Scars need love too! It is so important to give them attention so they can heal with good mobility and flexibility to allow for healthy muscle and tissue function. Instruction to our patients about the importance of scar tissue mobilization is a big part of the rehab process. After perineal tears, c-sections, or abdominal surgeries, this is imperative. Pain after delivery or surgeries can be related to scars that have decreased mobiltiy and can lead to pain and decreased muscle strength and poor coordination. Without specific love and attention, the scar tissue heals with poor mobility and sensitivity.
Scar tissue work is really imortant in healing, but is, unfortunately not discussed by most surgeons. We will share how to care for your healing scar, here. However, if you have pain or weakness that persists beyond normal healing time (12 weeks) we strongly encourage you to see a pelvic floor PT to help you rehabilitate after surgery or delivery.
Scar tissue mobiltiy has four distinct phases of healing and it is important to consider the phase of healing as we look at return to activity and treatment strategies.
The first phase of scar healing is inflammation. This is the phase immediately after an injury or surgery. This phase usually lasts about 1-2 days after surgery. Activity should be limited to gentle movement only.
The second phase of healing is the granulation phase. This is characterized by a significant increase in blood to the area to bring nutrition for the healing tissue. This phase varies depending on the tissue type and the extent of the injury or the surgery. Areas that have less blood flow will require longer to heal than areas with higher blood flow. Gentle movement is important during the granulation phase with the consideration that heavier activities like running and lifting can cause damage to fresh scar tissue.
The third phase of scar tissue formation lasts about 3-8 weeks after injury or surgery. This stage has an increase in fibroblasts, collagen fibers and ground substance. Collagen lays down with weak bonds that makes the scar tissue elongation easier. This is the ideal time to work on remodeling scar tissue without the increased risk of tissue reinjury. The fibroblasts are responsible for the tissue tightening of the scar.
The final phase of scar formation is maturation. During this phase, the collagen firms and tightens. This allows the scar tissue to tolerate maximal stress without increased risk of tissue reinjury or scar tissue failure. During this time, there continues to be an accelerated rate of collagen development. Because of this, scar remodeling can continue to take place with scar tissue mobilization. However, if scar tissue mobilization does not occur, the collagen fibers can continue to contract and form crosslinks that can cause a tight and painful scar that can limit the mobility of the surrounding tissues.
After the maturation stage of scar tissue formation, the tissues within the scar become less active and less pliable. With these changes, scar tissue remodeling becomes more difficult and will require more hands-on scar tissue mobilization with a PT.
Scar tissue mobilization can be gentle and helps to calm the nervous system. The mobilization can also relax the contractile tissues of the scar tissue. Even the gentlest scar mobilization can help to start making tissue changes. The scar tissue mobilization can also improve the hydration of the scar. After delivery with vaginal or c-section or abdominal surgeries, please see a pelvic floor PT to make sure your scar and surrounding tissue is ready to return to exercise. And if you are having pain after delivery or a surgery, we can make sure that your scar is moving well and help to decrease the pain and teach you how to get your scar moving and on the road to recovery.