Scar tissue sounds like one of those things that you can do very little about. But actually it is a little more complex than that!
Scar tissue is laid down in the key ‘proliferative’ phase of healing and then remodels during the maturation phase of healing. If you want to read more on this, read my blog ‘How do you heal after invasive surgery?’ http://www.injuredathlete.co.uk/how-do-you-heal-after-invasive-surgery/
This image is my simple visualisation of the haphazard scar tissue on the left, and then how it settles into the correct structure after remodelling on the right. This gives a sense of why the scar tissue feels tight, solid and lacks the usual movement and elasticity of the remodelled tissue on the right.
But not everyone lays down scar tissue in the same way!
It transpires that different people lay down scar tissue in different ways, and therefore can get more complications from the adhesions and slower remodelling.
How can you know if you are one of those people?
It is probably difficult to know, if you have never had any surgery before, but a couple of signs that would be worth looking at are:
- Do you still have lots of scars from cuts and grazes from your childhood? Or have these faded away now?
- When you have had cuts or grazes over the last few years, has the mark (both in texture and colouring) lingered for a year or more?
- And if you have had surgery, did the scar fade to an almost invisible light white line within 6 months or linger on?
If you are on the longer ranges, you could be someone who lays down stickier scar tissue and takes longer for it to remodel into the usual tissue, with usual movement and function.
What can you do about this before surgery?
If you already suspect this before your surgery, do talk over with the surgeon your previous healing and the types of movement and sport that you want to be able to return to. The choices that they make can really change your scar tissue – and counterintuitively, sometimes a larger scar can mean less scar tissue.
And if you are having keyhole (or arthroscopic) surgery, so not underestimate the scar tissue. If you can imagine, it is like a sticky rope of scar tissue that goes from the point of entry to the point of surgery. And that can be quite a distance. In areas like the hop there are lots of different muscles, tendons, ligaments and bone for it to stick to and in the abdomen there are also organs.
Straight after the surgery
As soon as the surgery is complete, the surgeon and physiotherapists will often get you moving through as much of the range of movement as you can. This is to gently tear the sticky scar tissue off things that it should not be sticking to and is especially important with joint mobility.
As soon as the wound has sealed up, there are four things that you can do to help the scar tissue to start to remodel:
- Massage it for 5 minutes at a time, using your finger tips and moving in all directions with as much pressure as feels comfortable. Remember that the surgery will have cut through 7 different layers of tissue and they each need to remodel.
- Rub in some Vitamin-E based oil, such as Bio Oil to help the process
- Protect it with a high factor sun protection cream if you are going out in sunshine, as it will burn really easily and this will damage the healing (as well as discolouring it)
- Keep drinking lots of water and eating a good high protein diet, so that there is lots of collagen for the body to call on. There are mixed views on whether a collagen supplement help, or whether a diet with things like oily fish and chicken broth are sufficient.
Through the next phases of healing, gentle movement through the range of movement (with no weight or resistance) will be key in order to get the sticky fibres to only stick in the right place! If you start to get into a lot of pain, you should be:
- Talking with your physiotherapist and surgeon about the risk of unwanted adhesions and sharing what pain you have at different parts of the range of movement.
- Showing them your scar – especially if you feel that it is too raised up from the surface of the skin, or too indented.
Best of luck – do not be despondent if you are someone who lays down scar tissue differently. The body is an amazing thing, and it will do the remodelling. It may just take a little more time, and that may mean a longer recovery phase for you and sadly more pain for a while, plus needing to keep focusing on range of movement for a little longer before you progress back to your activities and sports.