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Scar Tissue

Physical Therapy Management

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Updated June 05, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Knee Injury
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Scar tissue forms after injury to the normal collagen cells in the body. If you cut yourself, have surgery, or tear tissue in the body, scar tissue will develop. The development of scar tissue is part of the normal healing process in the body.

What is Collagen?

Collagen is a substance that is present in all of our body parts. There is collagen in muscles, tendons, and ligaments. There is also collagen in skin and bones. The cellular makeup of collagen makes it very strong due to the alignment of collagen cells. It can resist tensile forces, such as stretching and pulling, without tearing or breaking.

How Does Scar Tissue Form?

After injury to a muscle, tendon, skin, or ligaments in the body, the inflammatory process starts to heal the injury site. This process helps to ensure that the injured site is cleaned up and new cells are brought to the site that will soon become healthy tissue. Some of these new cells are collagen cells.

Unfortunately, the body does not know exactly how to arrange the collagen cells so that they become healthy tissue that can resist tensile and stretching forces. The collagen cells become a balled-up clump of tissue called scar tissue.

Is Scar Tissue Permanent?

After scar tissue forms in the body, it is not permanent. The scar tissue can become stronger and better able to tolerate stretching forces through a process called remodeling. Remodeling scar tissue is a must to ensure that the muscle, tendon, skin, bone, or ligament becomes normal, healthy tissue again.

Remodeling Scar Tissue

Scar tissue remodeling occurs as you start to stretch and pull on it. The stretching of the scar tissue helps to align the collagen fibers to allow them to return to normal. This realignment of the collagen fibers makes the tissue better able to tolerate the forces that are placed on it during the day.

If you strain your hamstring muscle or tendon, for example, you'd follow the R.I.C.E protocol for a few days. After some healing has taken place, gentle stretching of the hamstring muscle is indicated to help ensure that the scar tissue is remodeled properly.

After fracture or injury to bone, weight bearing with the bone helps to remodel the bone tissue to make it strong again. Wolff's Law states that bone grows and remodels in response to the specific load applied to it. Therefore, bone becomes stronger as you place more and more stress on it. After fracture, your physical therapist can help you learn strategies to place the correct amount of stress in the correct direction to help with the remodeling process of bone.

If you have had surgery, a scar may be present near the site of your surgery. Scar tissue massage is another way to help remodel scar tissue in the skin. This can also help loosen any adhesions between the scar and the underlying tissue and fascia.

For example, if you have knee replacement surgery, a surgical scar will be present in the front of the knee. This scar can become adhered to the underlying tissue and prevent normal range of motion from occurring. Scar massage, along with knee flexibility and strengthening exercises, can help loosen the scar tissue and ensure that proper remodeling takes place. Remodeling of the scar tissue is an important step to achieving full range of motion in the knee.

Many people feel that scar tissue is a permanent or negative thing. Scar tissue is part of the normal healing process in the body. Scar tissue that has not been properly remodeled can become a problem. That is why it is important to speak with your doctor and physical therapist if you are injured or have had surgery. Learning the correct methods to remodel scar tissue can help decrease pain, improve range of motion, and restore normal functional mobility.

Sources:

Kisner, C., & Colby, L. A. (1996). Therapeutic exercise: Foundations and techniques. (3 ed.). Philadelphia: FA Davis.

Hertling, D. (2006). Management of common musculoskeletal disorders. (4th ed.). Philadelphia: Lippincott Williams & Wilkins

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