I’m getting older, aging gracefully and have had many injuries and surgeries due to my athletic background. I’m trying to figure out what best to do to stay somewhat flexible and to stay active. I decided to start with Pilates and do more stretching and yoga.
Fibrosis, also known as fibrotic scarring, is a pathological wound healing in which connective tissue replaces normal parenchymal tissue to the extent that it goes unchecked, leading to considerable tissue remodeling and the formation of permanent scar tissue.
Repeated injuries, chronic inflammation and repair are susceptible to fibrosis, where an accidental excessive accumulation of extracellular matrix components, such as the collagen, is produced by fibroblasts, leading to the formation of a permanent fibrotic scar.
In response to injury, this is called scarring, and if fibrosis arises from a single cell line, this is called a fibroma. Physiologically, fibrosis acts to deposit connective tissue, which can interfere with or totally inhibit the normal architecture and function of the underlying organ or tissue. Fibrosis can be used to describe the pathological state of excess deposition of fibrous tissue, as well as the process of connective tissue deposition in healing. Defined by the pathological accumulation of extracellular matrix (ECM) proteins, fibrosis results in scarring and thickening of the affected tissue — it is in essence an exaggerated wound healing response which interferes with normal organ function.
- Shortness of breath, particularly during exercise.
- Dry, hacking cough.
- Fast, shallow breathing.
- Gradual unintended weight loss.
- Aching joints and muscles.
- Clubbing (widening and rounding) of the tips of the fingers or toes.
Fibrosis is similar to the process of scarring, in that both involve stimulated fibroblasts laying down connective tissue, including collagen and glycosaminoglycans. The process is initiated when immune cells such as macrophages release soluble factors that stimulate fibroblasts. The most well characterized pro-fibrotic mediator is TGF beta, which is released by macrophages as well as any damaged tissue between surfaces called interstitium. Other soluble mediators of fibrosis include CTGF, platelet-derived growth factor (PDGF), and interleukin 10 (IL-10). These initiate signal transduction pathways such as the AKT/mTOR and SMAD pathways that ultimately lead to the proliferation and activation of fibroblasts, which deposit extracellular matrix into the surrounding connective tissue. This process of tissue repair is a complex one, with tight regulation of extracellular matrix (ECM) synthesis and degradation ensuring maintenance of normal tissue architecture. However, the entire process, although necessary, can lead to a progressive irreversible fibrotic response if tissue injury is severe or repetitive, or if the wound healing response itself becomes deregulated.
Fibrosis and the resulting scar tissue happen when an injury doesn’t heal properly. It is a major cause of muscle weakness and a hallmark of aging, severe chronic muscle injuries, and muscular dystrophy diseases. Fibrosis prevents muscle regeneration after injury and increases the risk of re-injury.
Myofascial release (MFR) — MFR is one of the soft tissue mobilization techniques that is primarily used to break up scar tissue in the soft tissue just under your skin. This technique involves slow motions of gentle force in a targeted area to help release tension and break up scar tissue.
Can massage help muscle fibrosis? YES!
Massage is indicated to prevent the onset of fibrosis. As already noted, fibrosis can develop in cases of muscle overuse and postural imbalances.
Massage is therefore used to improve the function of the muscles and to correct imbalances in the postural muscles.
Tightness in the muscles is reduced and by-products of muscle activity removed.
Effleurage and petrissage are used to increase the circulation and to loosen up adhesion’s within muscles.
Passive stretching is also applied to muscles to secure full extensibility.
In the early stages of fibrosis, massage is indicated in an attempt to arrest the tissue changes by improving the local circulation and by stretching.
In chronic fibrosis, massage is indicated to reduce the nodules that are also likely to be present. Deep friction or thumb effleurage are applied to stretch the fibres transversely. Bodywork techniques such as the NMT are also applicable. These are followed by passive stretching.
Massage therapists like myself specialize in many techniques that can help with conditions like the buildup of scar tissue. When it comes to breaking up scar tissue, your massage therapist will carefully assess your condition to come up with a personalized approach for treatment.
- Soft tissue mobilization — Soft tissue mobilization is a hands-on physical therapy technique that involves gently mobilizing and maneuvering your soft tissue into positions that can help break up scar tissue.
- Instrument-assisted soft tissue mobilization (IASTM) — IASTM is a form of soft tissue mobilization that makes the use of stainless steel, ergonomic instruments that can help rub down the site of scar tissue in your body. This can help break up sections of scar tissue that are too difficult to manage with a solely hands-on approach.
- Myofascial release (MFR) — MFR is one of the soft tissue mobilization techniques that is primarily used to break up scar tissue in the soft tissue just under your skin. This technique involves slow motions of gentle force in a targeted area to help release tension and break up scar tissue.
- Stretching — Your physical therapist may guide you through gentle stretches that help improve your flexibility and break up scar tissue.
Is Scar Tissue Permanent?
Scar tissue is not a permanent fixture in the body. After it forms and heals, the scar must remodel. Stretching and pulling the area helps the remodeling process. This stretching allows the collagen to align and return to normal. Remodeling is essential to ensure that your injured tissue regains normal range of motion, strength, and mobility. When scar tissue doesn’t remodel correctly, it can lead to mobility loss and joint contractures (a shortening and tightening of fibers that make movement difficult).
Remodeling is a natural part of the healing process. During remodeling, your body rebuilds the scar so that it becomes stronger and more similar to the tissue that was there before the injury.1 This adjustment is necessary so the new tissue can tolerate the stress and forces that the body typically experiences in a day.
Is scar tissue permanent?
Yes, but the tissue can shrink with proper care. After scars are initially formed and healed (generally 6-8 weeks), the injured tissue begins to repair during the remodeling process (1-2 years).
How can massage help scar tissue?
Deep tissue and sports massages can break down scar tissue after it’s fully healed to reduce pain, increase range of motion, and possibly reduce the appearance.
Using techniques like cross-friction massage can help collagen fibers align properly. Myofascial release can massage the surrounding muscles and underlying tissues.
How often should I get a massage?
Treatments can begin after physician clearance, typically after 2 months. The entire remodeling process can take 12-18 months, and massage can be beneficial during this time. Ideally, 2x massage sessions per week is the most effective.
What if my scar tissue is old?
Massage can help if the tissue is less than 2 years old, before reaching full maturation.
Can stretching help?
Following recovery, long duration and low load stretching can facilitate the remodeling process. Stretching is not recommended immediately following surgery.
What does science say?
A 2020 study in the Journal of Alternative and Complementary Medicine concluded that massage can reduce scar thickness, as well as reduce pain in burn scars (Deflorin et al., 2020). Extracorporeal Shock Wave Therapy (ESWT) and high-intensity light therapy were also helpful for pain management and scar reduction.
When getting a massage focused on scar tissue remodeling (this can be incorporated into a regular session), let your therapist know how far along you are in the healing process.
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*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. The information provided is for educational purposes only and is not intended as a diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.