Scars & Mobility: How Scarring Affects Training and Exercise

When injured tissue heals, it can leave a scar. In some cases, the scar is visible on the outside of the body. (The scar on your knee from falling off your bike as a child is an example of an external scar.) Other times, the tissue that is damaged is internal. This can leave a scar on the inside of the body. Although you can’t see this type of scar, it is still there.

Both types of scar tissue formation are part of the natural healing process. It’s how the body repairs damaged tissue. But sometimes a scar can hinder mobility. Understanding how this happens—and ways to correct it—is important for fitness professionals.

The Connection Between Scars and Mobility

When soft tissue is damaged, the body releases collagen. Collagen is a protein that supports the structure and function of healthy tissue. We have collagen in our skin, bones, and other connective tissue. It also aids in wound healing, rebuilding, and strengthening the injured area.

Because scar tissue is stronger and thicker than normal skin or soft tissue, it tends to be less flexible. If the scar is big enough or in the right place, this inflexibility can limit mobility. A scar can also reduce mobility through adhesion. It can become “stuck” to nearby tissue. This can make it more difficult to move.

To be clear, not every type of scar will limit mobility. If you have a scar from acne or chicken pox, for instance, it’s not likely to restrict your movement. These are referred to as depressed scars. But other types of scars may. 

Both a keloid scar and hypertrophic scar form when there’s too much collagen produced at the site of the wound. This causes the tissue to thicken and raise. It can also cause the tissue to tighten. If either type of scar tissue is near a joint, it might make it harder to move. A burn scar can also limit movement.

What Causes Scar Tissue to Form?

Scar formation is generally the result of one of two things. It is usually either from an injury or surgery.

Cutting your finger while chopping vegetables is an example of an injury that may leave a scar. Or maybe you were playing sports and suffered an open fracture. In an open fracture, the bone sticks out from the skin. This type of injury could leave a scar as well.

The scar you have from rotator cuff surgery, which you may have had to help correct shoulder pain, is an example of a postsurgical scar. So too is the scar on your stomach from having your appendix out.

Abdominal surgeries are incredibly notorious for leaving an internal surgical scar. Roughly 93%of people having abdominal surgery develop an abdominal adhesion (1). This can lead to pain and trouble moving.

Signs a Scar May Be Limiting Mobility

How do you know whether scar tissue may be causing your client range of motion or movement issues? Signs to ask about include:

• Chronic pain at the site of the injury or surgery, long after it should have healed

• Pain or discomfort around the scar area (or area of injury) during movement

• Inability to achieve full range of motion in that area

Can Exercise Reduce Scar Adhesion and Limitations?

Research suggests that exercise can help reduce limitations caused by scars. For instance, one study involved 66 patients with burn scars (2). Some received conventional therapy (pressure garments and silicone). The rest engaged in exercise and physical therapy. After 20 months, the exercise and physical therapy group had better range of motion. This is critical as scar formation is a common complication of burn healing, often leading to functional issues.

Another study set out to find what type of exercise helps most (3). This one also involved burn patients. All did stretching as part of their workout program. Some also engaged in high-intensity aerobic and resistance exercises. After six weeks, the patients engaging in high-intensity exercise had greater improvements in strength, fitness, and function. They also reported a higher quality of life.

Stretching exercises can help by elongating the scar tissue. This improves flexibility and range of motion. Perform stretches slowly and hold them long enough to lengthen the affected tissue. The stretches that work best will depend on where the scar tissue is located. (Select stretches that target the scar area.)

A physical therapist can help determine which movements to do. And always get approval from the client’s health provider first. This helps ensure that the exercise is safe given their injury or type of scar. It also decreases the likelihood that the workout will interfere with any other type of therapy being received.

Additional Ways to Help Scare Tissue Release

There are a few other ways to help reduce movement issues from scar tissue. Here are four to consider.

Physical Therapy

Physical therapy aids in scar management and helps functional movement. A physical therapist knows which moves are better for healing certain injuries. They also know when and how to advance these movements so that healing continues to progress. 

If your client’s scar is a result of a recent injury or surgery, they may already be in physical therapy. If not, you may want to suggest this as a route to take. For insurance to cover it, they may need a referral from their healthcare provider.

Massage Therapy

Massage is another remedy good for people with scar tissue. Some therapy providers even issue a scar tissue massage.

A scar massage, also called a scar mobilization massage, works by breaking up or stretching the scar tissue. This option may be better suited for people who’ve had a scar for a long time. (As opposed to physical therapy which is more common with fresh injuries.)

Instrument-Assisted Soft Tissue Mobilization (IASTM)

This scar tissue treatment involves using a special instrument to work on the damaged tissue. It’s like a massage, but a tool is used to better reach the soft tissue. 

This technique may be used by a physical therapist. Sports medicine professionals and some chiropractors offer IASTM as well.

Laser Therapy

Laser therapy helps with scar management in a few different ways. For instance, it can help improve collagen production. This form of therapy also helps reduce scar thickness by creating holes or tunnels in the current scar. Both can make it easier to move while reducing pain. 

Research supports the use of low-level laser therapy for scar management (4). However, the American Academy of Dermatology Association stresses that this isn’t a magic solution (5). This therapy can’t remove the scar completed. Treatment effects also depend on the therapy provider and your adherence to the treatment plan.

The Bottom Line 

Diagnosing and treating injuries is outside a personal trainer’s scope of practice. However, you can help clients understand that their mobility issues may be scar related. Working with their health provider and physical therapist can help resolve or reduce issues.

If you have clients with any type of movement limitations, corrective exercise may help. Become a Certified Corrective Exercise Specialist to learn how to create workouts that help restore structure and function. This course also teaches you how to assess and correct common joint restrictions.

References

1. 4 Best Ways to Take Control of Abdominal Adhesions. Cleveland Clinic. (2020). Retrieved 24 August 2022, from https://health.clevelandclinic.org/4-best-ways-to-take-control-of-abdominal-adhesions/.

2. Karimi, H., Mobayen, M., & Alijanpour, A. (2013). Management of Hypertrophic Burn Scar: A Comparison between the Efficacy of Exercise-Physiotherapy and Pressure Garment-Silicone on Hypertrophic Scar. Asian Journal of Sports Medicine, 4(1), 70–75. https://doi.org/10.5812/asjsm.34536

3. Paratz, Jennifer D. PhD; Stockton, Kellie BPhty; Plaza, Anita BPhty (Hons); Muller, Michael MMedSc; Boots, Robert J. PhD. Intensive exercise after thermal injury improves physical, functional, and psychological outcomes. Journal of Trauma and Acute Care Surgery: July 2012 - Volume 73 - Issue 1 - p 186-194 doi: 10.1097/TA.0b013e31824baa52

4. Freitas, C. P., Melo, C., Alexandrino, A. M., & Noites, A. (2013). Efficacy of low-level laser therapy on scar tissue. Journal of Cosmetic and Laser Therapy: Official Publication of the European Society for Laser Dermatology, 15(3), 171–176. https://doi.org/10.3109/14764172.2013.769272

5. 10 things to know before having laser treatment for your scar. Aad.org. (2017). Retrieved 24 August 2022, from https://www.aad.org/public/cosmetic/scars-stretch-marks/laser-treatment-scar.