Active Scars – An often overlooked pain source

Classic article by Karel Lewit on scars as a pain generator.  Whether from a traumatic cut, post surgical or even and old adhesion from a blunt force trauma, painful non-functional tissue can have adverse effects on movement and coordination.

Most often this presentation is post surgical, I tend to see it most relevant in abdominal surgery, sometimes years afterward.  Often the patient is referred in for  lower back, pelvic or hip pain, but after a careful history and examination, we can find an active painful scar, especially during abdominal muscle activation and breathing evaluation.  When we start to activate the abdominal cylinder, especially in cases where there is very poor torso stability, the pain can expose itself. A sharp stabbing pain is a strong inhibitor for optimal muscle activation.  In cases of lower back/pelvic/hip pain with no apparent cause, but onset several months after a painful recovery from abdominal surgery, this presentation is more relevant, the abdominal cylinder shut down, and the surrounding joint structures began to suffer.

The solution is gentle manual therapy, typically more lifting and rolling movements then working more into range of motion restrictions.  The restriction can extend beyond the superficial scar and treatment can sometimes take an indirect route, almost an unwinding effect like working knots out of a ball of string.  We then retest muscle activation quality, range of motion and reaction time to see if the exercises are working better now.

On occasion I have used kinesiology taping to help allow exercise without scar pain, I usually take a strip of tape, break in the middle and use as a support strip to take the tension off the painful scar, so as the skin moves, the scar is supported. This wont fix the problem, but will allow the patient to start strengthening while the scar is mobilized and desensitized.

The active scar phenomenon can present in any part of the body, post surgical, laceration or other trauma.  It can undermine an otherwise excellent treatment plan, so requires us to be vigilant when evaluating issues holding back progress during case management.

Full Free Freaking Text link for case report by Kobesova  and Lewit


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