1. Scar Tissue 2.What makes a scar 3. Characteristics of Scar 4. Scar & Adhesion 5. Classification as External and Internal scars 6 Detriments/Disadvantages 7. How scar tissue forms in muscle 8. Phases of scar healing 9.Phases of wound healing 10. Release of scar and adhesion 11. Massage 12. Massage techniques 13. Conditions : Burns & Skin grafting 14. Cautions 15. Procedure 16. When to start massage after surgery 17. How to massage scar tissue 18. Effleurage, Kneading, Skin rolling and Friction 19. Caution 20. Keloid 21. Warning.

1. -By Dr. Rima Jani PT
(B.P.T.,M.P.T.)

2. A mark remaining after
healing of the wound which
consists of the fibrous tissue
replacing the normal tissue
destroyed by injury or by
disease.

3. • The problem with scar tissue is that it’s not regular tissue at
all. Scar tissue is body’s protective response to an injury.
Following the injury, whether it’s a sprain, strain, or external
cut/abrasion, there is a period of inflammation that aids the
healing process, but after a few weeks, scar tissue formation
begins.
• Scar tissue is connective tissue with an excess amount of
collagen. Collagen is present all throughout your body, and
gives your tissues extra strength, but can limit movement
when there is too much, as is the case with a scar.

4. • The skin and sometimes the underlying tissues can
become hard and non-pliable and the bands of fibers
can be palpated. The skin usually becomes tight and
short, which can compromise the joint integrity and
function and limit its range of motion.

5. • Scars become a vacuum in your body – drawing other areas
towards it as they continue to stiffen and brace themselves.
• Any injury to the skin may lead to extensive scarring and
subsequent induration.
• Scar formed during the healing of skin wound has a
tendency to contract.
• An exaggeration of this wound contraction process often
results in the formation of contracture, which restricts the
mobility of skin.

6. • This situation is commonly encountered in microsurgical
procedure of hand, burns, skin grafting and tendon
repairs.
• The adherent skin not only restricts the mobility of
adjacent joint, but may also binds the superficial tendons
and leads to the insufficient transmission of the muscle
force to its insertion point resulting in mechanical
weakness of muscle.

7. • Scars appear after an injury as collagen fibers that have
replaced normal skin or other tissues. They are a natural
occurrence as part of wound repair but are never as
functional as the tissue they replace. Every wound results in
some scar tissue formation except for very minor lesions.
• Adhesions are anchored bands of scar tissue supporting the
wound. They form when collagen fibers lay chaotically
across fascia and muscle fibers. Adhesions can be seen as
internal scars and they bind all tissues they contact. They
increase the stress on the body by restricting movement
and increasing pain.

8. • External
• Internal

9. • Inadequate circulation.
• Limits lymph drainage, blood flow and oxygen delivery in
the area.
• Makes the area slower to heal.
• As a result: Impinged nerves, numbness, pins and
needles.
• Postural misalignment and reduced flexibility.
• Muscle weakness.
• Ultimately increases the risk of future injuries.

11. • Immature phase, immediately after a wound heals, the area
may be itchy, painful or sensitive. It may be red initially but
over time it will return to normal flesh colour. Immature
scarring responds best to heat application, exercise and
massage.
• Mature phase is when production of scar tissue stops. This
can take anything from three to eighteen months depending
on the trauma. More disciplined and structured approach is
required to reduce scar tissue that has matured.

13. • By addressing scar tissue early in its development, a
therapist can help minimise the related problems and
prevent future ones.
• When you massage and move scar tissue, the layers of
collagen and fascia become more well hydrated and
organized, which allows the scar to then move with the
surrounding tissue, rather than be a stuck and stiff
structure.
• It is important to emphasize that the approach needs to be

14. • It is important always warm up the tissue with effleurage
and petrissage before applying any of the more invasive
techniques we’ll discuss.
• It is essential to alternate the techniques you use in a
way that varies the intensity. This ensures the client’s
body and nervous system are not excessively stressed.

15. • EFFLEURAGE
• KNEADING
• SKIN ROLLING

16. • BURNS
• SKIN GRAFT

17. • Massage should not be given until the tissue can withstand it
or graft is established, i.e. till 10-14 days after surgery.
• Recently healed skin appears red. It is thin and very delicate
which can be easily sloughed off if shearing forces are
applied to it. It can also destroy the newly formed capillaries
in the graft and lead to graft failure.
• Therefore, massage procedure should only be started when
healing skin gains considerable strength.

18. • A lubricant is used in early stage to have a smooth sliding of
the fingers of therapist over affected skin.
• The scar area is mobilised very gently with
• Finger kneading: first at periphery then at the centre.
• There should not be any drag on the injured part.
• As the skin becomes harder, the depth of kneading is increased
to treat scar tissue vigorously.
• After completion of the treatment lubricant must be wiped off
with swabs.

19. • Lubricant is applied at the edge of the graft.
• Finger kneading is used around the edge to mobilise the
tissue
• Effleurage and rolling of grafted structure is also
interspersed in between.
• Small range of movement is used and pressure is kept
superficial, in order to avoid the sliding of fingers over the
skin while applying pressure at it may cause blistering.
• After completion of the treatment lubricant must be wiped

20. • You should not massage your scar if you still have stiches or if the
scar has a scab on it.
• Not to give early massage or over zealous massage which can
encourage the formation of hypertrophic scars (keloid)
• When wound area still unhealed great care must be taken to avoid
infection.
• Lubricant must be sterile to allow gliding without friction.

21. • Deep transverse frictions can help break down scarring
and adhesions and prevent the formation of new ones.
This technique can be very effective both in mature and
immature scar tissue. Deep pressure is applied with the
fingers directly perpendicular to the direction of the
fibers.
• Client communication is essential to ensure pressure
stays within their comfort zone.

22. • It is important that you only start massaging your scar
once it is sufficiently healed.
• This should be after about two weeks.
• Massage scar no more than two or three times a day. Be
careful not to irritate scar through excessive massaging.

23. • With the tips of two or more fingers, gently apply
pressure to the scar and surrounding area while moving
your fingers in one of three directions:
• Back and forth along the length of the scar.
• From one side of the scar to the other, slowly moving
along the length so the whole of the scar and its
surrounding tissue has been massaged.
• In small circles while moving along the length of the scar.
The circumference of the circles should encompass the

25. • You should not massage your scar if you still have stiches or if the
scar has a scab on it.
• Not to give early massage or over zealous massage which can
encourage the formation of hypertrophic scars (keloid)
• When wound area still unhealed great care must be taken to avoid
infection.
• Lubricant must be sterile to allow gliding without friction.

26. • Never massage broken skin or an open wound as this
will inflame the area and could even cause infection. This
action could result in a more prominent scar after the
healing has finished.
• Stop massaging if one feels pain or notice increased
redness.
• Stop if the scar is inflamed and warmer than the
surrounding skin.

27. • Keloids are firm, rubbery lesions or shiny, fibrous
nodules, and can vary from pink to the color of the
person's skin or red to dark brown in color.
• A keloid scar is benign and not contagious, but
sometimes accompanied by severe itchiness, pain, and
changes in texture. In severe cases, it can affect
movement of skin.

29. • Scabs should never be picked off before they are ready
to fall off naturally as this can lead to infection, as well
as a more noticeable scar once the healing has finished.