary. Newer scars are more malleable.
Remodeling phase (lasts six to 12 months): The body works to return the tissues as closely as possible to their original condition. The collagen making up the scar tissue is constantly being replaced. How well the fibers align in the final scar tissue depends on a number of factors. One of the most important is the pulling tension (tensile force) the scar tissue experiences during remodeling. Now is the time that scar tissue massage is particularly helpful because it creates tension.
Although there are various approaches to scar tissue massage, a common technique is cross-fiber friction, which is often used as part of injury massage. Effectively using this technique requires precision. The massage therapist must locate the adhesion and then apply pressure to move across the fibers without sliding over the skin.
Cross-fiber friction can be uncomfortable, but the massage therapist should always do the technique within your pain tolerance. The discomfort gradually decreases over a number of sessions as excess scar tissue goes away and the remaining scar tissue becomes stronger.
The following video demonstrates cross-fiber friction massage for tennis elbow:
Scar tissue image adapted from an early edition of A Massage Therapist's Guide to Pathology by Ruth Werner.