The body has a miraculous power to activate a healing process after there is an incision, injury or inflammation in tissue or organs of the body.
The result is a scar, or cicatrix, which is medical terminology for what is created and left behind after healing occurs. A scar is a mark left on the skin or within body tissue after it heals, or a sign of damage. Scars can be visible on the skin but can also be invisible and internal.
Within scars lies a very powerful key to unlocking and improving the recovery and vitality of a person. As humans, we experience many traumas and injuries throughout our lives as we work and play. Scars are universal to all of us.
Beyond Localized Pain
Massage is the manual manipulation of soft tissues, which includes muscles, fascia, skin, tendons and ligaments, for the purpose of wellness. Massage increases circulation to muscles, increases lymphatic movement, softens muscles and fascia, and reduces stress and pain. Massage therapy also takes a holistic approach to the body and looks at the client as a whole being in which all parts work together.
Therefore, this leads naturally to the evaluation and treatment of the entire body, not just the local or specific area that is hurting. This evaluation will uncover physical scars throughout the body. Hidden scars need to be discovered during the intake or personal report of previous injuries.
After injury, the body lays down new collagen to build tissue back up; however, when tissue is repaired it is altered bioelectrically and biochemically, as compared with the undamaged skin surrounding it. This alteration in tissue feeds multiple disruptions in the body. The cicatrix connects to the sympathetic nervous system through the connective tissue, or fascia.
According to many anatomy experts, the fascial system is the only system that connects to every other system. The scar that once healed and then is overlooked can lead to “ripples” at distant and opposite ends of the body. As the sympathetic nervous system continues to be activated and irritated throughout our lives, it proliferates stress and immune dysfunction. This imbalanced state can progress to disease and chronic pain syndromes.
Every scar has a story to tell and holds emotions that took place during the damaging event. Every scar is different. Each scar represents a time in our lives that has remnants relating to our journey, hardship, loss, grief and endurance.
The fascia and muscles involved with scars can be pulled, strained and locked, resulting in decreased range of motion, stiffness and pain. Scars can lead to structural and postural dysfunctions.
The negative impact that the scar, or cicatrix, can leave on the body is enormous. Their impact accumulates and builds as we age. The pain and health issues we have could be aggravated by imbalance and cellular miscommunications within the nervous system and tissue due to scars and old injuries.
The Role of Surgery
Chronic pain affects most people at one time or another throughout life. Surgery is often a treatment for chronic pain. Shockingly, elective surgery is growing at an alarming rate and seems often to be a medical solution for the unknown.
According to Surgery Digest, surgery involves the cutting of tissues, fascia, nerves and organs in order to physically manipulate a body structure to diagnose, prevent or cure an ailment. The resulting effect is an injury response of inflammation, hyperalgesia, and alterations within the sympathetic (SNS) and central nervous systems (CNS) pain processing centers.
In literature, medical research is recognizing that surgery is creating a new diagnosis in postoperative patients called chronic postsurgical pain, which is loosely defined as pain lasting more than three months after surgery. This postoperative pain differs in quality and location from any pain experienced prior to surgery.
Surgery is the answer to a medical issue for many people, and research indicates that a larger number of surgical patients report undiagnosed and unrelenting pains post-surgery. Chronic postsurgical pain could be a contributing factor to the pain crisis.
The Center for National Health Statistics reports there were 48 million surgeries in the U.S. in 2009, the most recent year for which these statistics are available. Up to one third of patients undergoing common surgical procedures report persistent or intermittent pain of varying severity at one year postoperatively1. The human burden of disease from chronic postsurgical pain is potentially enormous if we consider the volume of surgical procedures performed annually.
It is reported in science that up to one third of patients undergoing common surgical procedures report persistent or intermittent pain of varying severity at one year postoperatively2.
Estimated Incidence of Chronic Postsurgical Pain by Surgery Type:
| Type of Surgery | Incidence of CPSP | Incidence of Disabling CPSP |
| Amputation | 30-50% | 5-10% |
| Coronary Artery Bypass Graft Surgery | 30-50% | 5-10% |
| Thoracotomy | 30-40% | 10% |
| Breast Surgery | 20-30% | 5-10% |
| Inguinal Hernia | 10% | 2-4% |
| C-Section | 10% | 4% |
—Source: “Persistent postsurgical pain: risk factors and prevention,” Lancet 2006
Clearly, scars are now classified as systemic agonists for chronic pain and stress throughout the entire body. With a 10% chronic postsurgical pain average post-surgery and 48 million surgeries annually, the minimum number of new chronic pain cases from surgery alone is 4.8 million per year. These numbers are significant and surely warrant further investigation.
It is reported in literature that only 10% of chronic postsurgical pain is actually at the local site that the surgery took place, with 90% of the pain located distant from the surgical site (IJCAM 2017).3
What other types of chronic pain can chronic postsurgical pain influence? In another study, the four top chronic pain locations were back (39.2%), shoulder (17.6%), neck (17.6%) and hips (7.85%), common anatomical areas that are the bread and butter of massage therapists.
Scar Massage
For this reason, massage therapists must learn to recognize that scars have systemic and local influences on the body. Ankle scars can cause pain and tightness at the ankle and also at the opposite end of the meridian, or fascia train. Knee scars can affect the knee, ankle or hip, setting the body up for a sacral imbalance that could alter the entire spine. Scars on the head can be culprits for neck pain, headaches and cranial nerve issues. Abdominal scars have been reported to cause back, hip and neck pain, along with all sorts of organ dysfunction. C-sections have already been linked in research to postoperative back pain4, shoulder pain5 and neuropathic pain6.
This is a startling revelation for massage therapists, who up to this point may have been focused on local tissue therapy to address their clients’ conditions — when the actual cause of the problem may be far removed from the pain site. The reasons why scars influence chronic pain is not fully explained by research. The most plausible explanation of scars’ body-wide negative influence lies within the fascial-stress theory.
In the future, as more research is conducted, massage therapists may have to change their focus of therapy to include distant scars for localized pain relief.
Footnotes
1. Kehlet H, Jensen TS, Woolf CL. Persistent postsurgical pain: risk factors and prevention. Lancet 2006. doi: 10.1186/s12871-016-0270-6. PMCID: PMC5069795.
2. ibid.
3. Gokal R, Armstrong K, Durant J, Todorsky W, Miller L. The successful treatment of chronic pain using microcurrent point stimulation applied to scars. Int J Complement Alt Med 10(3): 00333. DOI:10.15406/ijcam.2017.10.00333.
4. Chia YY, Lo Y, Chen Y, et al. Risk of chronic low back pain among parturients who undergo cesarean delivery with neuraxial anesthesia — a nationwide population-based retrospective cohort study. Medicine (Baltimore). 2016 Apr; 95(16): e3468. doi: 10.1097/MD.0000000000003468
5. Cift T, Ustunyurt E, Yilmaz C, et al. Shoulder tip pain after cesarean section. J Clin Diagn Res. 2015 Aug; 9(8): QC04–QC06. Published online 2015 Aug 1. doi: 10.7860/JCDR/2015/
6. Dualé C, Ouchchane L, Schoeffler P, et al. Neuropathic aspects of persistent postsurgical pain: a French multicenter survey with a 6-month prospective follow-up. J Pain. 2014 Jan;15(1):24.e1-24
About the Author:
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 16 years. She has instructed more than 250 CE pain seminars, and has co-authored 10 scientific papers.