by Eric Winder, DC 

Scars are visible reminders of past injuries, but sometimes they also create problems long after the initial trauma, even if we do not realize it. Pain from scar tissue is often missed because the scar itself might not hurt. Instead, scars can cause pain by distorting the sheet-like connective tissue in our bodies called fascia. This causes muscle imbalance and joint instability which can result in pain that is felt nearby in muscles and joints.  Fortunately, releasing the internal restrictions in scars can offer tremendous pain relief in these cases by restoring normal movement to affected fascia. 

New Scar, New Pain 

A patient I will refer to as Terry plays cello and recently asked me to help with a new pain and tension around her right shoulder blade. The pain started after healing from a skin biopsy by the right shoulder blade, and was constantly aggravated by the shoulder movement with her bow while playing. Terry was sure the new scar was the source of pain and tension, but massaging the scar and applying pain-relieving lotions had not helped this pain at all. The discomfort was increasing week by week and had started to prohibit her from playing. 

On examination of Terry’s scar, I noted that it had a hard, restricted feeling compared to the skin around it. Some of the muscles between the spine and shoulder blade were abnormally tight, and pressing on them caused Terry to feel a sharp discomfort. When I tested the muscles for strength, they were, in fact, quite weak. After stimulating the scar with precise pressure, the tight muscles relaxed and were much less tender to pressure. This confirmed that the scar was a source of pain and tension. 

After about five minutes of precise manual therapy designed to soften the scar, the muscle tension melted. Retesting the muscle demonstrated solid strength where there had been weakness. Terry practiced bowing movements as if playing the cello, and was delighted to find her shoulder restored to free, easy motion. Several months later she remains pain free. 

Old Scar, New Pain 

Samantha came to my office for help with hip pain that had begun after using her thighs to help lift a heavy box. She thought the pain might be from a muscle strain from the lifting, but weeks later, was still experiencing weakness and difficulty walking. My practice is focused on finding restrictions in connective tissue (specifically fascia) that can cause muscular imbalance and joint misalignment that result in pain, so I examined her thoroughly for fascia restrictions. Although she had mild inflammation in the painful hip area, there were no significant restrictions. 

However, what Samantha did have was a loss of muscle tone and weakness in her left abdominal muscles. Searching for the source of this weakness, I found a line of tissue tension in her left rib cage, which she informed me was actually the line of a surgical scar. At age two, she had an enormous incision made in the left side of her chest to allow for heart surgery. The scar had remained painful her entire life and was exquisitely tender to even light pressure. Lightly stretching the scar tissue triggered improved tone in the weak abdominal muscle. This suggested the scar was involved with the hip pain. 

The scar was large and could not be completely released in just one treatment, yet the partial release on the first treatment gave her enormous relief of her left hip pain. It had never occurred to her that a scar from early childhood could still affect her decades later. However, the scar had been creating a weakness in her abdominal muscles that made it difficult for her to rebound from a minor injury. Samantha had indeed strained some muscles with her heavy lifting, but the restricted fascia from her old scar had caused continuing stress in the strained area and was not allowing her to heal properly. 

Referred Pain 

Samantha’s story illustrates another potential aspect of pain that can be caused by scars. The pain can “refer” to somewhere distant from the scar, so that it is hard to know where the pain comes from. I see many cases where scars from abdominal surgeries, such as c-sections or appendectomies, cause distortions in the body wide web of fascia which results in hip pain or muscle weakness. This, in turn, can cause sciatica pain or knee pain and become prohibitive to accomplishing daily tasks. 

Sometimes scars can even cause pain to cross to the other side of the body. One example would be an abdominal scar on one side of the body that causes weakness and triggers a twisting of the pelvis. This, in turn, can lead to misalignment or binding of the joints on the opposite side, resulting in low back pain or sciatica. This is why I assess all patients, from head to toe, and take a detailed history of their past injuries and surgeries. It is entirely possible and even common for restrictions in fascia to have absolutely no pain of their own, while causing pain and dysfunction somewhere else in the body. 

Easy Does It 

Restriction in scar tissue is often painful to pressure, but effective fascia release can be gentle. Stiffening of a scar often responds to just ounces of hands-on pressure, restoring the normal softness and pliability to the tissue that allows for proper muscle tone and balance and joint stability. Scars that have been hard and dense for years can often be softened in just one treatment and completely restored to near-normal pliability in just two or three visits. 

Some of the types of scars most likely to trigger pain (even when the scar itself is not painful) are those from the following surgeries: hysterectomy, c-section, hernia repair, hip or knee replacement, spinal fusion or any surgery involving the implantation of hardware. I highly recommend an evaluation for scar tissue restrictions in any case of unexplained chronic pain where there is significant scar tissue not far from the pain area. For many people, releasing scar tissue offers the relief they could not find anywhere else. 

With the COVID-19 crisis, our evening programs have moved online. You are invited to attend a Zoom webinar on August 25, 6:30 p.m. You will learn in-depth about fascia, why it is important, and how fascia problems are resolved with gentle manual therapy. Dr. Eric Winder will discuss case examples and hold a Q&A session following the presentation. Visit GentleBay.com to register for the webinar.