Safety / Injuries
What Your Clients’ Scars Tell You About Their Pain
What you don’t know about your clients’ past injuries could be turning your workouts into torture sessions (and ending client relationships)...
When you assess a new client, do you make note of any scars?
Do you ask clients how they got the scars?
Do you follow up with questions about the injury that caused the scar…and how it affects them in their day-to-day life?
If you don’t ask about clients’ scars, are you setting them up for “renewed” injuries and more pain?
Don’t assume that scars don’t matter, or that the injuries are too old to make a difference now.
Scars tell a story.
No matter how old they are, scars impact how your client moves and feels pain.
Scars even affect distant parts of the body, hampering movement and causing pain in seemingly unrelated areas.
Remodeling and fascia - here’s why you need to add those 2 terms to your vocab STAT.
A scar is how skin repairs itself after an injury. You already know that.
But did you know that a scar represents the last stage of healing, called remodeling?
Remodeling is a process that can go on for years, changing the composition of the skin and the fascia underneath it.
Wait, what’s fascia?
The fascia is like the body’s cellophane casing that connects nerves like telephone wires throughout the body.
It’s connective tissue, made up of collagen, that underlies all skin. It surrounds and compartmentalizes every single muscle, bone, and organ in the body. While the fascia serves to separates these components, it also connects them. It allows communication between our body parts via the sympathetic nervous system.
As scars form and change over the years, the collagen in this connective fascia becomes stronger, and it loses elasticity.
The result is like a telephone wire gone hard and brittle. Signals can’t get through in the same way. Its flexibility is all but gone.
So scars impact movement and lessen nerve signals to other parts of the body. A “call” that used to get through clearly is now transmitted with static, muddying the message.
Old scars. New scars. They all impact how you train your clients.
Can scars from past injuries or surgeries really affect other parts of the body?
They can. And they do.
Scars affect the nervous system, muscles, and bones. And because these are all connected by the fascia and nerves, a scar can cause pain or restricted movement far from that site of the original injury.
Here’s what happens:
- The fascia connects everything in the body and transmits signals from one area to another through nerve cells.
- Nerve cells in the skin relay messages to the fascia below it.
- This in turn sends those messages - often of pain - to muscles, bones, or connective tissue in other parts of the body.
- Sites away from the scar can actually feel pain triggered at the site of the scar.
A physiological alteration, like a scar, to any part of the body can affect anything covered by the connective sheet that is fascia.
The nervous system receives signals to protect the site of the scar, and a new dysfunctional pattern begins to form that builds on that dysfunction over time.
Even years after an injury or surgery, a scar can change and contribute to dysfunction and pain.
An elbow scar can be a literal pain in the neck.
And a scar near the stomach can make you walk funny.
Here’s the science to prove it.
Who would have thought that a scar from elbow surgery could cause neck pain?
In a study reported in the Journal of Multidisciplinary Healthcare, researchers Bordoni and Zanier looked at several case studies of people who suffered pain, discomfort, or restricted movement because of scars.
The fascia beneath the scar on an elbow is connected to the brachial fascia, which connects to the fascia of the deltoids, the pectorals, and then on to the fascia of the neck.
Elbow scars have been shown to cause neck pain in patients. They have also caused postural problems, which impacts walking gait, and may cause even more pain in the neck and the back.
In another example in the same study, abdominal scars were shown to manifest as a dysfunctional gait.
See, the fascia of the abdomen connects to muscles that are important for a proper walking gait, like the adductor longus muscles. These muscles help distribute load when you take steps.
Abdominal scars can disrupt the regular signals between the fascia and these muscles, the effect being an improper gait.
It’s not just walking that is affected by this.
Running and common strength training moves, like lunges, can be impacted, leading to poor form, pain, and even injury.
Identify scars, and develop appropriate exercises to reduce or minimize pain. Work on form and ensure your clients are doing exercises correctly.
You don't have to be a doctor to connect the dots between scars and pain.
As a trainer, you know you have a responsibility to your clients. You respect that. So, for their best results - to minimize pain and to prevent injuries - make sure you take note of scars and what injury or surgery caused them.
Here are 5 clever action steps you should take from client intake through to training.
1. Get the story behind the scar
It’s not just the scar itself that may cause your client discomfort. Whatever caused the scar may also be affecting her. So get the 411 on what has happened to your client in the past so you have a complete idea of everything that could be affecting her movement and her workout plan.
2. Teat the body as a system
The body is a system of many parts working together, connected by the fascia. Starting at the site of the scar, consider how it impacts movements in other parts of the body. Also include the client’s regular habits and how these will affect your training plan. Ask these important questions:
- What do you do on a daily basis? A lot of sitting... or a lot of standing?
- Are you right or left side dominant when you move? (Ask and then watch.)
- Do you experience any pain with X movement? Y movement? Z movement?
Your powers of observation go a long way here. Note anRevy limited range of motion when you’re training your client, and then ask to hear the story behind that limited range.
3. Consider age and healing time
Over time, flexibility can significantly decrease because of past injuries. Keep this in mind when training older clients who have a past injury and scar that has not healed appropriately. It could have created a dysfunctional pattern of movement over time.
- Ask your client questions about how old the injury or scar is.
- Ask whether any pain or restricted movement from it has gotten worse with time.
- Develop alternative exercises that will help your client rebuild from a dysfunctional pattern of movement to one that is more functional and pain-free.
4. When in doubt, refer out
Again, you’re not a doctor and you want to be careful not to mistreat or misguide your clients.
If you have a client with dysfunction, pain, or restricted movement from an injury or scar, and if they can’t do your exercises, recommend another professional with the appropriate skill set. This could be a doctor, a chiropractor, or a physical therapist.
5. Reevaluate regularly
Don’t think that the initial assessment is where it ends. Throughout a fitness program you should be checking in with your client to find out if she is experiencing improvements or any additional pain or dysfunctional movement patterns. Adjust the program as necessary.
Scars are more complicated than you ever imagined.
Make scar stories a part of your regular assessment so you can provide the best fitness plans and avoid - or improve on - the pain and restricted movement your clients have from old injuries.
What’s your scar story? Have you had any of these experiences with your clients? Or maybe with your own injuries?
Do tell us about it in the comments below!
Bordoni, Bruno. Zanier, Emiliano. “Skin, fascias, and scars: symptoms and systemic connections.” Journal of Multidisciplinary Healthcare 20, 4:7 (2013): p. 11-24
Schleip, Robert., Divo, Muller. “ Training principles for fascial connective tissues: Scientific foundation and suggested practical applications.” Journal of Bodywork and Movement Therapies.” 17.1 (2013) p 103-115
Ogawa, Rei., Okai, Kazuhisa., Tokumura, Fumio., Kazuyuki., Mori., Ohmori, Yasutaka, Ohmori., Huang., Chenyu, Hyakusoku, Hiko., Akaishi, Satoshi. “The relationship between skin stretching/contraction and pathologic scarring: The important role of mechanical forces in keloid generation.” The International Journal of Tissue Repair and Regeneration 20.2 (2012): p. 149-157