Scars with Integrity:

Healing After Surgery and How Massage Can Help

By Erin Vincent

I find that most people coming in for treatment after surgery are surprised at how many different aspects of healing benefit from getting a massage. Physical changes to swelling and scar tissue are notable and fantastic visible outcomes. There are also psychological aspects that are affected by massage. Positive association and the calming of the central nervous system can also play an important role in recovery.

Healing after surgery happens in a progression of overlapping stages. The first stage is inflammation and is often very painful. The area around the incision is flooded with lymphatic fluid which causes pain by putting pressure on the nerves. This fluid is very important though. It provides the area with the building blocks of repair and should infection occur it also generates your immune response.

I use massage at this stage of post-surgical healing to focus on reducing edema and decrease pain, but it also plays a vital role in positive touch and association. This is a time for us to focus on your comfort in a way that is therapeutic but not clinical. Unfortunately, the healing pain of this swelling often gets combined with the previous pain of arthritic joints or disassociation of “bad” body parts in conditions like cancer. Many clients needing joint replacements have spent years in pain and the transition toward trusting a joint for support and movement will take time and conscious effort. After a cancer diagnosis your brain can cut-off the connection to an area of the body but gentle touch helps to stimulate the nerves and reintegrate you with yourself.

The second stage of healing is the proliferation phase. This means that the initial matrix that closed the incision is now being filled by collagen rich fibers produced by fibroblasts. Massage at this stage of scar formation is generally a combination of lymphatic drainage for the edema present and gentle therapeutic massage of the compensatory muscles.

You will know that you are in the third phase, characterized by remodeling, when you are beginning to return to normal movement. If you have had a knee or a hip replacement this means full weight baring activities like walking or climbing stairs. For upper body chest, abdominal, or arm surgery this looks more like lifting weighted objects in front of the body and raising arms up. As you build greater ranges of pain-free movement and strength for larger weights you are also building in your brain an understanding of what is safe.   

You might notice as your joint moves through it’s ranges that it has a ratcheted or clunky passage. This is common when the fibroblasts keep producing an increasingly hard and restrictive scar tissue. It is fueled by sustained inflammation and can be a result of radiation or slow healing. Massage can flush the area and over time soften the fibrosis. Watching for changes to swelling and following up with your therapist is very important as early interventions are often the easiest to resolve.  

Another reason movement might be limited is due to the restrictive nature of newly built scar tissue. The fibers that were important to “close the gap” can work against movement as they might lack the pliability needed or are laid down in a way that places restrictions along the joint. Working with a physiotherapist at this point is highly recommended. They will move your body in ways that bring your joints past what your brain understands is safe in order to break these restrictions.

Massage can also work on the scar tissue and the techniques are often much less painful. Mobilization of the scar is a simple and often self-applied technique that can be taught during a massage appointment. It helps to soften the scar tissue and reintroduce touch to the nerve endings that are regrowing in the area. Overly sensitive or dissociative scar tissue particularly benefits from this treatment.

What produces a scar with integrity? It is simply the normal progression of healing accompanied by appropriate movement. Massage and other therapeutic interventions like physiotherapy and exercise are recommended because they can be helpful to smooth the progression through these stages but much of the progress is done on your own.

By looking at treatment from a lens of recovery you can expect that my goal is to return you to your most functional self. I always look forward to meeting you where you are at and building a plan towards achieving your personal goals of recovery. If you would like more information about how to integrate massage into your healing journey, please visit my website or if you would prefer to talk prior to your appointment you can call and leave a

message at 403-284-1441 or email me at info@prairiespringmassagetherapy.com

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https://hospital.nhsgoldenjubilee.co.uk/application/files/7917/2588/0854/Scar_desensitisation_following_joint_replacement_surgery_v1.pdf

Poetschke J, Gauglitz GG. Treatment of Immature Scars: Evidence-Based Techniques and Treatments. 2020 Dec 8. In: Téot L, Mustoe TA, Middelkoop E, et al., editors. Textbook on Scar Management: State of the Art Management and Emerging Technologies [Internet]. Cham (CH): Springer; 2020. Chapter 22. Available from: https://www.ncbi.nlm.nih.gov/books/NBK586082/ doi: 10.1007/978-3-030-44766-3_22

Guney-Deniz H, Kinikli GI, Aykar S, Sevinc C, Caglar O, Atilla B, Yuksel I. Manual lymphatic drainage and Kinesio taping applications reduce early-stage lower extremity edema and pain following total knee arthroplasty. Physiother Theory Pract. 2023 Aug 3;39(8):1582-1590. doi: 10.1080/09593985.2022.2044422. Epub 2022 Mar 15. PMID: 35291929.