Scar Tissue Release

By | 15/02/2015

Conditions involving scar tissue or myofascial adhesions can be very painful and often unresponsive to treatment. Everyday activities from day to day living and simple injuries can result in a tender little lump of aggravation that just gets worse with time. Conditions include tennis elbow (epicondylitis), heel spurs and plantar fasciitis, post-operative scars and the aftermath of sprains and strains.

The range of treatment approaches is huge and somewhat confusing, with different practitioners variously offering advice to rest and recover, advice to move and stretch, gentle massage, hard transverse friction massage, deep tissue manipulation, ice-packs, hot-packs, alternating hot and cold, anti-inflammatory medications taken orally, applied topically or injected into the site of pain, nutritional supplements, ultrasound, cold laser, shockwave, trigger point dry needles or acupuncture. Over the past 40 years, we have seen patients who have tried “everything” and the results of their treatments vary greatly.

Our approach is to firstly assess the condition, determining the cause and importantly, the amount of pain that is occurring, because when the actual cause of the pain is properly addressed, it can lead to faster healing, with overall improved outcomes. Prolonged pain reduces both the potential for healing and the subsequent function of injured tissue.

Modern medical practice treats pain at a superficial level, using potent pain killing drugs, yet frequently ignores the causative factors of pain, as if they are somehow irrelevant. An example seen every day in our practice would be headache. Treated with analgesics, but caused by any number of musculoskeletal, postural or nutritional circumstances. Never caused by a deficiency of analgesics!1) Pain with inflammation signals the presence of a cascade of tissue altering processes (a problem not solved by mere pain killers). Alterations include reduced circulation and increased fibrosis…scar tissue formation. Scar tissue formation is necessary in more severe injuries where muscle, tendon or ligament has been torn, A degree of immobilization is essential to facilitate healing. Strapping, Cold Laser and acupuncture can be of benefit, combined with cautious drainage massage to reduce tissue congestion. Natural supplements can assist, quercetin, rose hips, Vitamin C and hesperidin are often used.

2) Pain from early stage injury that is too tender to properly massage can often be relieved by mitigating inflammation and hastening the withdrawal of any (toxic) excess fluids, thereby returning the tissues to the same state that they were in before any tissue injury. Local ice massage or alternate heat/cold, with adjacent drainage massage works well in the early stages.

We have to consider two very different causes of pain or tissue injury, initial and subsequent.

1) Initial injury can result in damage to previously healthy tissues or bones, thus causing swelling, an inflammatory reaction, edema and a condition that if allowed to remain will become degenerative due to reduced circulation and deficient tissue oxygenation.

When tissues are damaged, they release toxins, histamine and bradykinin. These then dilate the blood capillaries, causing a certain amount of blood proteins and water to escape (from the blood stream) into the tissue spaces. This is the process of swelling or inflammation that results in coagulating extracellular fluids and the morbidity of blocked circulation. We can consider this as a subsequent phase of injury that can cause further damage if not resolved immediately.

2) Subsequent injury is the result of swelling, inflammation and residual morbidity. This is the condition of all degenerative disease, because it damages tissues continually. Often, this process progresses so slowly that it is hardly noticeable. This can be prevented and eliminated if we take the right therapeutic actions. Taking action to reverse the edema and blockages to the circulation, can speed up the healing process.

Two essential aspects of treatment to relieve pain:

1) Work towards the reversal of inflammatory processes and

2) Help the lymphatic system remove, as much as possible, the toxins and excess fluid that has been trapped in the tissue spaces.

This helps improve the actual condition and importantly, permanently reduces any subsequent injury or its cause. When blood vessels can no longer irrigate tissues with an abundance of oxygen and nutrients, we rely on the lymphatic system to remove any trapped blood proteins and excess fluid from around the cells. This is why we suggest drainage massage. Trapped plasma constituents and excess fluid often remain after tissue is damaged, and so long as it does, it can be a catalyst of further inflammation, pain and eventually, degenerative conditions.

If damaged, congested tissue is to be treated, it is essentially an undoing of the excessive healing process that occurred subsequent to injury.

          Sometimes the tissue is so badly congested that a surgeon is required to remove adhesions, scar tissue and tissue calcification.

When the scar tissue is superficial and accessible to external, disruptive treatment, we advocate “Instrument Assisted Soft Tissue Mobilization” (STM). This is a modified drainage massage using a curved blade-edge tool, the objective being the release (disruption) of the myofascial adhesions and scar tissue.

Originating thousands of years ago in Chinese Medicine as “Gua Sha”, and now taught under many proprietary names, STM restores tissue integrity, alignment and circulation. It works quickly, you can actually feels the adhesions “popping” and after a few minutes the tissue has a more normal feel.

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