Scar tissue formation is a natural part of the body’s healing process after an injury. While scars are permanent, there are some non-surgical ways to help break up or soften scar tissue and improve range of motion and flexibility.
What is scar tissue?
Scar tissue forms when the body repairs damaged or injured skin and other tissues. It is made up of dense, fibrous collagen deposits laid down where the tissue is damaged. Over time, scar tissue can tighten and harden, causing restricted movement and pain.
There are several types of scars:
- Hypertrophic scars – Thick, raised scars that remain within the boundaries of the injury
- Keloid scars – Scars that grow beyond the original wound size, often becoming larger than the initial injury
- Contracture scars – Scars that pull together and shorten the skin, limiting range of motion
Scar tissue most often forms after injuries like burns, cuts, surgeries, or sometimes acne. Areas that commonly develop noticeable scar tissue include:
- Shoulders
- Knees
- Elbows
- Wrists
- Ankles
- Hips
- Back
- Face
- Abdomen (after surgery)
Can you break up scar tissue without surgery?
There are non-surgical techniques that may help soften or break down scar tissue over time. While results vary by individual, these methods may improve flexibility and range of motion to some degree without surgery:
- Massage – Helps align new collagen fibers and break down bands of rigid tissue.
- Stretching exercises – Gentle, gradual stretching can help loosen scar tissue over time.
- Physical therapy – Specific exercises and modalities like ultrasound or electrical stimulation targeting the scar tissue.
- Silicone sheets/gel – Worn over scars, helps hydrate and soften them.
- Compression – Special garments worn to help decrease scar thickness.
- Injections – Steroid injections into the scar may help soften and flatten thick scars.
While these non-surgical techniques may provide some improvement, those with severe, debilitating scar tissue may require surgery to achieve significant increases in mobility and function. Procedures like scar tissue excision and tissue expansion can remove and release contracted bands of scar tissue.
Massage techniques for scar tissue
Massage is one of the most effective non-invasive ways to break down scar tissue over time. It helps realign collagen fibers and prevent rigid, inflexible scarring. Key massage techniques include:
- Cross-fiber friction massage – Applying pressure across (perpendicular to) the scar line helps break up fibers.
- Compression – Pressing down on the scar mobilizes tissues.
- Kneading – Lifting and squeezing scarred skin mobilizes deeper tissues.
- Myofascial release – Gentle sustained pressure releases fascial restriction.
Tips for self-massaging scar tissue:
- Use vitamin E oil, aloe vera gel, or moisturizer to allow hands to glide over skin.
- Work across and along the scar line using moderate pressure.
- Start gently and increase pressure as scar tissue loosens over time.
- Massage 2-3 times per day for at least a few minutes each time.
- Never massage to the point of pain or excess redness/swelling.
It’s important to consult your doctor before massaging recent wounds or surgery scars. Once healed, they can help determine safe massage techniques for your specific scar.
Stretching exercises for scar tissue
Gentle stretching is another non-invasive way to help relax and loosen scar tissue over time. Stretches should be held for at least 30 seconds, and repeated 5-10 times per session. It’s best to stretch after warming up the area with heat or massage.
Examples of simple stretches for common scar locations:
| Body Part | Stretching Exercises |
|---|---|
| Shoulders | Shoulder rolls, shoulder circles, cross-body arm swings |
| Elbows | Gently straightening and bending elbows, forearm rotations |
| Wrists | Gently bending wrists up/down and in circles |
| Hips | Knee to chest pulls, knee rotations, sumo squats |
| Knees | Heel slides, calf stretches, quad stretches, kneeling hip flexor stretch |
| Ankles | Ankle rotations, calf stretches, towel stretches |
The key is starting very gently and progressively increasing stretch intensity over time. Stretches should not cause pain. Work closely with a physical therapist to develop a customized stretching program for your scar tissue.
Physical therapy treatment for scar tissue
Physical therapists are movement experts who can provide specialized non-surgical scar mobilization techniques and exercises. PT scar tissue treatment may involve:
- Massage – Using medical massage techniques like myofascial release, transverse friction, stripping to loosen tissues.
- Mobilizations – Gently moving the affected joints through range of motion to stretch scar tissue.
- Stretching – Designing a progressive stretching program to loosen scar tissue.
- Exercises – Targeted strengthening and flexibility exercises around the joint to improve mobility.
- Modalities – Ultrasound, electrical stimulation, heat/cold therapy help relax muscles and loosen contractures.
- Splinting or taping – Gentle splints or tape applied to constantly stretch and mobilize scar tissue.
A physical therapist can design a customized treatment plan using the most effective techniques to improve your specific scar mobility issues. PT is often covered by health insurance when prescribed by a doctor.
Silicone sheets and gels for scar treatment
Silicone is considered the gold standard non-invasive scar treatment. Both silicone gel sheets and topical silicone gels can hydrate, soften, flatten and smooth scar tissue when used consistently over time. Silicone works by:
- Hydrating the scar – Prevents excess collagen buildup
- Decreasing inflammation
- Helping realign collagen matrix
- Reducing itching and discomfort
Silicone sheets are thin, flexible sheeting that adheres directly over a scar. Topical silicone gels are rubbed directly into the scar. Silicone therapy should be used for 12-24 hours per day for at least 2-3 months to see results.
Tips for using silicone scar therapy
- Begin use once wound is fully closed without drainage/oozing.
- Cleanse and thoroughly dry skin before application.
- Massage a thin layer of gel into the scar.
- Use sheets or gel consistently every day.
- Smooth any wrinkles in the sheet to maximize contact with the scar.
- Secure sheets with medical tape if needed.
- Reapply gel 2-3 times per day; replace sheets every 1-2 days.
- Use for at least 12 weeks to see results.
Both silicone gel sheets and topical gels are available over-the-counter. Silicone therapy is considered very safe with minimal side effects like mild skin irritation. It can be used alone or along with other scar treatments like massage.
Compression for scar tissue management
Compression garments and bandages apply gentle, constant pressure over scars. This can help:
- Decrease scar thickness and soften scar tissue
- Flatten and smooth raised scars
- Reduce collagen production and realign fibers
- Manage swelling and enhance circulation
Compression is often used after burn injuries and surgery to control scarring. Treatment should begin once the wound is fully closed and no longer draining. The amount of compression used depends on the location – 15-25 mmHg is often recommended for extremity scars. Ensure proper fit to avoid restricting blood flow.
Compression garments should be worn as much as possible, at least 12-24 hours per day, for many months. They can be used alone or along with other scar therapies like massage and silicone.
Types of compression garments for scars
- Wraps and bandages – Self-adherent or elastic wraps for extremities like wrists and ankles.
- Stockings – Knee-high or thigh-high compression stockings.
- Sleeves – Arm or leg compression sleeves.
- Face masks – Custom-fit fabric masks to flatten facial scars.
- Pressure garments – Full body suits with custom pressure for extensive scarring like after burns.
Work closely with your doctor to determine the right level of compression and garment for your needs. Precise measurement and proper application are important for best scar management results.
Steroid injections for scar tissue
Corticosteroid injections may help soften and flatten hypertrophic and keloid scars. The steroids help decrease collagen production and immune response in the scar tissue. Steroid injections work best on raised scars less than 5-6 months old. Results are temporary – repeat injections are often needed.
The procedure is done in a doctor’s office and involves:
- Cleaning the skin over the scar
- Injecting a small amount of steroid solution into the scar tissue with a thin needle
- Applying pressure to prevent bleeding and leakage
- Bandaging the area
Potential side effects include pain, skin discoloration, weakening of tissues, and thinning of the skin. Doctors often limit the number of steroid injections due to risks with repeated use. Other options like silicone gel or surgical scar revision may be considered if repeated injections are needed.
Risks and precautions with steroid injections
- Should not be used on infected or open wounds
- Increased risk of skin changes like atrophy and depigmentation
- Can delay wound healing if done too early
- Not ideal for very large or thick scars
- Repeat injections may cause tissue damage or thinning of the skin
Talk to your doctor about whether steroid injections are appropriate for your type of scar. Used judiciously along with other treatments, they can help flatten and soften scar tissue without surgery.
When to consider scar revision surgery
For some individuals with severe, disabling scars, non-surgical treatments may not provide sufficient improvement in mobility and function. Surgical scar revision may be an option in cases where:
- Scar tissue is restricting joint movement or causing chronic pain.
- Non-surgical treatments have been tried for 6-12 months without significant improvement.
- The scar is very thick, raised, or covers a large surface area.
- Facial scars are causing functional problems like restricted mouth opening.
Scar revision techniques like Z-plasty, W-plasty, and tissue expansion resuture or reposition the scar into a different orientation that releases contractures to improve mobility and reduce pulling on the skin. Other options include surgical excision of the scar or laser resurfacing.
It’s ideal to start scar revision within 6-12 months for optimal results. The procedure is done under local or general anesthesia. Recovery time varies based on the extent of the revision. Physical therapy is often needed after surgery to maintain mobility gains.
Benefits of scar revision surgery
- Significantly improve range of motion and function
- Release contractures from scar tissue
- Reshape or flatten thick, raised scars
- Improve scar appearance by reorienting its position
- Reduce pain caused by scar tissue
- Permanently remove problematic scar tissue
For those with severe, limiting scars, surgery when done properly by an experienced surgeon can greatly restore mobility and improve quality of life.
Prevention tips to minimize scar tissue
While scarring to some degree is inevitable with most wounds, there are things you can do help optimize healing and reduce excessive scar tissue formation:
- Proper wound care – Keep the area clean and moisturized to prevent dehydration and minimize irritation.
- Silicone gel/sheets – Use routinely starting 2-4 weeks after stitches are out to hydrate and flatten the scar.
- Sun protection – Prevent UV exposure to reduce pigmentation and inflammation.
- Massage – Gently massage the wound 2-3 weeks after stitches are removed.
- No smoking – Smoking impairs circulation needed for optimal healing.
- Balanced diet – Eat a diet rich in vitamin C and zinc to support collagen synthesis.
- Compression – Use compression wraps or garments to help align collagen fibers.
While most scars cannot be completely eliminated, early intervention can help optimize the healing response and reduce their appearance and impact on function.
Conclusion
Scar tissue can form after any wound as part of the natural healing process. While scars cannot be removed completely, non-surgical treatments like massage, stretching, silicone sheets, steroid injections and compression garments can help improve flexibility and range of motion by breaking up fibrotic bands.
However, those with severe functional limitations from scarring may require surgical scar revision for substantial improvements. A combination approach using non-invasive techniques and good scar care can often help minimize the impact of scarring without the need for surgery.
Working closely with your doctor and therapists can help determine the optimal scar treatment plan for your individual needs and goals. Consistency and patience are key, as it often takes months of diligent effort to achieve measurable results in scar mobility and function without surgery.
