Scar Tissue and Adhesions

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What are all those knobly bits then?” is a frequent question I get asked during a sport & remedial massage. The answer is generally scar tissue and adhesions, which need further explanation.

Scar tissue on the surface of you skin needs no explanation.  There is usually an incident or surgery that can fully account for why the scar is there.  Internally, adhesions and scar tissue are indicators of the healing process the body undergoes where soft tissue trauma has taken place.  The difference with that scar on your skin is that you might not know that either an incident or internal equivalent of surgery has taken place. The only indication you might have is some pain accompanied by restricted movement and some inflammation, which you might not necessarily notice.

The Healing Process

When soft tissue trauma has taken place the body begins the healing process through:

Inflammation (Acute stage): This is an immediate and local response in the acute stage of injury.  The torn soft tissues can bleed at the site of the trauma, producing the red, swollen and hot appearance of the skin.  This may be accompanied by muscle spasm. Usually this phase can last up to 72 hours, during which time it is inadvisable to have massage.

Subacute stage: This stage doesn’t have a set time frame. It can last anything from 5-8 days for muscles and 3-5 weeks for ligament and tendons, dependent on the injury and trauma.  Generally, the inflammation will begin to subside and become less painful. Muscle spasm should diminish, although there may still be pain as the damaged tissues try to carry out their range of movement. Massage can begin in this stage

Chronic stage: This stage overlaps with the subacute stage as the inflammation has gone and the repair process has completed.  However this does not mean that full range of motion has not restored or that pain is no longer being experienced.  Massage is still advisable in this stage.

Scar Tissue and Adhesions

Scar tissue and adhesions are really the same thing. It is formed of the collagen-based tissue that is sent to repair damaged soft tissue during the healing process. The collagen is formed increased accumulation of interstitial fluid that is sent to the site of the trauma, known as an edema.  As it matures it forms scar tissue and because the local circulation systems are compromised during the trauma, it is not able to disperse.  It becomes noticeable eventually through the reduced mobility and pain experienced during the chronic stage of the healing process and as those ‘knobly’ adhesions found during massage.

Massage and Scar Tissue

The deep tissue techniques of a sport & remedial massage works to break down the edema, scar tissue and adhesions at the site of the trauma.  This has the effect of reducing the scar tissue and freeing the restricted bands of fibrous tissue.  This in turn enables mobility to be restored and pain-free movement to resume.

One thing to note about the healing process is that the collagen remodelling that takes place during the repair process is only 70-80% as strong as the tissue it is replacing.  This explains why there is a residual weakness at the site of the trauma and why adhesions can reappear in between massages.

4 November 2015