Every scar tells a story. We must ask about that story. It could be from a surgery a client neglected to list, an injury they forgot they experienced, or an actual contributor to dysfunction. In my time working in an Occupational Therapy clinic, I got a lot of practice working with scar tissue. I learned that it is essential that wound healing stages be understood, respected, and even more important – scars are not to be ignored.
There is also an emotional component to scars that we need to be sensitive to. Sometimes people are resigned to lowered expectations of restoration, or they still have strong feelings attached to the trauma that caused the wound, and some are afraid of additional pain. As we explore the narrative of the scar, we need to stay calm and professional. I know you are thinking, “duh,” but over the years, I have faced amputations and constricted scaring that took me by surprise and led me to ….. “Tell me the story about this.” If, like in an amputation, you don’t have a lot of experience, ask the client to educate you on that area's care. It’s a great way to ensure informed consent.
Basic Rules
When it’s OK to work: the scar is closed with no scabbing.
When to avoid/ stop working: redness; oozing; scar feels warmer than the skin around it; pain.
That being said, there are lots of effective modalities I have used over the years:
Therapeutic Spa: Exfoliation is a crucial first step, and I like to use Biotone’s Sea Salt Glow. I work it until I see hyperemia (pink); layer warm wet towels over and then a dry layer to keep it warm. Let it sit while I work in another area. Come back to it and remove the scrub with the towels and finish off with the bodywork.
Aromatherapy: Utilize different carriers and essential oils - depending on the scaring and age. Traditional essential oils for scars include Tea Tree, Lemon, Lavender, Helichrysum, Cedarwood, Geranium Rose, Rose absolute, Patchouli, Neroli, Myrrh, and Frankincense. A classic synergy is Lavender, Tea Tree, and Geranium Rose. Carriers include Castor oil, Rose Hip Oil; Shea Butter; Aloe; Honey; Emu, or a nutrient-rich massage medium with some of these ingredients like Pure Touch Organics.
Hot Stones: I have always had success with the combination of heat and pressure ….but the piezoelectric effect (from tapping the stones together on the area) I learned from Sacred Stone Medicine has taken it to a new level
Scar Mobilization: Two finger massages - first in small circles, then cross fiber, and finally along the fibers' length.
Myofascial: Pin and stretch; skin rolling and torque – I especially like the techniques from Walt Fritz, PT
Cupping: Check out YouTube videos by Anita Shannon
Gua Sha ”ish” techniques: I use a modified gentle scraping motion using thin stones or various tools for well-established scars.
I recommend reading Eric Dalton’s recent blog Restoring Function to Inflexible Tissues on why it’s important to address the tissue purposely. Also, explore the training out there specifically for scar work or others that provide good, effective tools. At the very least, we need to make sure we address it in the massage session as we would any other tissue and not skip over it just because it looks different.
Be well, do good work, and approach the body with curiosity.