Scars: The Overlooked Cause For Your Pain

That scar you forgot about might be the reason your pain won't go away. In this episode, we break down exactly what scar tissue does to your fascia, nervous system, muscles, and movement patterns, and why a completely painless scar from years ago could be silently driving your chronic pain today. Plus, practical at-home tools you can start using right now.

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Transcript

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Welcome back to the Uplift Wellness Pain Podcast. I am Mike Carroll. I'm a licensed massage therapist and owner of Uplift Wellness in Kingston, New York. If you're here, this is the show where we kind of dig into why people are in pain, why conventional approaches often don't help and kind of fall short, and just kind of talking about how movement, pain, and all those things can integrate with interrelate with each other, and ideally go over some different types of strategies or things that you could do to get better from that. So today I want to talk about something that uh I think can go very overlooked in a lot of people's pain experience, and it can kind of not come up in a standard clinical intake for certain people. And because of how important these things are, I think it's a really big problem that it doesn't get looked at as much as it should. So we're going to be talking primarily about scars today. So before you click away thinking that this doesn't apply to you, I want you to stay with me for just a second. Um, when I say scars, it doesn't mean like a fresh new wound. It means any type of scar that you have on your body that might even be from a decade more ago. So if you had a C-section from childbirth, like 20 years ago, or if you had like an ACL surgery, a shoulder surgery, whatever. Like literally any scar on your body falls into this category. Even a like dermatological scar, if you had to get something removed off of your skin, that falls into this category as well. So those old scars, the ones that you forget about, they might be running and contributing to the pain that you're experiencing right now, or any type of movement issue that you're experiencing right now. So hopefully by the ending of this episode, you're going to understand why scars can impact you and also what you can do to help negate how much these scars are affecting you. So let's get into it. So I think a good place to start is talking about like what is a scar. So the scar is not just the visible mark that's left behind after an injury or surgery heals. Um, yes, of course, the portion of your skin that has the actual mark on it is obviously a scar. But depending on what the scar is, what the injury was, or what the surgery was, that scar goes deeper down as well. So think of like the skit the scar on your skin being the tip of the iceberg where there's a lot more stuff happening underneath it. So when your body heals from any kind of tissue, it goes through different phases of healing. Um, and having a good understanding of these phases of healing can help you understand why scar tissue behaves so differently for so differently from the tissue that it replaced. So in the first phase of healing, we have hemostasis, which it's basically like the immediate response to an injury. Your body sends clotting factors into the region so that way you basically don't bleed everywhere, um, and it helps to kind of kind of glue everything together. Um, then different growth factors are released to help repair, um, and this is all totally normal. The second phase is the inflammatory phase. Uh, this happens within the first few days. Basically, immune cells come to the area, your body's essentially trying to clean everything up. Um, it's extremely necessary, but when this phase gets extended for too long, or it's like dysregulated in any certain way, um, which can happen a lot of different types of healing and different types of chronic pain issues, this is where things can kind of become an issue. So, going into the next phase, the next phase is the proliferation phase. Um, this is where like the actual like patching up of what happened happens. So different types of cells called fibroblasts come into the region and they start laying down new tissue called collagen. This this collagen is a specific kind of collagen. It's called type 3 collagen. And it is thinner, weaker, and less organized than the type 1 collagen that makes up healthy tissue. Your body is basically trying to patch up a tear in a very high performance type of like fabric with a completely different type of fabric just to close it up and to add some layer of like stability and protection to it. But keep in mind that this patch is not the same as the original tissue most of the time and in most tissues. So the fourth phase is the remodeling phase. Um, and this is the phase that can start around 21 days and then it can last for potentially, depending on the type of surgery and the injury, up to two years. So that type 3 collagen eventually gets replaced by type 1 collagen over time, and it'll mature and it'll get stronger. But this is kind of where uh things go awry is the the scar tissue that you get is almost never going to achieve the same organized, multi-directional, kind of like basket weave pattern that your original tissue has. Instead, it gets laid down in a more parallel unidirectional pattern. So the far the scar is basically less capable of handling forces from multiple directions. It's a little bit more brittle, it's a little bit less adaptable, and it behaves a little bit differently under load than the original tissue did. And keep in mind, like if especially if you have a scar tissue going through muscle, um, it is not a contractile tissue either. So it's going to affect how the region transfers and produces force. Um, and because that scar tissue is gonna get laid down the way that it does, if you have muscle fibers that run in this direction, you could very well have scar tissue that gets laid down in more of like a horizontal direction, or just any kind of mismatched direction, which is gonna affect the force transfer of how uh contraction goes and just how load goes through the structure, the structure in general. So when someone is saying that their scar is healed, what they mean is that the wound is closed. But don't confuse that with the tissue being the same as it was before. Uh it's not, and it literally will never be, and that matters, especially as we get further into this conversation. So before we go on, I also want to talk about the skin and just how important the skin is and how connected to your nervous system your skin is. So if you didn't know, your your skin that covers the whole external portion of your body is an organ. Basically, it just holds everything together, and it is one of the most sophisticated sensory systems that we have. So it has a ton of receptors in it. Mechanoreceptors that sense touch and pressure, gnosisceptors that sense like like potential damage information. Let's just keep it at that for now. Um, thermoreceptors, so you can tell if something's hot or cold, um, and proprioreceptors that help to kind of tell you where your body is in space, how much tension there is there is on regions and tissue. Um, and all of this is constantly feeding into your brain and giving it a constant real-time stream of information about the world and your body's relationship to the world. So developmentally, your skin and your nervous system come from the same embryological tissue, and this is important. Um, they both develop from something called the ectoderm, and this basically means that in the earliest stages of human development, the skin and the brain are like the same tissue for all intents and purposes. Um, they eventually differentiate and and become different, but they are very intrinsically formed in the beginning, and we could see this because we have you can look at like a dermatome map, you can look at like a um a peripheral nerve uh sensation map, and you can just see that like there's so much information that your skin gives going up to the brain. And the reason being is it is it is it gives you this live information for your brain to do it to kind of adjust what it's doing for you. So when you damage your skin and you form a scar, you're not just damaging like a surface layer of your body, you're disrupting a portion of your nervous system technically, um, because it's going to affect the sensory input that you have going in, which is then therefore going to affect output coming outwards. So we have some background on the scar. Now let's talk about what it does. We can first start off by saying that nothing happens in a vacuum, not one single injury in your body affects one single thing. Um, even to the point where, like, you get a paper cut, yeah, sure, your skin is damaged, but you also have blood that comes out, right? So that means that circulation is damaged. That means that you're you start to get that repair cycle that we were talking about before, that healing cycle, and you start to get a little bit more blood to the region. We start to get some platelets to close it up, then your skin has to heal, your nerves are being affected because it produces pain, it's basically telling you, like, be careful, we don't want this to get infected. So there's a lot of systems being affected by just that one paper cut. Now let's extrapolate that to major injury or major surgery. So the scar obviously doesn't just affect the skin, it affects your fascia, your circulation, your lymphatics, um, your nervous system, muscles, and even your emotional state. So let's first talk about fascia. So fascia is something that I'm sure a lot of us have heard about. It's kind of been popularized over the last decade or more. Um, but it's basically this continuous multidimensional web of connective tissue that surrounds and run through and runs through pretty much everything in your body. Every single muscle, bone, organ, nerve, blood vessel. It's all wrapped by this connective tissue. It's kind of like a like kind of like a scaffolding for your body that holds everything together and like helps to suspend you upwards. And fascia is not a passive thing, it's a very dynamic, load transmittive and mechanosensitive structure. So it responds to force, it can transmit force, and it communicates with your nervous system as well. And because everything is like literally connected through fascia and the different connections and slings that it has, when there's like tension in one portion of it, that tension can disrupt something elsewhere. So, for example, if I take the this corner of my shirt here and I pull it, right, there's an effect going up to the other side of my shirt as I pull my shirt downwards. And that tension in one spot can be thought of in the same way in the body. So that tension can affect blood flow locally and distilly. It can alter sensory signals going up to the brain because there's a constant uh there's constant information from that region going upwards, and it's gonna change how your brain interprets what's happening in that region, and it can change force distribution and things like that. And it also houses something called your interstitium, which is this like fluid-filled space within connective tissue that's a very big component of like waste clearing, delivering nutrients. It's it's uh it's like where the circulatory system and the lymphatic system kind of meet, where fluid leaves the circulatory system, goes into cells and into this interstitium, lymphatics pick it up and clean it. So when you have extra tension and disruption in that fascia, then the fluids of your body get compressed and kind of get affected as well. So then you can have issues with clearing waste efficiently, you can have inflammation build up, um, and this all again feeds back into the system, potentially even as pain. So fascia works off of like a very important idea called tentegrity. Think of this like a tent in camping. So the poles provide compression, the ropes provide tension, and together they create a stable structure, right? Without one, the uh the other doesn't work. And if you can pull on the ropes from the outside of the tent, the tent's gonna shift. And that idea is what tentegrity is. Um and this is how your body is kind of held up. The bones are the compression, the fascia and muscles provide the tension, and all that tension onto these uh like compression structures, your bones, helps to hold you up in space. So when a scar is present, it can kind of pull onto that fascial system and it can affect and and uh shift that tent. Not only mechanically, but then we add in how it affects all the other systems of the body, and then we can get a kind of a major shift. So in a healthy tissue, your fascial layers are supposed to glide onto each other, like tissues should glide. Um, it's not a crazy amount, it's between like 10 and 75 millimeters during movement. Um, but when there's these adhesions and like actual adhesions formed from scar tissue, not just like tightness that you feel, that gliding gets really reduced. Like it's it literally like glues everything together. When that gliding is lost, that's when drag accumulates. And sometimes it could be right at the scar, and sometimes it can also be distal and from a different spot rather than the scar. Uh, if you're not familiar with anatomy train, it it's something by this guy called Thomas Myers. He's a major like uh component uh in the fascial world, and he basically created and like dissected these slings of fascia throughout the body to illustrate how tension is transmitted through it and how movement works. And they're they kind of cross the whole body. So one very easy example to kind of wrap your head around is the superficial front line. Um and you can look this up, you can Google this if you'd like, but basically, like the whole front of your body superficially is fascially connected. So it runs from the top of the foot all the way up the shin to the quads, the abs, the chest, your neck, and then your scalp. So if you have like excessive restriction on anywhere on that line, it can affect the other ones. And this like logically makes sense. Like if you were to have a lot of tightness and restriction in your core, that's going to completely flex you forward and then affect where the positioning of everything else is and where tension is transmitted, right? If there's a lot of tension here, then something elsewhere uh elsewhere may not be able to take up tension because it's all focused on going down here, or vice versa. This is so overworked that something else needs to pick up the slack somewhere else as well. So when you get something like a C-section scar, which goes like right across the pelvis, it's not impossible to imagine how your C-section scar can contribute to your hip tightness, or it can affect your lower back or your neck. Or another example, if you have a lateral knee scar from an ACL surgery, that can sit into the lateral line, and that connects the foot to the hip and all the way up to the neck, right? Um, epinectomy scars, uh, they're in the lower right quadrant, um, crosses and cuts through some very important abdominal musculature. Um, so you can have like asymmetrical issues going on, or even bilateral issues going on. It can affect the the right side of your hip, or it can affect the right side of your ribs, which can then stress your SI joint, which then can go down to the hip. Right? So, this is how this one thing can have this up and downstream effect because of these fascial connections, and again, not to mention how it affects musculature and how neurologically it affects you as well. And this is just not like some theory, right? This is like something I see literally every single day when I work with people. So the second one that we're gonna talk about is the circulation and your lymphatic system. So when you have a tissue that's damaged, local blood and local lymphatics are going to be affected. And that is going to affect fluid dynamics in the region. And over time, this can have a bigger and bigger issue. So fluid moves off of pressure, right? So if you have an area of high tension and high pressure, it's going to basically not allow blood to flow into it so much because fluid goes from areas of high pressure to areas of low pressure. So think of what happens when you step on your garden hose, right? It's an area of high pressure, so water is going to go out from each side and it's not going to be able to go through the area that has the high tension of which is where you're stepping on it. So this can happen with blood and lymphatics in your body as well. Scars are an area of high tension and they can affect the lymphatic and fluid flow in the region. So less flow is less oxygen delivery and less nutrient delivery, less waste clearing as well. Just generally more stagnation and the fluid doesn't really like to be stagnant. More inflammation can form, and then that inflammation can then increase in nociceptive inflammation, which can then cause pain. Not to mention that vasculature in scars is very disorganized and it's just less dense than a healthy tissue. It's generally considered avascular. So if you have less blood flow through a region, it can become ischemic, and ischemia can cause pain. Um, and it's also just going to again affect energy production in the region, uh function in the region, uh, inflammation in the region, etc. And the lymphatic system is just as affected, if not more affected. And when your lymphatic system doesn't drain well, normal resolution for inflammation doesn't happen. Swelling forms, right? Your lymphatic system is very important in moving proteins through the body, so that way you don't have an accumulation of them, which then creates swelling. So then the region stays in a very low-grade inflammatory state that perpetuates your sensitization, which is one of the reasons why your scar can stay tender and stay reactive for many years later. Alright, now let's get into the nitty-gritty, the nervous system, which is probably going to be my favorite portion of this conversation. So your skin is a sensory organ, right? We established that earlier. And it's loaded with mechanoreceptors, gnosyceptors, and things that are constantly sending information up to your brain. Scars will disrupt all of that. And the mechanoreceptor, uh, the mechanoreceptor profile of scar tissue is very different from healthy tissue. The quality of the information going in is going to just be less. It's basically like trying to have a conversation on the phone when there's constant static going through. Like you can get bits and pieces of it, but it's not really like effective information. It's like playing telephone when you're a kid. So if your nervous system is receiving poor quality information from a region, then it's not going to be able to produce as precise coordinated movement through that region. And this is one of the reasons why post-surgical patients so frequently often show ultra movement patterns. Like there's literally something called arthritic inhibition. It's because there's been so much damage around the joint that just got the surgery, and so much pain and inflammation that it literally inhibits everything locally. And then it could take a little bit for strength to get back, proper movement patterns to get back, etc. So your hardware might be repaired, but the software still has to kind of be updated with the new hardware that you have, and that just takes time. So if scar tissue mechanically creates tension, then it's like a it's a stitch that's holding tissues together and creating tension to really prevent further tearing. But that tension is also constantly sending information up to up to the nervous system. And when that no-ciceptive input reaches a sufficient quantity, sufficient frequency, like all the environment is right, then the brain can output pain as a kind of like pathological reflex, even long after that scar tissue had formed. So there's no new damage, there's no new injury, but the brain is just responding to this information based off of past information that came in and just what it's literally getting biologically from the body ext the body distally. And then not to mention like nerve entrapments can happen. You can literally just trap a nerve and nerves don't like to be pressed on. There are also little tubes that like have things running through it that kind of determines how it works. So if uh nerves regenerate within the scar tissue, then it could be compressed, then you're just gonna have like constant, persistent numbing, which then affects what your brain thinks is happening in the region. Everything can become hypersensitive, even light pressure or like normal movement can trigger pain or just trigger like uh that like staticky feeling, which can just be uncomfortable. And all these signals feed into the central sensitization process. Um and when pain persists over time, the nervous system undergoes like a real change. Uh it becomes sensitized to information, producing pain in response to things that should not be painful, like light touch, very gentle movement, very normal daily movements that you might do, uh, it might become more painful despite no damage actually occurring into the body. And this is like a very documented neurological change that happens. And scars, by delivering that constant stream of tension and potential no-ciceptive input over months and years and years, are a mechanism that can drive your nervous system to being more sensitized. And your brain also has a very detailed map of the body, it's called your somatosensory cortex, or like the homunculus of your body in your brain. And when sensory from a specific region is disrupted, such as by a scar, and uh that region's representation of the brain can start to deteriorate deteriorate. So what we call this is smort uh so what we call this is cortical smudging. Uh the brain's map of the area can become very blurry and very inaccurate. Um blurry map means less precise motor control, uh less accurate pain discrimination, and a higher likelihood of producing pain from that region. So we're gonna put a pause on the nervous system, we're gonna talk now about muscles. Um, when a muscle is significantly damaged, it doesn't heal back muscle, it will heal back in the form of scar tissue. But if this if the damage is small, something called parenchymal healing can happen where the original muscle cells are restored. It just depends on the the breadth of damage that somebody has. Um but the other type of healing, which is called stromal healing, is where scar tissue. Tissue fills up instead of the original tissue type, which would in this case be muscle. And when you get a lot of scar tissue healing, then you end up with a region that has more scar rather than the muscle that was already there. And this is going to affect force transmission and also just the function of the muscle itself. Muscles contractile and scars are not. Muscles often run in a very specific fiber direction that helps it contract effectively and move your body. Scars don't. They can form really in any direction that they want. And when scars interrupt that directionality, it can impair the strength and the function of the muscle that it is formed in. And added on top of it, less proprioreceptive information from the area. The brain can lose precision and decrease how much motor unit recruitment that you get. So basically it just recruits less of the muscle. And this is where like really proper rehab is very important early on when you're healing from like something that requires scarring. Because you when you when you go through rehab, you can like remodel the direction of the scar tissue so that way it actually goes in more in line with the muscle fiber direction. And you're you're like training yourself to be able to recruit those motor units and to try to maintain as much strength as possible. So we're also going to speak on how scars can be very emotionally charged. And I think this next session section is very fascinating. Um, but also it gets very dismissed, like very quickly. So every single scar happens in the context of trauma. Not one single star scar happens because the tissue is healthy and it's pretty and it's totally fine. Like scars literally is the process of healing something. So every time, 100% of the time that there's a scar, there's physical trauma with it. And a significant portion of that time where there's physical trauma, there's probably some emotional trauma layered on top of it. Um, so for example, you probably didn't get surgery because your life is going dandy, right? You got surgery because something is broken, something is like very damaged, um, things like that, right? You're trying to fix something. Um, traumatic injuries are really scary. You're you're questioning what's gonna happen. Even procedures that go smoothly can carry a very heavy emotional weight, especially if they're connected to a difficult life circumstance. Like, for example, getting a C-section when you didn't originally expect to is a scary thing. Like if you thought that you're gonna give a vaginal birth and you have to get an emergency C-section, even if the C-section went totally fine, like there was no major hemorrhaging, the baby was safe, like that's a traumatic experience. You were not expecting to go into it, and even if you were expecting to go into it, you probably don't want it. And we know at this point, just based on pain science literature, that emotions don't just live in your head, they're stored as physical manifestations in the body. And you you probably intuitively know this, right? Like I carry all of my stress in my neck. Every time I get anxious, my shoulders go up to my ears. When I'm like really angry or going through something hard, my back always acts up, right? These things aren't coincidences. This is your nervous system encoding emotional states as physical patterns and tissue, which by the way, like evolutionarily makes total sense, right? Like if there's a stressful thing going on, you don't want your body just to completely go lax and like fall asleep. You want to you want to tense up and run or fight. So same thing can happen with scars, right? Your body can create associations between the emotional state that you were in during the injury or surgery or after both of these things. Um, whether it be being limited by it, you like can't work, you're just living through the circumstances around that time period, it can kind of tag on emotions to the actual injury itself. So, where this can get very clinically significant is if that scar is already delivering a constant stream of painful information going up to the brain, or no susceptible information that your brain interprets as pain, that information is already pain-producing. You layer on top of that a negative emotional association, your brain is gonna wire these things together, and scar, the emotion, and the pain all are gonna come bundled together. So think of it like this: if you're a coffee drinker and you make coffee every single morning, and after a while, you're gonna wake up craving coffee because before you have even consciously thought about it, your brain already knows, like, oh, it's that time, it's that time to make coffee. Your brain has wired all the contextual associations together, and now the morning context automatically triggers coffee. And this is just like literally how the brain works, it just builds associations and then runs them. It's for efficiency's sake. So this happens with scars and emotions as well. The scar can be a physical anchor for the emotional state. So I once had a client who had a C-section scar that was 25, 30 plus years old. Um, and it was like completely asymptomatic. Never thought about it, like even after the surgery healed fine, didn't really worry about it. Um she was coming to see me for chronic lower back pain, and through neurokinetic therapy testing, um, we learned that the scar was a driver of some of her back pain. So as we were working on the scar, there was a very unexpected, extremely strong emotional release that happened with it. I knew that there was a c-section and I knew that it was an emergency one, but I didn't know the full context behind it. And it turns out that the lower back pain that she had was also tied to some grief surrounding this C-section. So that grief and the altered motor patterns that she had from the C-section itself had developed and kind of linked together years and years later, creating the issue that she had then. So addressing the scar didn't just you know do stuff for her back pain, it also kind of opened up a door to this emotional release that had been sitting there that she wasn't like intuitively aware of, but if you have this emotional kind of trauma being stored physically in the body, then it's no wonder it's gonna represent as back pain as well. So that and that's not a unique thing, like this is something that comes up r relatively regularly in this kind of work whenever you work with scars. The science behind this involves something called interoception, um, which is the nervous system's ability to sense and interpret the internal state of the body. Um, and there's a certain part of your brain that integrates these signals and plays a central role in uh body awareness and emotional processing. And so when the scar disrupts the quality of the input going in from a region, it can create what we call a sensory blind spot. And a blind spot is basically just a region of the body that the nervous system has a hard time perceiving. And that disconnection contributes to both physical dysfunction and a complicated, sometimes unconscious emotional relationship with that part of the body. So now we're gonna move on to movement because this is where a lot of people start to connect the dots between a scar they forgot about and some pain that they couldn't get rid of. So scars can cause both inhibition and facilitation of tissues. It's kind of confusing and kind of annoying. Um, and also scars can be facilitated to another scar or inhibited by another scar and to itself, so it kind of gets into the weeds. But just to make it simple, a scar can turn certain muscles down and other muscles up. It can make certain structures very underactive and others overactive. And this typically starts as a local issue, but then can very easily go and turn into a global issue. So here is the pattern. You have an ankle scar from a surgery that that starts off affecting how the local foot and the ankle move. So that changes how your foot and ankle move onto the ground, which then affects the load going up the chain. So that's going to affect how your knees track, then the hip starts to compensate, and then your spine starts to wiggle around trying to figure out what's happening. Your neck starts to turn and rotate, and now you have a persistent pain on the side of your neck that you can't figure out, and it's really hard to make the connection. But turns out that ankle surgery that you had eight years ago could very well be created by that. And that's just from affecting that distal mechanism, causing restrictions there that then have other parts of the body going upwards try to compensate for it. And because the brain is constantly wiring relationships together, these compensatory patterns really become neurologic neurologically set and can become like the default motor program that you have. The brain stops treating them as a workaround and starts treating them as normal because it's working. And then physically the mechanical uh loading across the system changes. Then you have a pattern that deepens in compounds over time without any new injury occurring. So think of like a thoracic or like a mastectomy scar. So mastectomy scars are like known for inhibiting the serratus anterior. When the serratus anterior doesn't work, then your whole scapular movement isn't gonna work either. Then your upper traps or your levator scapula, which are muscles up here, will start to overcompensate and you're gonna shrug your net your shoulder up. Then your shoulders completely lost its stability, you start to tip it in different directions, then you go to move your shoulder, then you get an impingement, and then your your neck gets really tight, right? And over time, because of that impingement, you start to damage your rotator cuff, right? And then, but is your rotator cuff actually the problem? Or is it because you had a mastectomy scar that totally turned off a very important scapular muscle? And then you can get like into like visceral issues. If you have a C-section, like that scarring could affect different viscera locally. Not to mention like all the implications that C-section scars have on like the whole intrinsic core unit. And from what we've talked about so far, all these can contribute to chronic pain, uh, if it's affecting organs, potentially digestive dysfunction, and also having different referred patterns from organs, from like just poor gut motility, etc. And by the way, your scar doesn't have to actually be painful to the touch to be causing all of these different issues we've been talking about. You may not even realize it, but it is most certainly affecting things downstream and upstream. So when I work with people, one process that I use that really helps me narrow down how scars might be playing into people's motor and movement issues is neurokinetic therapy or NKT to keep it short. It's this uh very, very strong and very unique assessment and treatment system that's built on motor control theory. And basically, you have your motor control center in your cerebellum, which is like the small brain on the back of your brain, uh this stores, coordinates movements, and dictates how your muscles are going to get recruited during literally anything that you do. Um, when the system gets disrupted by injury or pain or scar tissue, the motor control center will find alternative recruitment strategies to be able to get the tasks done. So those alternatives get stored as new programs and the compensation then becomes normal, right? So this is the default way that you do things. So NKT uses um manual muscle testing as like a an insight into the nervous system. It's a biofeedback tool, which you can use to help determine what muscles, ligaments, structures, etc., are inhibited and which ones are facilitated in doing too much work. So oftentimes a scar is going to be facilitated. A portion of a scar or one scar could technically be inhibited, but that's gets too much into the weeds. Let's not worry about that right now. So your nervous system is constantly like monitoring, monitoring and bracing around a scar and organizing movement to like protect it or affect or the scar itself is just literally affecting the movement. And things have adapted to either protect the scar or just to protect your body or just to manage the forces of the body. So basically the assessment protocol works like this: you find tight muscles, you test the tight muscles if it's a relation to the chief complaint, and based on like how the muscle tests, you can use the scar to see if it changes or affects the way that a muscle is testing. And if by doing stuff to the scar, you can change the output of a structure, then you're proving that that scar is related to what we're working on, because otherwise it just wouldn't do anything. So, based on that process, you can then do some stuff to see what's happening basically. Like how much, how many different structures is this scar affecting? And is it downregulating all of them? And usually that is the case. So you can do stuff to release the scar, you can do stuff to activate whatever structures need to be activated and stimulated, and as you do that protocol for yourself, and as you kind of work on that as a homework piece for you at home, your body will start to learn this new way of moving, which is like technically just more efficient and probably produces pain. And and so long as you keep up on the homework, you know, your nervous system takes a little bit of time to adapt, but it will adapt. Um, you will have a new default of movement that won't have a very facilitated scar inhibiting everything else around it. So basically, the session that you do with one of with somebody who works with scars will create an opening, but the homework that you do is what's going to make it stick. So you might ask the question, like, okay, if everything's just inhibited, why don't I just strengthen everything? And that logically should make sense, but it doesn't always play out that easily. So if a muscle is already neurologically inhibited by a facilitated scar, you can do hundred direps of something, and that muscle may not fully come back online. It's not to say that it's not like contracting because it is, but it may not contract or be recruited as much as you want. The timing of its contraction may not be good, uh, especially if that scar is actively suppressing it. You might have co-contractions from something else and not be able to fully use the muscle that you're trying to target. Or you might get a temporary improvement that regresses quickly because you're not like releasing the facilitated thing. That's also very possible. Why people can plateau in physical therapy or any type of rehab. It's because the exercise could be totally fine, but the the route that's driving the inhibition is not being addressed. So let's talk about what you can actually functionally do about this. First off, always seek out a professional. It's their job to do this all day, and it's going to be better than whatever you think that you do, just based on piecing the other information that you find on the internet, even in if it's this information here. So if you're working with somebody, make sure that you tell them about your scars. Um, and if they're a good clinician, they understand how scars can play into it, they will assess it and see if they need to work on it. Even if it's like seemingly unimportant, just bring it up. It might like even a bone break as your bone calluses, that's technically a scar as well, that might play into it as well. And you can ask them, how often do you work with scars? And if there's somebody who doesn't for whatever reason and you feel that your scars related, then go find somebody else that does. So if uh you know you're at just at home and you want to start doing stuff on your own, there are things that you can do to really help your scar out. The key here is consistency, not intensity. You don't need to be digging aggressively into your scars. Less is actually probably better. So, first thing you could do is just different types of mobilizations to the scar itself. So this is very foundation of scar management. So research supports regular scar massage and mobilization work for improving improving scar pliability, tissue quality, and pain. And you don't need to do that with a professional. So, of course, please wait until your wound is fully closed, it's no longer fragile, and you know, you're not at risk for it opening. This usually is around six to eight weeks for most things. Make sure you get cleared to actually do stuff on it. Okay. So let's talk about a different strategy, a few different strategies, right? So if we have a scar that's going up and down, you can take your fingers, put it on each side of the scar, and you can have your fingers do opposing movements. So you can have your right hand go down, left hand go up, or whatever vector the scar is going. Um, and you can kind of find places of restriction and hold it in those directions. And then you could do it in all different directions in relation to the scar. You can go onto the scar and s see what parts of the scar are moving very slowly or just feel really tight. If superficially you don't feel it, especially if it's an area that doesn't have bone right underneath it, you might have to go a little bit deeper, like especially in your abdomen, right? Usually you have an abdominal scar because you got some surgery of an organ which is like in you, and those that scarring is going to happen all the way through it, multiple layers. So you might have to go a little bit deep on it depending on where the scar is. So basically just find directions that are restricted, gently hold it into that direction, and just feel it release under your fingers, and then move in a different direction. And as you progress, you can mobilize the tissue by picking it up in between your fingers and gently rolling it. There's different things that you can do, but doing really honestly any type of mobility work on a fully closed scar is probably going to be a good idea. So do this for like three to five minutes. It might get sore, it might get discomfort, that's okay. Um, if it's like super sharp aggressive pain, stop doing it and go seek help. And you can do stuff with cupping as well in a very similar manner. Um, start with doing the cupping on the side of it. The cup on one side of the scar, one cup on the other. You could still do the same thing by moving it around. Uh, you can try putting it on top of the scar as well, just make sure it's not like super, super aggressive. Um, so basically, cups help to create negative pressure and like lift tissue. So depending on how much tension there is, it could separate different layers of tissue. You can also just have the cup be on something statically and breathe. That also totally works. Um, again, maybe uh play with the time frame on this. Uh believe it or not, getting bruised is actually not the goal. Uh, it is just to facilitate the neurological change and the local tissue change that you're looking for. So if you feel good after holding on a spot for a minute, then stop on a minute. And then lastly, this is something I actually learned from uh Dr. Perry Nicholson recently, um, stop from Stop Chasing Pain. Uh K-tape is one that like I think people are very aware of, and there's different strategies that you could do. Um, but honestly, just getting some K-tape, so kinesio tape, and taking it and just putting it directly over the scar and not excessively tensing the K-tape can help to decompress that skin, lift it a little bit, and just the different layers of tissue, and might help free up the nerves, free up some blood flow, free up some lymphatic flow. And with K-tape, it's cool because it's very passive. Put it on, kind of forget about it for two to three days. Usually good K-tape can survive through water. Um, take it off, give your skin a break for a day or two, put it back on, see how you feel. If it's really helpful for you, then this might be a very low-grade thing that you could do just to make yourself feel better. So, regardless of where the scar is or what caused it, these principles apply across the board. Uh, of course, always get clearance from your healthcare provider before you're doing scar massage because timing does matter. If you do it too early, you are going to affect wound healing, and that is not good. So you can work on the scar, work around the scar. Uh the visible scar is like just the tip of the iceberg. If you have a scar that goes deep because of like some organ um surgery or whatever, you can go pretty deep. Again, if you feel any sharp pains or notice any big negative impacts, then stop doing that and seek professional help. And then you can always pair scar release with movement, and it's very encouraged that you do. Um release a scar and do some breathing drills, go for a walk, like do different things. I can't be specific about what things you might need because I haven't assessed you, but just I encourage some kind of movement afterwards. With this, consistency is also better. A few minutes every day is better than doing it for 20 minutes one day. Uh, this is a daily thing that you have to do to keep up with it. And also, uh, if there is any emotional things surrounding the scar, just be aware that that might come up. Um and if you find that it's very disruptive and you don't know how to deal with it, then pursue uh some sort of therapy with a qualified professional. And finally, if you're doing this work consistently and you're not seeing changes that you're looking for, then this scar's influence just might be outside of the scope that you're doing stuff in. Um and it might be more complex than just what you can do on your own. So that's when you should bring a professional in who can assess and kind of understand what's happening. Or the scars just isn't related to what you're dealing with. Okay, so that's a wrap. That was a very, very long episode. I apologize, but uh, I was really excited to make this one personally so I can also learn more about scars and just be more better educated on it. But because I also love when people come in with scars because kind of makes my job easier. I think it's always interesting of how they can affect people. Um, and also I just found that it's like extremely potent for most people. If any of this has resonated with you, I want you to do something right now. Think about your scar history, whatever surgery or injury that you might have had, and no matter how minor it might have seen, and ask yourself, has anybody ever assessed whether those scars are contributing to what you're dealing with now? And if the answer is no, then that's a conversation worth having with somebody. If you're in the Ulcer County, New York slash Kingston area, Dodges County, Green County, Columbia County, uh Rockland, you know, all the surrounding counties, I can help. Definitely book a free intro call in the notes down below. As a listener of this podcast, you are going to get $100 off of our 90-minute deep dive evaluation when you book that call. And in that eval, we are going to do a bunch of different kinds of assessment to see what are the major contributors or potential root causes of what you're experiencing, and that very well may be a scar. And we also just want to generally hear from you. If you have a scar that you suspect has been contributing to your pain, or if you tried any of the home treatment approaches and you've noticed a change, please let us know. That'd be really cool. Thanks for listening, and I will see you on the next one.