Q: What is scar tissue?

A: Adhesions (scar tissue) are dead fibrotic tissues that form mostly in muscles, tendons, ligaments, fascia and joints. They occur as a result of injury, surgery, prolonged inactivity or repetitive motion.

When a muscle, tendon or ligament is torn (strained or sprained) or a nerve is damaged healing occurs in three stages. First there is acute inflammation where swelling, redness, heat and pain occur. This lasts approximately 72 hours. After inflammation recedes, repair can begin. This is the second stage, when scar tissue begins to form, and is when massage can do the most good in the shortest period of time. Once the body decides that an area needs to be reinforced, it will tend to do more than is needed rather than risk not doing enough. As adhesions continue to bind surrounding structures, mobility and flexibility become more and more restricted. Muscle fibers become unable to slide back and forth properly, joints become restricted and nerve fibers can become compressed. This final stage is called remodeling and once complete can take a long time to reverse. Refer to my article How Your Muscles Heal – Strains for more information on this process.

When muscles and joints are in one position for a long time or doing repetitive motions, the oxygen supply can become restricted. Muscle imbalances will also occur (some too strong/short and others too weak/ overstretched) and combined with lack of oxygen (hypoxia) this can also lead to scar tissue as the body again tries to reinforce a perceived instability. Unfortunately, scar tissue is weaker, less elastic, more prone to future re-injury and is much more pain sensitive than normal. Scar tissue from an injury will always be present to some degree no matter how well it’s addressed during the healing process and will ultimately have some effect on function. Adhesions that form from within normal tissue can be manipulated and restored to their original healthy state. In either case, prevention and early intervention is always best.

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