Kristin Bignell - PT, MScPT, BScES(hons), CMAG
Scars: The Impact on Pain, Function and Performance
Did you know...
--> Your c-section scar could be contributing to your shoulder pain, "weak" core
--> Your appendectomy could be the reason for your hip pain and stiffness
--> Your hernia repair to your back pain
--> Your low back surgery to your neck pain...
Our skin is intimately connected with our vascular system, nervous system and connective tissue. Because each of these systems connect all regions of our body, when the integrity of the skin has been altered, there can be far-reaching consequences. Using acupuncture in the treatment of scars can have significant positive clinical implications even when those scars seem far removed from your area of complaint.
A scar can result in symptoms that are felt in seemingly unrelated areas of your body.
Our skin is the largest organ in our body. Our skin contains lymphatics, blood vessels and numerous different types of nerve endings which are capable of sensing and transmitting different types of information to our central nervous system. Deep to the skin, we have fascia. Fascia is a type of connective tissue that surrounds and connects every muscle, bone, nerve and organ in our body and therefore the fascia is a system that provides structural continuity throughout our entire body.
In the healthy individuals, injured skin undergoes healing in a predictable fashion. The final stage of tissue healing is called remodelling. During the remodelling process there is realignment of tissue (collagen) and type 3 collagen is replaced by type 1 collagen (stronger form) to produce greater tensile strength of the wound. This stage of remodelling can take place for years after an injury. The result of this process is a scar: tissue with good strength but limited in its elasticity and organization. Depending on the depth, scars have the potential to impact the nervous, vascular, muscular, visceral and fascial systems. The result can be pain, tension, stiffness, decreased strength and/or sensitivity, all either local or removed from the scar.
When we consider the relationship of the skin to the nervous, fascial and vascular systems, it becomes easy to understand how scar tissue in one area could result in a pain or movement problem in another area of the body.
These problems may be evident shortly after the injury, or they may emerge years later when the body has run out of ways to compensate for the dysfunctional tissue. For that reason, it is important to take a proactive approach to managing scars. Even if you aren't experiencing pain, all scars deserve an assessment and some individualized treatment.
You can begin by checking your own scar:
Colour: Your scar should ultimately be light. If your scar is fully healed and it is still dark, red or purple, it may benefit from some more attention.
Texture: Your scar should feel relatively soft and not hard.
Mobility: You should be able to move your scar in all directions without it feeling stuck and without feeling pulling into other areas. It should move as freely as uninjured skin. It should not feel stuck to the deeper tissues.
Comfort: You should be able to touch, pinch and move your scar around without pain or discomfort.
If you find that your scar is sensitive, red, stuck, or generally uncomfortable, there are many different treatment options available to help improve the quality of your scar tissue and set you up for success in your movement and performance. Acupuncture +/- electricity is clinically very effective in the treatment of scar tissue. Scar acupuncture can help to modulate local vasomotor tone (improving blood flow to deliver nutrients and clear out irritating chemicals) and decrease nociception (the transmission of noxious stimuli). These changes result in improved tissue remodelling, decreased tissue adhesions, improved sensation, improved motor activity and decreased pain perception (Elorriaga Claraco, 2013).
Acupuncture needles cause local, biochemical changes which have the ability to normalize tissue health and neural activity in the region of scar tissue.
Figure: An example of an acupuncture treatment for a scar. Notice the difference between the top 1/3 of the scar and the bottom 2/3. The top 1/3 had been treated 3 times prior to the taking of this photograph, whereas this was the first time treating the entire length of the scar. The result of treatment was improved scar appearance, decreased scar tissue adhesions, improved pain, decreased sensitivity with palpation, and restored neuromotor recruitment/strength of the shoulder.
If you aren't a fan of needles, don't fret! There are also manual interventions that can help you improve the quality and functionality of your scar. Regardless of the treatment that feels right for you, most scars could benefit from some form of intervention. The potential consequences of scars are many, but so are the opportunities for improvement. It doesn't matter if you scar is months or years old. It's never too late to make a positive change that your body will thank you for.
Figure 2: Change in scar appearance (decreased redness, decreased hollow) after 4 treatments (acupuncture, cupping, manual techniques) on a 5 year-old scar.
About the author: Kristin is a Registered Physiotherapist and the Owner of East Mill Physio in Elora, ON. She has a special interest in Neurofunctional Acupuncture and Sports Performance. She enjoys pushing the boundaries of what we traditionally believe to be possible with respect to injury rehabilitation and performance optimization by using a holistic treatment style. Kristin trained in Neurofunctional Acupuncture and Neurofunctional Sports Performance at The Contemporary Medical Acupuncture Program through McMaster University and is currently completing her second year of training to become an Instructor in the Acupuncture Program. The information presented in this article is her interpretation of what she has learned to date. To learn more about East Mill Physio, visit www.eastmillphysio.ca.
Elorriaga Claraco, A. (2016). Neurofunctional Acupuncture on the Treatment of Sports Injuries and the Protection of Athletic Performance: An Integrated Neuromechanical Model.
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