As sports therapists we see clients with a wide range of injuries – spanning from head to toes – some of which present with severe and often extended visible scars. However, another type of scar, not visible to the naked eye, exists within the body as a result of injured muscles, tendons or ligaments.
What is scar tissue and how is it formed?
Scar tissue is fibrous tissue that acts as a replacement for pre-existing tissue when the latter is damaged due to injury. A good example of scar tissue is the one located at the site of a piercing. If you have your ears pierced, squeeze your ear lobe, feel that little bump? That’s scar tissue.
When tissue is damaged it goes through a healing process that consists of three overlapping stages: inflammation, proliferation and remodelling. Scar tissue is formed, during the remodelling phase, and can be seen on the skin as well as organs and tissues throughout the body. In addition, when collagen fibres are deposited in excess or in a non-parallel sporadic orientation the scar tissue can lack elasticity, strength and quality (Lee & Jang, 2018).
What does the research say about the effects of massage on scar tissue?
Medical and scientific research has shown that manual therapy, such as massage, has the ability to break down scar tissue, reduce associated pain and increase range of motion.
Scientific research on pro-massage benefits
In a recent paper, Cho et al., 2014 conducted a study in which participants either received standard therapy (group 1), or standard and massage therapy (group 2). The results clearly demonstrated that the standard and massage therapy (group 2) had a significant improvement in scar thickness – as measured by ultrasound imaging – compared to the standard therapy (group 1) after just one course of treatment.
The authors suggested that the benefits of massage were due to its mechanical effects causing an increase in venous return and lymphatic drainage.
However, this study had several flaws such as not determining the long-term effects of massage on scar tissue past 35 days. Furthermore, it did not consider the age of the scar tissue and suggested that this may have influenced how successful the massage treatment was on the patients.
Scientific research against massage-benefits
Conversely, Shin & Bordeaux (2012) concluded that massage does not always have a positive effect on scar tissue. The authors reviewed ten publications that met their inclusion criteria of studies that had original data and investigated the use of massage for the prevention or treatment of scars. The study showed that 45.7% of the treated patients improved along with the Scar Assessment Scale. Plus, they experienced a general improvement in their well-being (for instance, less pain, depression and anxiety).
Based on the above results the authors concluded that although benefits can be seen with massage therapy, it does not provide evidence for massage therapy actually breaking down scar tissue.
However, we must keep into consideration that scientific research surrounding the application of massage therapy on muscle fibrosis (scar tissue) is limited. Rather than investigating if the scar tissue can be broken down through the mechanical force of massage, scientific studies focus on how wound healing can be optimised from the early stages of injury by using appropriate and progressive mobilisation, strengthening and flexibility strategies (Jarvinen et al., 2017). As stated by Chapelle (2016), recent studies suggest that the fibrotic response and collagen deposition that cause the accumulation of scar tissue can be reduced by applying stretches to the area. These stretches will vary depending on the location of the scar tissue and available range at the joint.
What do I think as a sports therapist?
In my opinion, to fully understand the optimal treatment procedure, and clarify the mechanisms behind the theory, more research is needed on the relationship between massage and scar tissue (especially, because of the conflicting evidence).
However, I believe that although massage therapy can have beneficial effects on visible scars, such as improving pain, range of motion and appearance, the scar tissue will not fully be broken down but encouraged to become more organised and functional in nature, like the pre-existing tissue.
A more active approach would be more beneficial, especially at the early stages of the healing process after an injury occurs. To improve scar tissue healing, the focus should be placed on gradual passive and active mobilisation and isometric strengthening exercises.
This will encourage the formation of organised scar tissue that is strong and functional, whilst decreasing the risk of muscular atrophy that is often associated with injuries.
Injured? Looking for a sports massage?
- Ault, P., Plaza, A. and Paratz, J. (2017) Scar Massage for Hypertrophic Burns Scarring – A Systematic Review. Burns, Jun; 44; 24-38
- Chapelle, S.L. (2016) Understanding and Approach to Treatment of Scars and Adhesions. (PDF)
- Cho, Y. S., Jeon, J.H., Hong, A. et al. (2014) The Effect of Burn Rehabilitation Massage Therapy on Hypertrophic Scar After Burn: A Randomized Controlled Trial. Burns, Dec; 40 (8); 1513-1520
- Jarvinen, T. A., Jarvinen, T. L., Kaarianen, M. et al. (2007) Muscle Injuries: Optimising Recovery. Best Practice and Research. Clinical Rheumatology, Apr; 21 (2); 317-331
- Lee, H. J. and Jang, Y. J. (2018) Recent Understandings of Biology, Prophylaxis and Treatment Strategies for Hypertrophic Scars and Keloids. International journal of molecular sciences, Mar; 19(3); 711
- Shin, T. M. and Bordeaux, J. S. (2012) The Role of Massage in Scar Management: A Literature Review. Dermatologic Surgery, Mar; 38 (3); 414-423