From the moment we come into this world and encounter a scratch, a cut, or anything really that will inflict some letting of blood and a mark to remind us of what occurred there in that spot, we start our life with scars.

I am so amazed when my daughter, who is 9 years old, can recount a lot of the scars that she has received over her short life. Even the faintest of marks on her body, she can recall where she got it from and what event had taken place to create that mark on her body.

Why Are Scars Important?

Scars can mark time, they are reminders of what once was or maybe what could have been or even what was lost.

Our bodies do a remarkable job of helping us to remember what once was.

I sometimes like to refer to my scars as battle wounds, but that may be too harsh to see the body as a battleground. For some scars that I have seen as a physical therapist, they can almost be akin to a battleground.

The scars that I received over the last few years were a testament to how I saw my body in the past, it was something to battle over and to bring into submission and for it to do my bidding, I guess you know who eventually won.

Either way, my scars help me remember who I was at a time when there was so much uncertainty and vulnerability as well as excitement.

Types of Scars

I write this blog to not just discuss surgical scars, but the myriad of scars we all face on the regular:

burn scars, cuts, scrapes, abrasions, surgeries, treatments, biopsies, catheter insertions, port placement, tattoos, piercings, c-section, hysterectomy, laparotomy, laparoscopy, and emotional scars which can probably leave the biggest wound.

What is a Scar?

So, let’s begin!

What is a scar and why does it leave such an indelible mark on us? A scar is essentially a disordered collection of collagen fibers that are laid down in the presence of an open wound.

It is the formation of scar tissue that helps to ensure that the wound stays closed and is one of the essential parts of the healing process. Depending on the type of wound that was created will also depend on the type of scar that will form.

A tattoo for example creates tiny wounds that are made with the needle gun and that scab over to eventually form a very cool image on one’s skin.

However, it is not just the layer of dermis and epidermis that is affected when getting the tattoo. In some cases, when the tattoo is placed over a bony prominence, such as the sacrum for example, that can also create some level of tissue damage for the collagen fibers that cover the bone and thus create adhesions.

The Impact of C-sections Scars on the Body

If a tattoo, a scarring that a person wants, can potentially create some level of adhesion within the various layers of tissue what happens with an unwanted scar?

Glad you asked!

Essentially the same thing, but to a greater extent especially if it is surgical scar such as from an old appendectomy or freshly cut c-section.

In a research article, they state that “scars affect soft tissue in all its layers from the skin to the subcutaneous tissues, the superficial and deep fascias, the muscles, and even the tissues of the abdominal cavity.”

Essentially a c-section scar does have a big implication affecting many of the tissues in the abdominal cavity. Because the uterus is a fairly thick muscle, when doing a c-section scar massage, it has to impact not just the superficial layer of tissue such as the skin but also make an impact on the muscle layer of the uterus as well.

When there are adhesions present from the forming of scar tissue around the uterus, it does not just affect the uterus, but can also affect the functioning of the bladder as well.

The various layers of connective tissue that ensure the bladder and uterus maintain its current position are also affected and will greatly limit the mobility of the organs themselves and they do need to move for them to function optimally.

How Surgical Scars Affect Pelvic Mobility and Health

When I am doing visceral mobilization on a patient who has complaints of urinary incontinence or even constipation, the lack of mobility in the lower pelvic cavity can usually help me conclude that the scarring present from a previous surgery is the cause. When the scar isn’t moving well, the underlying structures will not move as well either.

There are the seen scars as well as the unseen physical scars and one that can have a big impact are cervical biopsy scars.

When one gets a LEEP (loop electrosurgical excision procedure), there is a removal of a portion of the cervix where there is potentially abnormal growth where it is biopsied to ensure that it is not cervical cancer, a cancer that is very treatable when caught early.

This is a very life-saving and at times necessary procedure, but the consequences that can occur afterward are not really discussed much by doctors nor are the effects from it seen until much later such as when trying to either conceive or birth a baby vaginally.

The os or the opening of the cervix needs to be able to dilate or widen during childbirth. The scarring that can be present on the os may delay the thinning and effacement that needs to occur as part of labor and at times can be the cause for a stalled labor.

The Connection Between Physical and Emotional Scars

Our physical scars also lend a hand to our emotional scars as well. The scar that one may have received after a traumatic motor vehicle accident and all of the subsequent surgeries and treatments one needs to do to recover from the injuries leave a toll on one’s body. I would also put this under the category of unseen scars.

Seeing or touching a scar can bring you back to that place where the traumatic event or the loss happened and rip open an unseen wound that is much harder to heal from.

However, because our bodies are so deeply connected with our minds and are not separate entities but a full and complete package when addressing any emotional component, it is always helpful to bring the physical component into the picture as well.

In another study, it was stated that “scar tissue is associated with physical wounds and their mending, but it is also descriptive in portraying the emotional scarring that occurs following adversity, resulting in potential psychological morbidity.”

No matter the scar, big or small, insignificant or extreme, they all hold some level of significance in one’s history.

How To Heal Your Scars

Understanding just how significant scars can be and the story that they tell, and learning how to tend to them is just as important. When working with patients who might have worked with a pelvic PT in the past and had their symptoms resolved but end up coming back with the same symptoms sometimes the result of it was because of the scar. I mention to them that caring and tending to their scar is and will be a lifelong practice for them.

Scars do not go away and will always be a part of you, so you might as well learn how to take care of it! Here are five ways that you can tend to your scar:

1. Touching the scar daily -

   This does not necessarily need to be a hard task if you are showering or lotioning up, putting your fingers and running them over the scar while applying soap or lotion is one way of regularly encouraging mobility of the scar and helping with nerve regeneration especially if there is nerve damage or sensitivity present

2. Avoid tight or constricting clothing over the scar -

   This might already be a given for those who already find sensitivity or discomfort, but having constant pressure placed over a scar can greatly limit the level of circulation and mobility in that area.

3. It may also contribute to feelings of itchiness, tenderness, or restricted feeling of the scar

4. Using silicone strips on scar tissue -

   They have been proven to be very effective in the healing of scars and also in reducing the look and appearance of scars, especially for keloid scars which are more raised and can create more discomfort.

   They should only be used on closed wounds and can be effective for any size scar. Supposedly they can help with reducing tension around the scar, preventing more collagen fibers from forming (which is what causes more thickness around the scar), and decreasing circulation as well (which also promotes more collagen production).

5. Massage the scar -

   This is one of my favorite things to teach patients is how to massage and mobilize their scar. There can be a lot of fear in touching it and I want to dispel that fear that touching and moving your scar regularly after it has fully healed is important and can be very nourishing for your body as a whole.

   If you go on YouTube, there are lots of videos that will describe how to massage a scar, especially ones for doing a c-section scar massage. If you need guidance, definitely follow along but one of the big no-nos for me when massaging is to avoid pulling or tugging at the scar like you are trying to flatten it out.

   I like to use the analogy of a necklace.

   When there is a knot in the necklace, you don’t want to pull at the ends as that will just make the knot even tighter and hard to unfurl. Ideally, you want to bring the ends of the necklace closer to the center or midline and that will allow for more softening and a better opportunity to unknot the necklace. The same applies here with scars.

   I have seen wonders occur when allowing for this natural unfurling rather than pulling and forcing. The story and the trauma that is embedded in the scar should also follow a natural and gradual unfurling as well.

   When we can lovingly approach our scars in this way, it allows for the healing of the body to follow the healing of the mind.

6. Movement is everything! -

   I am a physical therapist and movement is my jam.

   If you have read anything so far about scars, especially its effect on the several layers of tissue and the abdominal layer, you should know that when there is a big scar, like a c-section scar, it can inhibit things like hip extension, thoracic rotation and even muscle activation.

   The movement does not need to be big. Things like gentle yoga, stretching or mobility work around the area can all be beneficial. Even something as simple as mindful walking and ensuring good even movement with each step are all opportunities for mobilizing the scar.

   Good luck with your scar and may it provide you with lots of opportunities for learning about yourself and your body!

1.https://www.sciencedirect.com/science/article/abs/pii/S0161475404000995

2.https://pubmed.ncbi.nlm.nih.gov/26631526/#:~:text=Scar%20tissue%20is%20associated%20with,resulting%20in%20potential%20psychological%20morbidity.