Scar Massage: Evidence, Mechanisms, and Clinical Reasoning

Introduction

Scar work is an increasingly popular area in soft tissue therapy. From post-surgical scars such as C-sections to traumatic injuries, many therapists describe being able to “release” or “soften” scar tissue. But what do these terms actually mean, and what is the realistic mechanism behind the changes clients experience?

To raise standards in practice, we need to move past outdated narratives and ground our explanations in evidence. This article explores the current understanding of scar massage, highlighting what may be happening physiologically and perceptually, and setting a foundation for CPD discussions.

Scar Tissue: The Biological Context

• Composition: Scar tissue is mainly type I and type III collagen, laid down rapidly in a disorganised structure during wound healing.

• Remodelling: Over months to years, collagen undergoes remodelling. With exposure to mechanical load and movement, it becomes more organised, aligned, and pliable.

• Adhesions: Scars can sometimes adhere to underlying fascia, fat, or muscle, limiting movement and altering local mechanics.

Possible Mechanisms of Manual Therapy

Massage cannot “break down” or “dissolve” collagen. However, several plausible mechanisms may explain the changes clients report following scar work:

1. Mechanical Loading & Collagen Alignment

   • Gentle shear and stretch forces may influence fibroblast activity and collagen alignment.

   • This may not remove scar tissue, but could encourage a more functional collagen structure.

2. Viscoelastic & Hydration Effects

   • Pressure and shear can change local fluid dynamics, temporarily improving tissue glide and suppleness.

3. Neural Desensitisation

   • Scars can be hypersensitive due to altered nerve supply or peripheral sensitisation.

   • Gradual, safe touch helps normalise sensory input and reduce discomfort.

4. Restoring Interfascial Mobility

   • Massage may reduce the feeling of “sticking” between the scar and deeper tissues, supporting more efficient movement.

5. Psychological & Perceptual Integration

   • Scars, particularly post-surgical ones like C-sections, can feel alien or disconnected.

   • Gentle, non-threatening touch fosters reconnection, reducing protective tension and improving movement confidence.

What Scar Massage Does Not Do

• It does not mechanically break down scar collagen (too strong for human hands).

• It does not erase scars or physically remove an overhang “shelf.”

• It does not reverse the natural, necessary process of scar formation.

A Modern Narrative for Practice

Rather than saying we “release” or “remove” scars, a more accurate explanation is:

This is clear, client-friendly, and evidence-informed, without overpromising structural change.

CPD & Future Directions: The STARS Framework

Scar work connects into a wider field of continuing professional development. One useful way to think about this is through the STARS framework:

• S – Scars (post-surgical, traumatic, burns)

• T – Trauma (physical and psychological aspects of healing)

• A – Adhesions (fascial restrictions, fibrosis, post-radiation changes)

• R – Restrictions (functional movement limitations)

• S – Sensitivity (neuropathic pain, altered sensation, body schema changes)

This highlights the complexity of scar therapy – it’s not just about the tissue itself, but also neural, functional, and psychosocial dimensions.

Conclusion

Scar massage is best understood as a supportive and symptom-modifying approach, not a method of physically erasing scar tissue. By focusing on mechanisms such as desensitisation, improved mobility, hydration changes, and client reconnection, therapists can provide meaningful benefits while staying within an evidence-based narrative.

This approach raises professional standards, supports client trust, and opens the door to deeper CPD exploration in the STARS domains.

References

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