Working with scars and stretch marks offers an opportunity to explore the deepest aspects of the human condition.
Instead of shying away from a potentially emotional topic, massage therapists can offer a safe space to explore the past as a way to create more clarity in the present.
Massage therapy is based on safe touch and trust. Helping clients inhabit their bodies more fully and with more awareness is one of our goals as therapists.
It is rare that someone comes into my practice who doesn’t have a least one scar from a scrape, fall or cut.
Many clients have more dramatic scars from medical interventions or a traumatic event. Many women have experienced pregnancy and childbirth and have stretch marks and even scars from this.
When I see a scar or feel irregular tissue, I want to know more—I want to know about the event(s) that lead to the scarring.
I want to know how the client feels about this tissue and how it feels to her. This background information helps me target various levels of awareness while working with the client.
Scars, burns and stretched tissues are living tissue. Massage therapists can help address the fallacy that nothing can be done to change this tissue by practicing focused therapy on scars and burns.
Clients need to be educated about the living matrix so they can bring attention and touch to injured or damaged areas.
This attention will help re-program false thoughts and rewire the brain to re-map and re-integrate this tissue back into the whole system.
All of us—clients and massage practitioners—need to practice self-care. Taking care of oneself is a proven way to stimulate health and wellness.
This means talking with clients about daily stretching and movement, frequent manipulation of the affected tissues, rest, sleep, and general health and wellness principles.
Manipulation may aid waste removal and stimulate the creation of blood vessels. Scar tissue and stretched tissues are living tissues in the truest sense of the word.
All tissues are formed of varying amounts of collagen, elastin, cells and other components.
The body feeds and nurtures all parts of the body—so why would a scar or stretched tissue be any less deserving? Oxygen, nutrients, fluid and waste products are all found in the matrix of any scar.
Scars tend to be missing lymph return and blood supply (capillaries). The research I have done shows manual manipulation may stimulate the creation of blood vessels (angiogenesis) by stimulating the area, causing local inflammation and then triggering a remodeling phase.
This is thought to occur because various growth hormones are released in the remodeling phase of scar or wound repair. These hormones can trigger angiogenesis.
My client, “Susan,” represents a good example of false thinking. She presented with pain in the neck and shoulders and said she always had trouble breathing since her surgery eight years earlier.
It turns out Susan had surgery for a collapsed lung after an accident and has an 18-inch scar running parallel to her fifth and sixth rib on her left side.
This scar was very pliable and well-formed, yet Susan couldn’t get comfortable breathing even though she was flexible, a frequent yoga practitioner and in generally good health.
My first instinct, in this case, was to find out more about the accident, her recovery, and any residual thoughts and feelings about the event.
Susan was clear she had no ill feelings about the event. We talked about working on the areas that seemed most important: her neck and shoulders. She would give me feedback about the pressure, pace and sensations created as we proceeded through the massage.
During the session, Susan could feel a pulling through the connective tissues that anchored the scar.
I offered her the option of exploring that connection further, and she agreed to have me touch and mobilize the scar in the side-lying position. I simply touched and manipulated the length of the scar and pulled up on the scar to feel for adhesions to the tissue below.
I also had her use her own gentle breathing to assess the expansion and retraction of the thorax.
As we did these gentle movements and manipulations, Susan said she became clear on her thoughts and ideas about the scar and its limits.
In fact, she realized she had been imagining she couldn’t move the left-side ribs “because they would hurt,” even though they did not when we palpated them—and that the scar would tear or open if she moved in rotation or too vigorously.
The takeaway from this example is people have imaginations that don’t always correlate with reality. Also, postsurgical patients are not educated as to when it is appropriate to stop resting the tissue and start challenging the tissue, so the matrix can be used in proper function and remodel in the direction of use.
The complex cascade of cellular interactions and the secretion of growth factors and various proteins needed for tissue repair are documented throughout the literature.
I will outline the basics of tissue repair for you in this article. Further study and reading about this critical function can be reviewed in such publications as Nature, Wound Repair and Regeneration, and the Journal for Biochemical and Cell Biology.
You probably reviewed the phases of tissue repair in your anatomy and physiology classes.
Yet, it is clear to me that the process is so complex and detailed that only students who have clients, friends or family members who have been affected by a wound, burn or other trauma to the skin and the deeper tissues can grasp the vital role tissue repair plays in our well-being.
Let’s look at the steps of tissue repair and then apply that knowledge to our clients’ treatment. The phases of tissue repair are: homeostasis, inflammatory response, proliferation and remodeling. These phases are not entirely linear; instead, they can overlap one another.
- Homeostasis is characterized by two features: clotting (closing the wound and creating a temporary matrix); and chemotaxis (attracting the immune cells to fight infection).
- In the inflammatory stage, the immune cells go to work patrolling the wound area and ingesting devitalized cells and tissue. This phase prepares the area for rebuilding.
- During the proliferation (repair) phase, the provisional wound matrix is remodeled and replaced with scar tissue, which partially restores the structure and function of the tissue.
- In the final phase of wound healing, remodeling, cell density and metabolic activity decrease.
Changes also occur in the collagen, enhancing tensile strength. This newly repaired tissue has only about 25 percent of its original tensile strength, increasing slowly over time to a maximum of about 80 percent.
Stretch marks (epithelial stretch marks) are different than scars, but may also be addressed in a similar manner. Clients who have quickly gained or lost a lot of weight, had lymphedema or been pregnant are all candidates for stretch marks.
Generally, this is a condition where the skin (the epidermis, dermis and superficial fascia) is stretched quicker than the epithelial tissue can adapt, so the tissue that is affected is elongated and stretched.
Generally, there is a weaker matrix to support this stretched tissue; thus, the epidermis appears rippled and has wrinkles.
Most health care practitioners recommend early treatment and care of stretched tissues.
Gentle pulling and manipulation of the area with skin-healing oils are effective to help rebuild and remodel the affected areas.
Examples of healing carrier oils are tamanu, rose hip seed, avocado and shea butter.
Examples of essential oils to add to the blend are rosewood, frankincense, palmarosa and carrot seed.
A wonderful self-care treatment would be to apply a blend of these oils and carriers to the treated tissue. This manipulation could cause remodeling and thus, angiogenesis.
Research into the biological effects of massage therapy is still limited, but we are seeing progress in the field. It is clear to me that manual therapy has some demonstrated effect on scarred and stretched tissues.
I encourage you to practice working with tissues that have been scarred or damaged due to trauma, surgery, burns, lymphedema or pregnancy. Including scar work will deepen your therapy practice and help you see the potential in each person to heal on all levels.
About the Author
Pete Whitridge is an educator and frequent presenter at state and national massage therapy and chiropractic conventions.