Surgery is a hugely traumatic experience for the body regardless of its purpose. The surgeon is cutting through many layers of tissue including skin, fat, fascia, blood vessels, nerve endings, muscles and sometimes organs. After the procedure is completed the surgeon closes the incision and monitors for healing and infection. Post-surgery follow up is usually concerned with complications from the procedure.
The problem is that the complications don’t stop there. It’s clear that declaring a patient healthy post surgery is the priority, but once that’s done there are other non-surgical aggravations that can arise.
As an incision starts to heal there are many stages that the wound goes through. Blood flow increases to the area, bringing with it cells that destroy any infection. There is more oxygen. Lymph flow increases, helping to remove inflamed or injured tissue. The sight of the incision may feel itchy as the new skin cells regenerate. The presence of bruising is more physical evidence of the trauma, which can be as emotionally challenging as well as physically.
When the incision goes through fascia and muscle that’s where a lot of post-surgery pain and debilitation can come from. Muscle cells don’t regenerate so when they tear or are cut through the muscle is left shorter, greatly impacting range of motion (ROM).
Fascia is an in-elastic tissue that envelops most internal structures. When tissues are cut the body heals itself by placing down layer upon layer of fascia/scar tissue in all directions, leading to a spider-web of adhesions. As the incision heals, tissues from surrounding structures along the fascial chain are pulled towards to scar. Since fascia is all encompassing to the body, this can cause pain locally as well as distally.
This is where massage therapy can be helpful. Myofascial techniques are used to break up these fascial adhesions, helping the scar tissue to align itself with the muscle, bringing you back into optimal ROM. Administering fascial techniques can range from uncomfortable to painful, so having an open dialogue with your therapist will help keep you within a healthy range.
The optimal window for beginning to treat scar tissue is as early as 3-4 weeks post surgery. Attempting too soon can cause re-opening of the incision, although gentle movement is advised as soon as the surgery is complete.
Failure to address scar tissue can result in chronic pain and reduced ROM. As tissues continue to be pulled towards the scar, permanent changes can happen to your posture, your gait and your ability to use your body to its fullest ability.