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Updated: Jun 25, 2019

Although osteopaths recognise the influence scar tissue can have upon the patient many bodyworkers have not made the same connection. Scar tissue is often an ignored component of bodywork techniques and so it is pertinent to review osteopathic principles and how important and interrelated with scar tissue they really are:

Here we outline the four main osteopathic principles:

• The body is a unit, and the person represents a combination of body, mind and spirit.

• The body is capable of self-regulation, self-healing and health maintenance.

• Structure and function are reciprocally interrelated.

• Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.

The body is a unit, and the person represents a combination of body, mind and spirit.

Psychological trauma and distress is often associated with a variety of scars. These may be as varied as planned routine surgeries (such as appendectomies), emergency surgeries (such as unplanned C-sections), trauma wounds (knife and bullet wounds) as well as scars from self-harm and amputations.

Depression is often one of the main emotions felt by scarring. Other emotional effects include self-loathing, fear, anger and feelings of failure. This is not unlike the effects of Post Traumatic Stress Disorder. The patients exhibits these feelings and emotions and may re-experience all the events surrounding the acquisition of their scar simply by touching or thinking about the scar.

A patient may feel physically sick just by speaking about or touching their scar. They may feel repulsion of the scar - rejecting part of their own self.

Feelings of being ‘disconnected’ in the body is also a reasonably common expression of how scars affect individuals particularly with Caesarean section or hysterectomy scars.

Scars are powerful reminders of the events that created them and they affect the body, mind and spirit.

The body is capable of self-regulation, self-healing and health maintenance.

A scar compromises the delicate structure of the skin and other underlying structures such as blood vessels and neural pathways.

A scar also affects the body’s protective skin making it more susceptible to UV damage due to alteration of melanin pigmentation. Hair follicles and sebaceous glands will also be affected.

As regards self-regulation mechanisms there are several phases of scar creation. These include:

1. The inflammatory phase - bacteria is destroyed, debris is removed and the wound is prepared for the growth of new tissue

2. Epithelial healing - the wound is rebuilt using collagen and extracellular matrix

3. Wound contraction - the wound closes and collagen continues to be expressed

4. Remodelling phase - when collagen continues to be laid down, peaking at around 21 days after injury but continuing for perhaps 2-3 years

The appearance of a scar can change according to its location, severity of the wound and individual healing response times. Hypertrophic and keloid scars are an over-expression of scar tissue formation.

Structure and function are reciprocally interrelated.

The body repairs itself as far as possible but if the tissue is damaged then the function of that tissue is compromised. Healing is a continuous process and the scar impacts upon surrounding structures in many ways.

Due to reduced elasticity in the skin and the resulting binding of fascia, overlapping and interrelated membranes and structures become restricted. Scar tissue formation can continue for 2-3 years (or more) and can become intertwined with organs and glands, inhibiting function and creating pain. It is not uncommon for bowel and bladder disorders as well as infertility, digestive disturbances and chronic lower back pain to be associated with various abdominal surgeries.

Thickened fascial masses can inhibit joint function. Scars of the lower leg and ankles can create hip and back pain. Appendectomy scars can create right sided low back pain and left shoulder restrictions. Thyroidectomy can produce neck restrictions and swallowing difficulties. Open heart surgery can produce scar tissue that pulls the patient forward into a kyphotic posture. The list of physical, structural and functional effects is unending.

Scar tissue also creates congestion of blood and lymph flow. Stagnation or restriction of blood and lymph results in toxic waste congesting at the site, de-oxygenation and lack of nutrients to the tissues. Often a scar appears white due to lack of blood flow, swollen or congested due to poor lymph drainage and even red and irritated due to toxic build-up and tissue irritation.

Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function.

Just because a patient has a scar does not mean we need to immediately offer treatment.

Practitioners must see the need to offer treatment and determine the rationale for doing so. Therefore we must constantly enquire within ourselves: What is the reason for offering treatment for this scar? What is our objective in doing so?

We divide scars into ‘active’ and ‘passive’ categories. An active scar is one that exerts biomechanics restrictions due to the contractile nature of the tissue. There may be full or partial loss of sensation in the tissue. The scar may be painful to touch. It may be exerting an influence both locally and remote from its origin. It may be exerting emotional trauma in the patient.

An inactive scar has none of these active components and can usually be dismissed as not requiring treatment. We must be astute to ensure we have not overlooked any possible effect of what we might at first consider to be an ‘inactive’ scar. Often application of MSTR® reveals it actually does have an influence on the client as freedom of movements return and referred pain disappears.

The specialised form of scar tissue treatment known as MSTR® is now undergoing clinical research to determine what tissue changes can be observed using ultrasound imaging. We hope to share our findings with you very soon.

We can positively state that scar tissue and the principles of osteopathic practice are interrelated. Scar tissue should not be ignored. It should be evaluated and treated effectively otherwise other therapeutic interventions will either not realise their full potential or will be ineffective.

For more information about practitioner training see:

© Alastair McLoughlin

Contributed by Tina S. Hull, LMP, PBP


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