Fascia is a three-dimensional structure of dense connective tissue that wraps like Velcro around every muscle, bone, blood vessel and nerve, forming the largest system of body.
Fascia connects everything and allows for the possibility of smooth kinetic movements.
Fascia also maintains the shape of all the muscles. Fascia is made up of several layers that constantly communicate and exchange information. Any strains, kinks or injuries — even minor — in fascia can alter the entire fascial structure, causing fascial dysfunction and far reaching body wide pains.1
Fascia is also highly innervated by the sympathetic nervous system, and together, they are the most enveloping systems of the body.
Sympathetic nervous systemactivation is called stress. There are three ways to induce stress: environmentally (job, relationships); emotionally (grief, holding onto past traumas); and physically — the least understood stress agonist. In a state of prolonged stress, muscles tighten, blood vessels constrict, and microcirculation diminishes as parasympathetic healing shuts down.
Scars are now recognized as a key source of physical stress. Scars directly connect to the skin through the peripheral and central nervous systems, so any injury to the skin or underlying fascia will cause a prolonged sympathetic response. It is theorized that each surgery or injury compounds this stress aggravation until the sympathetic nervous system goes into hyper load, resulting in disease or prolonged chronic post-surgical pain.
It may be difficult to determine if fascia or sympathetic stress, or both, are responsible for this phenomenon of scars’ systemic pain influence. What is known is that scientists now know they cause prolonged chronic pain.
Chronic pain has always been extremely difficult to diagnose and costly to treat, with wider costs associated with increased health service use as well as reduced quality of life and economic productivity. The burden of disease from chronic post-surgical pain is potentially enormous if we consider the volume of surgical procedures performed annually.
Clearly, the tsunami of research which has surfaced over the past few years cannot be ignored as to the significant influence of post-surgical scars on chronic pain.
Massage therapy stands to benefit from increased awareness that surgical scars might trigger chronic post-surgical pain. Massage therapists must start to understand the connections between scars and chronic pain to help reach the root issues inside the body. This would be a new additional technique, teaching the age-old theory that the mystery to a person’s pain lies somewhere within their tissues.
Massage therapy represents natural health, wellness, and recovery and with the advantage of adding scar treatment to their focus could change the lives of many suffering people and also reduce the risk of a patient developing chronic post-surgical pain.
Surgery requires cutting through skin, connective tissue, muscles, and often adjusting the organs underneath. During surgery, fascial layers are injured during cutting, severing communication between fascia layers and altering its very structure.
Then after surgery, during the healing phase, scar tissue build-up pulls fascia inwards, severely straining fascia planes, shutting off muscles far removed from original trauma and restricting body-wide movements.
Surgery, by nature, involves the cutting of tissues, fascia and nerves, inducing an injury response (inflammation, hyperalgesia) and alterations within the sympathetic and central nervous systems pain-processing centers. According to the National Center for Health Statistics, there were 48 million surgeries in the U.S. in 2009, and all surgeries have something in common: They produce physical scars.
Science is now recognizing that surgical scars are contributing to the number-one post-operative problems experienced after surgery, chronic pain. Called chronic post-surgical pain or persistent postoperative persistent pain, it is defined as pain lasting more than 3 to 6 months after surgery, differing in quality and location from any pain experienced prior to surgery.
Up to one-third of patients undergoing common surgical procedures report persistent or intermittent pain of varying severity at one year postoperatively.2 With almost 50m surgeries annually, this may add up to over 18M new chronic pain cases each year due to surgery.
Do Surgical Scars Cause Chronic Post-Surgical Pain?
Surgery requires cutting through skin, connective tissue, muscles, and often adjusting the organs underneath. These invasive procedures coupled with the body’s own cellular healing response in producing collagen, cause scars to negatively influence:
1) Sympathetic (fight-flight-freeze) stress. The highly innervated skin reacts negatively when injured, and post-operative scars provide 24/7 SNS irritation, leading to tighter muscles, reduced blood flow and a shutting down of the parasympathetic healing nervous system.
Scars have been reported in science to act as physical agonists to sympathetic upregulation (stress) and pain.3
2) Fascia, which connects to all muscles and organs of the body. During surgery fascial layers are injured during cutting, severing communication between fascia layers and altering its very structure.
One small injury can cause significant fascia straining throughout the body, producing body-wide structural changes and asymmetry leading to chronic pain and muscle weakness far removed from scar or trauma site.4
3) Scars form adhesions inside the body. Adhesions act as internal “strait jackets” by restricting organ, viscera, fascia and muscle movements, producing pain.5
4) Scars block the movement of lymphatic, circulation and energy flows. This forced stagnation has a significant negative influence on extremity circulation, especially in the lower limbs. Below is an example of an abdominal scar causing peripheral neuropathy.
The precise reasons why scars influence chronic pain is not 100% scientifically fully understood. But a recently published scar study6 reports on how powerful an influence they have throughout our bodies long after surgery.
In this study, only small percentage off the chronic post-surgical pain experienced by patients was localized at the scar site, proving scars have a far-reaching influence over the entire body.
When scar locations were compared to patient pain location, revealing patterns evolved.
Abdominal and knee scars accounted for 82% of total, but only 10% of the pain. There were no breast or ankle pains reported by patients, and no reported back scars despite being the number-one pain complaint.
Almost all of chronic post-surgical pain experienced by patients was distant to the site of the injury or scar, proving scars are systemic agonists for chronic pain and stress throughout the entire body.
Most Active Scars for Inducing Distant Chronic Pain
• Abdominal Scars
• Knee Scars
• Breast Scars
• Neck Scars
• Ankle Scars
Science that now presents scars as causing chronic pain throughout our bodies will change how many massage therapies approach patients who suffer from chronic pain. Client assessments now support the inclusion scar or surgical history with patient intake in order to provide deeper insights into the real cause(s) of client pain and suffering.
Current Options for Post-Operative Scar Therapy
Treatment of post-operative scars still remains challenging. Many invasive and non-invasive options are available for surgeons and patients to prevent and to treat abnormal scar formation, such as manual therapies, corticosteroid injections, silicone sheets, oils, lotions and creams.
However, current evidenced based strategies to minimize the risk of scar formation and reduce the incidence of chronic post-surgical pain after surgery can be disappointing to patients and improvements are subjective at best.
Scar-release therapy is an innovative breakthrough in reducing patient pain levels and dramatically improving functional outcomes. Scar-release therapy uses the latest advances in science to address both chronic pain and dermal scarring after any trauma or surgery.
Scar-release therapy applies Microcurrent Point stimulation, a patented solution that is based on the scientific concept of increasing skin’s inter-cellular metabolism, protein synthesis and healing functioning to re-awaken the skin’s ability to self-generate.
Scar-release therapy applies concentrated microcurrent to each side of scar tissue for the purpose of electrically “repolarising” scars by enhancing metabolism and ATP production. Newly “repolarized” smaller scar is noticeably softer, with increased pliability and diminished size/physical appearance.
By targeting direct cellular stimulation of microcurrent waves through the scars, this simple and discomfort free procedure works by reducing dermal trauma, adhesions and fascia restrictions SRT physically changes the scar tissue, actually reducing the scar physical depth (fig 2 – 20% reduction) and proven to deliver 73.2% pain relief after a single application. (IJCAM 2017).
Benefits of scar-release therapy can include:
• Reduced stress and muscle tone (-39%)
• Reduced chronic pains (-73%)
• Reduced trigger point tenderness (-45%)
• Reduced scar size (-24%)
Scar-release therapy may be safely applied clinically in the massage setting within five to 15 minutes and is usually before massage to help enhance manual outcomes. Integrating scar-release therapy with manual therapies can provide greater pain relief for clients.
Scar-release therapy introduces concentrated microcurrent into manual therapy. Since microcurrent literally fuels every cell, nerve and organ of our bodies, it is the perfect pre-massage modality, permitting deep cellular penetration where sometimes hands cannot go.
A particular type of scar-release therapy that I perform is done using two microcurrent devices. The devices are applied to scars in a simple six-step process:
1. Select correct microcurrent polarity
2. Simultaneously treat one-half-inch to each side of the scar, with the intent of forcing (directing) cellular changing microcurrent back and forth through the scar in a horizontal release. Hold each device for 20 to 30 seconds per segment.
3. The entire length of the scar is treated, every quarter inch.
4. Plug both ends to provide a longitudinal end-to-end release.
5. Circuit or Connect key acupoint B62 for deep, internal fascia release.
6. Circuit key acupoint Sp 6 to reconnect the body electrically.
Clinical integration of microcurrent devicesinto massage practice is permitted on a state-by-state basis. As an over-the-counter device, in restrictive states microcurrent devices may applied to keep yourself, friends and family healthy and pain free.
Scars are universal and impact the population of all professions and walks of life. Both research and clinical feedback proves integrating scar-release therapy into any clinical setting provides a highly effective adjunct to massage by reducing muscle tone, fascial restrictions and sympathetic stress prior to any therapy session.
1. Willard FH, Vleeming A, Schuenke MD, et al. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012 Dec;221(6):507-36. doi: 10.1111/j.1469-7580.2012.01511.x. Epub 2012 May 27.
2. Kehlet H, Jensen TS, Woolf CL. Persistent postsurgical pain: risk factors and prevention. Lancet 2006. doi: 10.1186/s12871-016-0270-6. PMCID: PMC5069795.
3. Bordini B, Zanier E. Skin, fascias, and scars: symptoms and systemic connections. J Multidiscip Healthc. 2014; 7: 11–24. Published online 2013 Dec 28. doi: 10.2147/JMDH.S52870.
4. Willard FH, Vleeming A, Schuenke MD, et al. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012 Dec;221(6):507-36. doi: 10.1111/j.1469-7580.2012.01511.x. Epub 2012 May 27.
5. Morris H. Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms? Int J Gynecol Pathol. 1995;14(1):16–20.
6. The Successful Treatment of Chronic Pain Using Microcurrent Point Stimulation Applied to Scars. Gokal R, Armstrong K, Durant J, Todorsky W, Miller L. Int J Complement Alt Med 10(3): 00333. DOI:10.15406/ijcam.2017.10.00333
Kelly Armstrong, OTR/L, SIPT, MPP, is a published researcher and international author and speaker who has lectured extensively around the world on the topics of scar therapy, pain management, sport performance, and pediatric and women’s health for over 15 years. She has instructed more than 250 CE pain seminars and has co-authored 10 scientific papers.