You cut yourself. You bleed. After a few minutes, the bleeding slows and stops. A day or two later, you notice a brownish scab forms over the wound. After a while, the scab falls off and a smooth, hairless patch appears underneath—a scar is formed.

Chances are you’ve witnessed the life-cycle of a scar on your skin without knowing what was really going on under the surface.

Cuts and surgical wounds separate layers of skin, fat, muscles, tendons, ligaments, and other tissues. To bridge the gap, your body’s myofibroblasts make collagen and knit the edges of your soft tissues together, closing the wound.

This process occurs whether you slice your finger with a paring knife or have joint replacement surgery. Most of the time, these amazing healing cells do their jobs quietly and efficiently as a natural part of healing.

When these repair cells work too hard and produce an abundance of collagen and fibers, they can form ridges, tighten skin, cause pain, or limit movement. This malfunction gives scars a negative reputation.

Are scars permanent?

Yes. The trained eye of your medical provider will always see the marks of surgery or injury on your body.

Fortunately, scars caused by minor cuts, mild cases of acne, and other injuries which disrupt the skin fade over time to become almost invisible.

Your body produces scar tissue inside and out.

You can see the scar develop on your skin, but did you stop to think about scar tissue that forms inside your body?

We know the body needs time to heal after an injury or surgery, but we rarely think of healing as creating a scar—but that’s exactly what happens.

Most of the time, the scar does its job and brings the edges of the skin, muscles, ligaments, tendons, and sheaths together without incident. At other times, the body overreacts and develops too many healing cells.

The overactive response creates raised red areas the length of the wound on the skin’s surface.

The same response can create adhesions inside the body. Adhesions occur when scar tissue attaches to the healthy tissues and organs around the wound. They can be painful and limit movement.

Often medical providers can treat scars that cause pain and block movement to reduce the symptoms—especially when those scars interfere with joint movement.

Physical therapists can help reduce the impact of painful scars.

Scars forming near the joints need special treatment. When injury or surgery affects the layers of skin, subcutaneous fat, muscles, and other connective tissues near a joint, it takes special care to reduce scarring as the body heals.

For some people, this means moving your joint shortly after surgery or injury. Movement helps to prevent scarring by keeping the muscles and other tissues supple, limber, and active. Often, a physical therapist prescribes special movements to target areas susceptible to scarring.

Scar massage therapy is another tool physical therapists use

Massage helps release the fibrous tissue under the skin’s surface. When scars attach to muscles, ligaments, tendons, or bones they block motion. Gentle but targeted massage techniques can break those attachments and allow a greater range of motion.

When working with scarred areas, physical therapists can start massage therapy in the office. They often give patients special instructions and a schedule to follow at home. The coordinated efforts of the physical therapist’s ability and the patient’s follow-through often yield better movement, less pain, and the best results.

When massaging a scar at home, use proper technique and pressure. If you feel intense pain or you notice bleeding, stop massaging the scar and contact your physical therapist.

Painful adhesions may need surgical treatment.

When adhesions occur deep in the body, you may need surgery to relieve the pain and discomfort.

If your pain does not diminish or you feel constriction near your wound or surgical site weeks or months after surgery, you may have overgrown scar tissue.

It’s true that most scar tissue forms immediately after a wound heals. But sometimes a trigger reactivates the body’s healing cells and scar tissue forms months or years after sustaining the original injury. We don’t understand why this happens. Nevertheless, this delayed response can cause painful internal scars.

Adhesions may cause generalized pain or a painful tugging or pulling sensation. Don’t ignore these symptoms.

Contact your medical provider and discuss your healthcare history and its relationship with your current symptoms. Your medical provider will take the next steps to see if there is something else going on inside.

Minimize your risk of scarring

The best way to minimize your risk of scarring is to talk to your healthcare provider before surgery.

Ask about minimally invasive procedures and incision placement. These can proactively minimize the risk of scarring. Talk about ways you can care for yourself after surgery.

Following your healthcare provider’s post-surgical instructions and checking the healing progress may be the best way to minimize your risk of scarring inside and out.

Should you see a doctor for scarring?

If the look of your scar bothers you, or you:

  • experience pain,
  • feel a pulling or tearing sensation,
  • experience tightness near the wound or surgical site that keeps you from normal movement,

contact your healthcare provider for an assessment.

You may be a candidate for scar massage or another medical treatment. You shouldn’t have to suffer from unsightly scars or scars that cause pain and limit mobility.