On Scar Tissue

While I do believe the best way to learn how to work with scar tissue is to have someone show you how to do it, perhaps something written will indicate the path well enough for some of you become curious and start experimenting.

Some orientation might be useful, so I will start with the story of the first scar.

It was 1973 when, Hector Prestera, MD and I moved from living in a wonderful hand made wooden house on the Hudson’s mountain 1500 feet above Esalen into Carmel Valley. We wanted to live as close as we could to our dear friends at Esalen and still be near a decent school Hector’s two young boys. Esalen did not have a school until several years later when the director Dick Price had a daughter. Dick then realized the lack and Esalen’s own Gazebo school was created.

Hector is a fine physician, board certified in internal medicine and cardiology. He was also trained as a Rolfer by Dr. Rolf, and he studied Acupuncture with Jack Worsley and many others. He treated many of his medical patients in Monterey with acupuncture and Rolfing with quite good success. Lucky for us Hector started his medical career in Monterey reading EKG’s at the hospital. The other doctors got to know him and got to see how very competent he was and they voted him hospital privileges. A doctor without hospital privileges is not allowed inside the hospital to treat his patient. This makes him rather useless when his patient ends up in the ER. This is the way doctors have a good old boy club that unofficially polices their ranks for the unconventional. Hector said that If the other doctors had known he was planning on treating his patients with Rolfing or acupuncture, most likely they would have voted no for his hospital privileges. Rolfing and Acupuncture were exceedingly unconventional in 1973.

We bought into a new medical building in the planning stages to be built in downtown Monterey. I got to work with the architect to redesign our medical suite with health in mind.

Ours was the only office out of the eight suites in this new state of the art medical building where all the windows opened and had screens. The lights were full spectrum. We had large plants in most of the rooms which did splendidly because of the lighting. The carpets were natural wool to avoid chemical off-gassing and they had extra anti-fatigue padding. We had extra sound insulation in the walls for privacy which worked so well we later had to install an intercom for patents to call us if they needed something. With the addition of a sliding glass door, a very large planter outside of Hector’s personal office became a private walled outdoor patio. Two black iron chairs and a small table made the patio a very good place to relax outside for lunch and breaks. One treatment room was designed for the future installation of one of John Lilly’s Isolation Tanks. The Tank room was the largest treatment room and was big enough to do Rolfing in. We even installed a shower so Hector could freshen up after a long day’s work before going out to dinner. We had a huge supply closet with an autoclave to sterilize the acupuncture needles and other instruments. The three exam room tables were finely crafted in wood with steps up and drawers with dovetail corners with a beautiful natural dark wood finish. They were made for Hector by a grateful master carpenter who’s wife Hector had helped. At the carpenter’s suggestion, I had the tables upholstered with real rubber padding with matching back supports and knee bolsters. All of our little old ladies would remark that they were more comfortable at our office than at home.

For about a year and a half I ran the office, doing all of the reception, appointments and charts, taxes, insurance claims work, and dealing with the drug company representatives. I learned a lot. I also maintained a Rolfing practice and was taking care of Hector’s two boys who were 5 and 7 years . After everything at the office was running well, and we were making good money, we hired some medical staff. I am amused to say that It took five people to replace me; A nurse to follow Hector around and keep him supplied, a book keeper who also did the insurance work, a tax accountant, a nurse receptionist, and a janitor.

The nurse who took over reception in the front office was the person who had the first scar I worked on. She became curious about Rolfing and decided to try it. She both liked the work and was in an educated position to appreciate what Rolfing was doing for her. We did a ten session series at our office using the Tank Room.

She had been the driver in a car accident where the car had rolled over about six times. She was not wearing a seat belt and was thrown part way out of the window of the driver’s side. As the car rolled, it caught her legs just above the knees and broke both her femurs. The worst trouble was on her right leg where the break had been close to the knee. She could not fold her knee to 90 degrees so she could not sit for long without pain. By noon every day she was on pain killers and muscle relaxants. Her doctors had done five surgeries using the same scar through her right fascia lata to try to make it so her knee would fold again. They had even trimmed the top of the fibula off to make room for it to fold but with no luck. The last surgery had been about 15 years earlier. Her doctors told her she was about as good as they were going to get.

When I got to the third session, I was supposed to create a “mid-line of the sides”. I did OK for her left side and then started on her right. I found that I just could not get her right knee to move straight forward and straight back because that scar was so stuck down it would not let her knee track properly.

This scar was about 8 inches long and with a deep wide square edged groove wide enough and deep enough that I could almost hide my first finger out of sight in the groove. For an inch and a half around the scar, the discolored red-brown tissues were plastered to the bone with leathery, ropey ridges and strings. It looked shiny and felt stiff and hard and very uneven with lumps and holes everywhere. There were large areas of numbness and loss of sensation around the scar.

I remembered asking Dr. Rolf about scars. Her advice was to ignore them and establish the function anyway.

I had done everything I could think of and ignoring this scar wasn’t working out. I had the thought that if I could ease the rigidity of the tissues around that scar perhaps that would help. So I asked my lady if it was OK to work on her scar. She had no problem with the idea, and I set about working on it.

Since I had never seen Dr. Rolf or anyone else work on a scar, I let my fingers just go and do whatever they wanted, and after about ten minutes of work, I stopped to get a good look at what I had done. Where I had worked, the deep groove had completely filled in and smoothed out all nice and even feeling. All of the ridges and lumps and holes had disappeared. Except for a white line, it now looked pretty much the same color as the rest of her. Where I had not worked was just the same as before.

I had her sit up and look her scar over because I could not believe it. We both agreed that neither of us had any idea that it was possible to change scar tissue like that. Then we joked that we’d better not tell anyone because no one would believe us.

As I went back to work on the rest of the scar, I had a moment of panic as I realized that I did not clearly remember all the things I had done to get such a dramatic change. I was afraid I would not be able to repeat what I had done and would be unable to match the scar up. It was an interesting split of consciousness as I let my fingers fly again, only this time I was also watching what they did. I was able to get the same result for the second half of her scar.

When the scar was finished her right knee tracked properly, and with the slack I gained, I was able to get to the fibula. I unstuck her fibula and rolled it out of the middle of the joint at the back of the knee to where it belonged on the side of the knee and then she could fold her knee very close to full range again with no pain. One surprising result was that all of her lost nerve sensation areas became fully functional again. There were no more areas of numbness and diminished sensation around the scar. All of this occurred within this single session.

At the end of the ten series she was free from pain and off of all of her daily pain medications and muscle relaxants Without her pain, she was able to let her naturally sunny disposition shine. She became a warm and friendly and cheerful. The most perfect person for our front office.

From this initial discovery, I became interested in scars and began to work on them in the course of Rolfing. I have discovered was that scar tissue quality changes quickly and easily. Lumps, gaps, ridges, holes, bumps, knots, and strings in the tissue all smooth out. The amount of change in one intervention is extensive. Between 15 to 30 minutes of work can make a few week old scar look and feel like it is years old. Very often work on a scar contributes significantly to whole body release and integration. Historical memories and emotions are often recalled. The improvements are permanent with scars continuing to improve rapidly for some time after a session. Although the techniques are a bit different from Rolfing, like speaking a different language ( thank you for this insight Caroline Widmer), the guiding working principles are quite similar to those of Rolfing.

One question that comes up is how soon it is safe to work on a new scar. Scars that have been there awhile are fair game. It is just for brand new scars that you need to consider when it is safe to work. One thing that you don’t have to factor into your decision of when to work is being afraid of causing too much discomfort. Scar work is not painful even for new scars.

I prefer the scar to be closed over as I am the most concerned about avoiding introducing infection. The tissue should be thick enough to withstand moderate pressure and stretching without splitting open. Gloves would be necessary to work any sooner, but wearing gloves for scar work does not work as well for me as waiting a few more days. I don’t sense as well through the gloves and have not had the need or the patience to learn.

From a structural perspective, there should be no sense of urgency about working with a scar right after surgery. No matter when you start, the work seems get to the same place in the end. There is no loss of end results. However, there is the consideration of the probable benefit of the work shortening the duration of pain and suffering.

For new clients, liability, and absolute safety, I might want to wait until the doctor will prescribe regular massage before starting work on a scar.

For family, and for dear friends, who are in pain and out of spirits, I will do mercy rescue work asap. It does feel good at heart to be able do something to improve their situation and scar work usually helps the pain and restores soothing order and function to a traumatized system. Work on the scar seems to speed the healing for awhile right after the work.

For me, asap is as soon as the scar is healed over enough to be dry, and thick skinned enough to take some light pressure. I find that starting with delicate light work on the surface for a few minutes produces a better quality of tissue. This better quality tissue can then take stronger and more casual pressure and you can go on and work with good results.

For the less experienced scar worker, waiting a little longer – another week or so – to start work on family and dear friends might be a good comfort and safety margin.

Scar work fits seamlessly into a standard ten series or advanced series. Some of the factors in deciding how to work with a scar are; where it is, how extensive it is, how much it impacts the rest of the structure, if it has an emotional history, and how well it responds to work.

You may add the scar work into the session whose line it most affects. An example, scars from facial plastic surgery may be worked on in session 7, or a C-section in session 5.

Some scars do well with shorter amounts of work over several sessions. This way you give time a chance to aid the situation. For example, you could do small amounts of work on a badly adhered appendix scar in session 1, 3,5, 8 &9 and 10, and you could work on a big toe bunion surgical scar in 2, 4, 6 the lower of 8 & 9, and 10.

Some scars are slight and only require a few minutes work, while at the other end of the spectrum, the more involved, larger scars may take a up to an hour and may have whole body releases with their associated historical emotional content. These more significant scars may deserve the larger integration of a session.

Scar tissue work sensation levels are generally very mild. Most folks say it feels in the range of 3 to 5 on a scale of 1 to 10. My Rolfing is higher for sensation level… mostly between 4 and 7.

There is never a scar that is exactly like another…each scar is unique. Typing and generalization for the sake of shortcuts or formulaic learning is a waste of time.

Attitudes towards scars are interesting. Scars are not generally loved by their recipients. Many people seem to have an aversion to their own scars. Some have not touched their scar since their surgery and have no idea what it feels like. This probably is some form of denial. I almost always have folks feel a scar before I change it so they can appreciate the change.

When I inquire about scars at first, many folks don’t give me much information. Instead, they say diverting things like.. that was a long time ago. I like to hear the story. I inquire for two reasons. It can help the physical release when they express themselves about it, and hearing the story of the scar helps me to figure it out.

Unresolved history and emotion often become conscious with work around scars. While some of this is rather hair-raisingly intense, thank heavens I have never had anyone re-live their surgical procedures. Folks will describe everything they were conscious for —right up to the anesthesia. What happens during the surgery under anesthesia never has come up in a session. Except for every now and again I do hear about a most intriguing journey of the spirit. I do hear lots and lots about the recovery process; the stitches coming out and the good luck and the bad luck of the healing process, and how they can tell that the weather is changing.

I think of reverse engineering the scar. The surgical report which details what was done for that particular surgery is somewhat useful. Some general knowledge of common surgical procedures is good to acquire. Videos of surgeries are available to see in medical school libraries and on the web.

Extreme positions that patients are sometimes put in for the convenience for the surgeon can be a part of their structural troubles afterwards. Deep surgical cuts allow for things to slide further away from each other than was possible in their connected state. Things get stuck where I would have never imagined it possible. Following scars has led me into finding some fascinating surgically related structural distortions

Scar work usually progresses from the surface all the way into the interior far reaches of the surgery including the internal organs. If I don’t resolve the adhesion from the scar, I can’t have optimal placement or function in any involved internal organ.

One of the more interesting aspects of scar work is observing the whole body changes that can result from it. Because of the possibility of whole body changes scar work is best received by people who are being Rolfed. However, most scar work does not need a whole session to integrate what is released. It is usually enough to do back work, neck work and pelvic lift for balance. This allows for the use of scar work outside a Rolfing series as a “stand alone intervention” with good success.

I don’t think of scar tissue as stuff to break up or material to get rid of. I think scars are made up of the valuable stuff you want to liberate to become vital tissue again. If feels like you use all of it to the good with nothing left over when you are done.

Techniques

There are many different techniques that change scar tissue. Each technique looks and feels different from the others and work a little differently. The names that we are using are in-house and still changing as we come up with amusing names that stick. Here is a list of techniques:

“The Eraser” — for this one I mostly use my index finger. I hold my finger curled with the tip pointing down and brace the first finger from the palmer side with my thumb. I often brace from the dorsal side with the middle finger. There is some squeezing in the bracing. Staying at the same depth in the scar, I rub with the finger tip forward and back with a motion similar to using an art eraser. I use my other hand to stabilize the surrounding tissues. Erasers can be made with the medial edge of the thumb braced by the first and second fingers. For a large area, sometimes I use my three middle fingers with the thumb and little finger squeezing to brace. I use the heel of my hand as an eraser on large, rough textured burns.

“Scraping” — this consists of bracing by pushing away from the scar with one hand, while using a clawing motion with my index finger through the tissue into the gap. I pick up and do this again in the same direction rather than flip back through the tissue to the starting place. On the larger scale, for example, on a long and large hip replacement scar I use all my fingers at the same time. I usually scrape both sides to the middle to fill in scar gap. I use all my fingers for scraping forwards and backwards for some cross fiber work in some of the more ragged “natural” scars- a little like using a brush with a arcing lifting motion.

“Filling In” — is good for gaps and holes. Using one hand to hold and stretch the area some so you have something to pull against, work all around a hole or gap sweeping the tissue into the area. One finger starts and before the first is finished the second starts over and over. I Use two, three or four fingers one after the other in sequence. It looks a little like “drumming the fingers” I have found that if the hole is due to the loss of tissue, this does not fill in very well. It seems you need all the pieces to really complete the job and if something large enough is gone, the hole won’t fill in.

“Drawing” — This has some of the look of scraping, but instead of pushing the tissue ahead of your finger, it is pulled along deep behind the finger. I don’t do much bracing with this as I want the pressure to run deep. It is kind of like using the trailing wake of a boat to work with. I used this recently on a table saw cut into the tips last three fingers. I ran up the cuts, from the palm side to the end of the finger, the opposite way from the saw blade went. At the same time I was lifting and hooking the tissues straight back into the spin of the blade, drawing wake off the nail side of my finger. I don’t have a big version of this one.

“The Sewing Machine” (zig zag) — this one works well for little tiny striations left within wide, white part of the scar. These are possibly generated by the stitches as the scar pulls apart. The striations feel a little like tiny splinters embedded in the scar and usually go crosswise to the long cut. I hold my stabilizing hand in the area to be worked using a spanning, spreading motion with the thumb an fingers while I move with a superficial fast zig zag motion through the surface of the scar with the grain of these splinter like scars. I brace the index finger squeezing with the thumb on the thumb side and the third finger on the other side.

“Dropping” — can be done on a small scale and on a large scale. Small scale is with a finger tip into a piled up scar. Relaxing the hand and arm, The finger drops into the tissue just to the depth of working… and takes a little of the scar down. This is done over and over in the scar, taking it on down until the scar is smooth. I don’t use any bracing with the other hand. On the large scale it can be done with the whole hand to break those odd adhesions resulting from an over expansion. The too soft poofy feel to abdominal tissue after pregnancy that won’t go away with exercise or anything else… or the strain left from the swelling from an infection. Whole hand dropping will also release a pattern of stuck in over-expansion like a drowning episode where the diaphragm is bulging out with the strain of not breathing. Shayna Alexander, a Structural Integrator from Israel who also teaches Karate agrees with me that dropping has something in common with Karate’s soft break.

“Skidding” — takes a whole plane of tissue and repositions it. Sometimes in surgery, the doctors take a large “flap” of skin and fold it back. When this large piece of tissue comes back into contact with what it was severed from—it adheres— usually slightly out of place. I use a flat contact as much as I can of the whole surface involved, push down to the depth of the scar and skid sideways in the direction of the most resistance. The whole sheet comes loose at once and will reposition. I use the palmer surface of both hands sometimes with a touch of torque. When the sheet hits home, I moush it a bit to set it in.

“Moushing” — this one works well for a deep ragged scar. I compress the tissue from above so the torn edges meet up and then smush and mush the edges together, fitting and tucking… It looks somewhat like wiggling under pressure. I will brace into my own pressure from the other side if I am not using both hands and if I can reach that far.

“Compression” — consists of pushing things back together both large and small scale. I usually use flat fingers or flat hands with quite a bit of force. It has the feel of gathering things together towards each other… of fitting parts together. I usually do it with both hands at the same time from complimentary angles. I usually find many compressions from many angles effective. In surgeries sometimes tissues retracted and held with quite a bit of force over a long time. Compression will release the surgery retraction pattern.

“Rolling” — on the small scale, this is a pinch and shear motion with thumb and first finger, or the first two fingers. The shear or roll is done within the limits of the tissue, gradually increasing the range of the shear as the tissue lets go. I have used this for ear piercings that were badly done, a dog bite on the lip or on scar on the ends of the fingers. For anything larger, one hand on top and the other from the bottom I use for things the size of fingers and forearms. The larger size body area limits the use of this one for me.

“Combing” — is good for long strands along the edges of long scars. On a long cut, there is retraction over time. The longer the time before closing… the longer the surgery takes, the more distinct both edges of the scar become. I usually brace a section of scar stretched between thumb and fingers with one hand and and with an thumb or finger edge sometimes backed closely by a nail for a little stiffness I use long sweeps up and down along the fibers along the direction they run with the idea of separating out the strands, like combing. Sometimes it feel a little like scrubbing for the some of shorter strands. I put quite a bit of tension on some of these edges with both the bracing hand and the combing hand.

“Knitting” or “Matching Layers” — both small and large scale — Knitting uses a flat contact. On the small scale, two flat index fingers with most of the pressure in the distal section of the finger. Put one finger down flat on either side of the scar parallel to the scar. Push down until contact is made. Wiggle forward and back in the horizontal plane, one had going forward, the other back as well as up and down looking to match the layers, combined with pushing together with some torque. When a match is made the layer feels like it disappears and I pick up the next layer to work. I work through the layers in the scar. This meshes the layers in c- sections together and bridges big gaps. It can be done with the whole hand as well for big scars. With the whole hand, I sometimes use a touch of torque to aid in the meshing. Impaired nerve function often resolves in the course of using this one.

Burns

Burns have their own requirements and seem to be among the more difficult scars to restore.

Burns from fire are the most common, often with large areas of damage. If the healing of a large burn is not carefully managed there can be extensive scaring. Burns seem to heal quite slowly, leaving time for further damage and infection which makes the surface rough, often crisscrossed with raggedy strands. The hollows are delicate and seem to damage especially easily.

Irradiated tissue is one of the most difficult burns to restore. (From x-rays or other high energy sources like synchrotrons, cyclotrons, or linear accelerators) These burns seem to lack the long fibers we rely on for directional vector. Their thick denseness is probably a form of atrophy.. and can feel like leather. Sometimes they feel like some of the surface fat cells have “melted” leaving the deeper granular layer exposed. If the tissue gets a high radiation overdose, it can get puffy, fragile and subtly weepy for many years after the radiation.

I don’t have very much experience with electricity burns; the couple of linemen I worked with who got shocked and lived both had fine ripples and ridges in the gumline. The one person I worked on who got hit by lightning also had ripples in the gum line. None of these folks had any burn marks —entry or exit— to work with.

Most burns will respond to short applications of fingertip Scraping and Dropping. The motions are often extra small and light and short until some resiliency is established. The Eraser works for some of the surface crosshatching, and roughness. Drawing and Sweeping over the surface for smoothing with fingers or a broad flat hand surface seems to work reasonably well.

Overall I do not get the same level of resolution from burns that I do from other kinds of scar work. Burns take more time for work. They often have profound emotional residue. They probably do best with many moderate interventions over time.

Plastic Surgery

Plastic surgery has its own unique considerations.

Plastic surgeons will bevel the edges of cut before stitching, which gives a cleaner join, but with tissue trimmed away, the resolution is not going to have the feel of “home and done” that other scars that are not trimmed will have.

Plastic surgeons are better at matching internal layers and they use more internal dissolving stitches. I look for places where stitches can leave odd little knots through the tissue.

Plastic surgeons match up the cut edges of an incision more evenly with less excess tissue to “tuck” in at end of the scar. The usual procedure of stitching a scar is to start at one end and go to the other. This often leaves extra tissue to deal with. Devices like medallions are used to take up the extra tissues from joining the two unavoidably mismatched edges of a tummy tuck. Medallions look like a circle an inch or two in diameter with the tucks done around them. These medallions are sometimes surgically removed at a later date.

Plastic surgeons mostly do their cuts with one hand, which means the arcs they cut are not a mirror image from side to side. Using only one hand to cut with creates an interesting asymmetry to be aware of and to work with.

The long arcing cuts of plastic surgery at the hairline may be helped by scraping a shallow plane along the line of the cut with the little finger edge of the hand or the first finger side. Bracing the tissue behind the scraping with the opposite hand helps. Running a ripple ahead of a flat surface through the flat scar, like running a wrinkle through the carpet to reposition it, can also help. Huge stiff areas like tummy tucks where the whole top sheet of abdominal tissue is cut loose and pulled down like a window shade and reattached are helped by whole hand dropping. I drop in to where the layers are joined and then sometimes I will using a little moushing to reconnect the top layer to the layers below so it feels soft and bouncy like a tummy again.

Sometimes there are mistakes that end up as knotted up places. Often at the eye corners you find a piled up hard knot that feels like it was perhaps improperly stitched together. Plastic surgeons will schedule another surgery to take care of these knots. Dropping is particularly effective for reducing these knots and flattening the tissue out again.

Some general things to keep in mind while working.

  • Assess locally and whole body results with vision and touch before, during and after working
  • Use “seeing” and feeling for the entry into the scar — over and over
  • Work with what is easy and obvious — over and over
  • Find the directional vector of the tissue and follow the directional vector as the tissue changes
  • Determine the optimum rate of speed of the tissue change
  • Work from the surface layers down
  • Figuring out where the structure has gone is most of the work— but If I haven’t a clue I just start working… sometimes I find out what the problem was after it releases
  • Ask your client for movement when you think it will help
  • Integrate the release from the scar into the whole structure.

I don’t imagine I have figured out all the ways of working scar tissue. I do hope some of you will come up with more and send word.  

Read 294956 times