by Eric Winder, D.C.  

Scars are visible reminders of past injuries. Sometimes they also cause problems long after the initial trauma, even if we don’t 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 can lead to muscle imbalance and joint instability, which could then cause pain in nearby muscles and joints.  Fortunately, releasing internal restrictions in scars can provide relief by restoring normal movement to affected fascia.  

New Scar, New Pain 

A patient, whom I will refer to as Terry, is a cello player who asked me to help with a new pain and tension around the right shoulder blade. The pain started after healing from a skin biopsy in the right shoulder blade area, and was constantly irritated by the shoulder movements with her bow while playing. Terry was sure the new scar was the source of pain and tension, but massages on the scar and pain-relief lotion applications had not helped the pain at all. The discomfort increased each week and soon become prohibitive to her playing. 

Upon examining Terry’s scar, I noticed a hard, restricted feeling, compared to the skin around it.  Some muscles between the spine and shoulder blade were abnormally tight, and pressing on them caused Terry to feel sharp discomfort.  When I tested the muscles for strength, they were, in fact, quite weak. After stimulating the scar with precise pressure, I noticed the tight muscles were more relaxed and became much less tender to pressure. This confirmed 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 weak muscles helped restore their solid, normal strength.  Terry practiced bowing movements as if playing the cello, and was relieved to experience a free, easy motion in her shoulder once again. Now she is able to play pain-free.  

Old Scar, New Pain 

Another patient, whom I will refer to as Samantha, came into my office for relief from hip pain that started after she used her thighs to help lift a heavy box. She thought the pain was from a muscle strain from the lifting, but weeks later, she still experienced weakness and difficulty walking.  My practice focuses on restrictions in connective tissue (especially fascia) that cause muscular imbalance and joint misalignment, so I examined her for fascia restrictions. Aside from mild inflammation in the hip area, there were no significant restrictions. 

However, Samantha’s issue seemed to be a loss of muscle tone and weakness in her left abdominal muscles.  Searching for the source of this weakness, I found a line of fascia tension in her left rib cage, which she informed me was 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 extremely tender to even light pressure.   

Testing the scar, I stimulated it with light pressure while retesting the strength of her abdominal muscles. They were much stronger, and movement at her left hip became less painful. The scar was large and, therefore, could not be completely released in just one treatment, but the partial release of the first treatment offered her enormous relief from the left hip pain. Further treatments resolved her pain entirely. 

It never occurred to Samantha that a scar from her early childhood could still affect her decades later. Unbeknownst to her, the scar had been creating a weakness in her abdominal muscles that made it difficult to rebound from a minor injury. She had strained some muscles with her heavy lifting, but the restricted fascia from this old scar 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, making it hard to discern where exactly the pain comes from. I see many cases where scars from abdominal surgeries, such as c-sections or appendectomies, cause distortions in the body’s web of fascia and result in hip muscle weakness.  This, in turn, can cause sciatica or knee pain and, ultimately, become prohibitive to accomplishing even routine daily tasks. 

Sometimes scars can also cause pain to cross over to the other side of the body. One example would be an abdominal scar on one side of the body that causes weakness and activates a twisting of the pelvis. This, in turn, can lead to misalignment or binding of the joints on the opposite side, which results in low back pain or sciatica. This is why I assess all patients, from head to toe, and take an extensive 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. The 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 restored muscle tone, balance and joint stability. Scars that have been hard and dense for years can often be softened in just one treatment, then completely restored to near-normal pliability in two or three visits.  

The 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 operation 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.   

Dr. Eric Winder has been practicing chiropractic for 25 years, with a focus on fascial treatment and soft tissue therapies for the past 22 years. Dr. Winder’s practice focuses on relieving pain and restoring alignment and motion through gentle soft tissue therapies. For more information, call 941-957-8390 or visit GentleBay.com.