Painful scars? Yes, you can do something about it!



I can’t help it. Every time I think scar, I think… Scar (and yes, I used to have a much better picture of Scar from The Lion King for you…but I had to remove it in my attempt to make sure I’m not violating anyone’s copyright laws!)  I was going to try to think of some funny way to explain why scars and Scar are the same… but I can’t… I relate it to the 50,000 times I have watched The Lion King... so I’ll leave it at that.

Scars can be a big pain though– literally! I have treated women who even after several years cannot tolerate pressure on a c-section scar. Men who have nice huge abdominal scars that ultimately contribute to problems with constipation. And moms who have discomfort near their perineal tears every time they have sexual intercourse.  The truth is that scar tissue is often something skilled physical therapists will evaluate and treat as part of a comprehensive program in men and women with pelvic floor dysfunction(and really, with any type of problem!). And the best part– treating scar tissue can make HUGE differences!

So, what is a scar? 

When there is an initial injury (and yes, a surgical incision is an “injury”), the body goes through three phases of healing: Inflamation, Proliferation and Remodeling. Through this process, the body creates scarring to close up the initial injury. Scars are composed of a fibrous protein (collagen) which is the same type of tissue that is in the tissue the body is repairing (i.e. skin, etc).  The difference, however, is that scars are not quite organized the same way as the tissues they replace, and they don’t really do the job quite as well. (i.e. scars are much more permeable to UV rays than skin is). Scars can form in all tissues of the body– even the heart forms scar tissue after someone has a heart attack (myocardial infarction).

How do scars lead to problems? 

After the inflammation and proliferation stage of healing, comes the remodeling. This stage can take months to years! During this time, the body is slowly adapting and changing the scar to the stresses on the tissue. Have you ever noticed that some scars initially are pink and raised and then over time become light/white and flat? That’s remodeling.  Ultimately, there are a few major reasons why a person might develop pain from a scar:

  • Adhesions: Scars are not super selective when it comes to tissues they adhere to. So, sometimes, scars will adhere to lots of tissues around them and this pull can lead to discomfort.
  • Sensitivity: Scars can become very sensitive for a variety of reasons. Sometimes, small nerves can be pulled on by the scar which can lead to irritation. Other times, people themselves will have a significant amount of fear related to the scar. This fear, can often make people avoid touching the scar, and that, along with what we know about how our brain processes fear and pain (See this post, this one, and this one), can lead to a brain that is veeerrrryyy sensitive to the scar. Along with this, muscles near scars can become tender and sensitive. This can occur due to the scar pulling on the muscle or due to the sensitive nerves in the area.
  • Weakness/Poor Muscle firing: So, we know that when our tissues are cut, the muscles around the tissues are inhibited (have you ever seen someone after a knee replacement? It can be quite a bit of work to get those muscles to fire immediately after surgery). That’s why it’s important to get the right muscles firing and moving once a person is safely healed. Moving the right muscles improves blood flow too which promotes healing.
  • Changing Movement: Painful scarring can lead to altered movement. We can especially see this with postural changes after c-sections or other abdominal surgeries, but movement patterns can change with scars all around the body. We also know that abnormal movement patterns over time can lead to dysfunction and pain.


What can we do about it? 

There are several ways physical therapists can help decrease pain from scars. Can we actually break-up/melt/eliminate scar tissue? I don’t really think so– honestly, scars are made from strong material and truly breaking up the scar is typically something that has to be done surgically– but most of the time, that is not necessary. We can decrease pain from scars by:

  • Improving the mobility of the scar: Gentle techniques to massage the scar and the tissues around the scar can facilitate blood flow to the area and decrease some of the pulling on the tissues around it. There is a thought as well that scar tissue massage can disrupt the fibrotic tissue and improve pliability of the scar (basically, help the scar organize itself a little better, and ultimately move better), and help to promote decreased adhesions of the scar to the tissues around it. Unfortunately, there really is not a lot of great research out there about scar tissue massage. However, this review published in 2012 found that 90% of people with post-surgical scars who were treated by scar massage saw an improvement in either the appearance of the scar or their overall function–which is very promising!
  • Desensitizing the scar and the nervous system: This is where I think we can make huge changes–both by improving someone’s worries/fears about the scar (calming the nervous system) and by slowly desensitizing the scar and the skin around the scar to touch. This is a slow process, but over time, many people who initially can barely tolerate pressure on the scar can be able to easily touch and move the scar without discomfort.
  • Promoting movement: So, we talked about how muscles can become inhibited or tender after a surgery? Part of improving scar tissue related pain is helping the muscles around the scar move well and learn to fire again. This can include some soft tissue treatment to the muscles to reduce the tenderness of the muscles, but ultimately leads to learning to use the muscles again in a variety of movement patterns. Movement is amazing for the body and can not only improve blood flow, but decrease pain too!

Wanna learn more? 

Several of my colleagues have written wonderful information about scar tissue! Check out this great, article and free handout by Kathe Wallace, PT on abdominal scar massage! My colleagues at the Pelvic Health and Rehabilitation Center have also written a few blogs on scars, which you can find here and here.

Have a great rest of your week!

~ Jessica

12 thoughts on “Painful scars? Yes, you can do something about it!

  1. Hi I have a question for you about a scar on my foot. So back in 2007 I had a bunion fused. I had no issues with the scar. Everything healed it was great. Pain was resolved in my foot for years. Then in August I was diagnosed with a stress fracture caused by a screw left in my fission. A surprise to me I had no idea this could be a problem the original dr removed the screw. Cut out the old scar and now I have a new one that dimples and hurts like a son of a ***** when I go to move it. I am 8 weeks post op and i did a lot of scar massage and stretching. I have had a cortisone shot in my foot. I am a very active person, I hike and bike ride and snow shoe and I can’t hardly put shoes on right now. I came a crossed your post. Any thoughts?

    1. Hi Ashley, I apologize for my slow response. That must be so stressful! Have you worked with a PT to help with your scar? There are lots of options you could try with a PT, like manual treatment, dry needling, and other interventions. It may be worth seeking out an evaluation. I hope that helps! ~ Jessica

  2. Hi Ashley,I have almost the same problem,mine is a full fusion of the left big toe,I’ve had 3 operations cutting the same scar,it’s now very sore and tender although it’s 4 years since the last operation,I was recently advised to use lidocain patches which can be cut to size and shape ,they do work and ease the pain by about 90%, unfortunately there is no remedy for getting rid of the pain completely without having to use something,is a patch of painkillers.I hope this is of some use.

  3. I have the same issue except mine is not from a bunion it’s from a cut along the top of my foot which runs from below my toe to near my ankle. The cut healed but now whenever I move my foot or flex it the scar stretches and it hurts. I’m a very active person so when I’m doing burpees or planks I can even feel the pain through my work out and shoes! I am hoping this will go away but now it seems it may not after reading several posts about scars on the foot. The scar is red and a little raised as it’s still somewhat new but right now I’m using silicone strips in hopes it will fade away. Any comments to help would be great.

    1. Hi Melissa! I’m sorry your scar has been bothering you. Have you seen a physical therapist yet to help? There are many interventions which can help improve the mobility of the scar as well as the joint and tissues around the scar. My specialty is pelvic health, but for a bunion scar, I would recommend a good orthopedic PT. You may just need a few sessions to get some strategies you can use to help this improve! All my best, Jessica

  4. Hi, I have a scar from an operation from 1 year and 2 months ago. The scar is still sensitive under pressure. Do you think that the sensitivity can still go away on it’s own?
    Thank you for your answer.

    1. Hi there! The sensitivity could absolutely improve. You could try some of what’s mentioned in this blog, then if it still is sensitive, consider seeing someone for an in person evaluation to see if that can help.

  5. Hi there!! I have a scar in a really private part of my body from a perianal abcess surgery. It’s very close to my anus. It rubs my thighs and hurt often. I don’t know what to do about it. It’s very painful.

    1. I’m sorry you’re dealing with that, and even more sorry for not responding previously! I would recommend seeing a pelvic floor PT who can evaluate the scar and help you begin to desensitize and improve mobility around the scar. These areas are so private for sure, but know that we (pelvic PTs) work with these types of things all the time, and would be happy to see you!

  6. Hi! I have had 2 surgeries on my wrist. One was to fix a fracture and insert plate and screws, the other was to remove the hardware. During the second operation, the dr found a neuroma, cauterized it and buried it into a hole in the bone. I also had a tendon partially cut to help straighten my fingers. I have pain or discomfort at the crease of the wrist by the scar. I am nervous it’s another neuroma but the dr said that would be very rare. How do I calm my mind so I’m not hypersensitive to the scar discomfort? It’s 7 weeks since my last procedure. The dr said to have patience and give it time. Any suggestions? I am getting depressed. Thank you in advance!PUDDLES104@AOL.COM

    1. Hi there- I’m sorry for my delayed response. I would encourage you to consider seeing a hand therapist ( usually a physical or occupational therapist) who could help you specifically with this. They should be able to do some treatments to improve the mobility of your scar and help you feel better! I hope it helps! ~ Jessica

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