Adding regular massage sessions to scar recovery can help clients better manage the sometimes troubling side effects of the healing process.
by David Malone, November 1, 2023
A scar is the result of the body’s natural attempt to heal lost or damaged skin and is usually composed of fibrous tissue. Scars represent the body’s best attempt to heal damaged tissue, but are not an indicator of full recovery. Often, scars can feel painful, tight or itchy for months or years after forming, which can be aggravating for people long after the original injury has healed.
Massage therapy, when included alongside other therapies focused on helping people manage scars, is showing real promise in helping clients not only get relief from some common scar side effects, like pain and itching, but also help them get more comfortable with touch.
Scars develop for a variety of reasons, but some of the most common include burns, surgeries or injuries. According to Johns Hopkins Medicine, there are many different types of scars, but some of the most common include keloid scars, hypertrophic scars and contractures.
Keloid scars are thick, rounded, irregular clusters of scar tissue that typically grow much larger than the original injury that caused the scar. They usually appear red or darker in color compared to the uninjured surrounding skin, and can appear anywhere on the body and are most common on the chest, back, shoulders and earlobes.
According to the American Academy of Dermatology Association, keloid scars can take months to appear after original injury, and can continue to grow for years. With these scars, collagen fiber arrangement is random and disorganized, and more blood vessels are present than with hypertrophic scars.
Keloid scars do not go away without treatment.
Some Risk Factors for Developing Keloid Scars
According to The Mayo Clinic, keloid scars are most common in people with Black or brown skin, though the reasons for this predisposition is not known.
Hypertrophic scars are similar to keloid scars, but their growth is confined within the boundaries of the original injury. Hypertrophic scars may also appear red, but they are usually thick and raised. These scars may improve on their own over time.
The Cleveland Clinic describes hypertrophic scars as being an abnormal response to wound healing, wherein extra connective tissue forms within the original wound. In contrast to keloid scars, collagen fibers are arranged parallel to the the upper skin layer.
Hypertrophic scars may fade and become less noticeable with time.
Some Risk Factors for Developing Hypertrophic Scars
Contractures differ from keloid and hypertrophic scars in that they occur when a large area of skin is damaged or lost. This scar formation pulls the edges of the skin together, causing a tight area of skin.
This decrease in the size of the skin can affect muscles, joints and tendons, and decrease range of motion, especially when the scar occurs over a joint. According to the American Academy of Dermatology Association, any scar that limits movement is called a contracture scar.
Some Risk Factors for Developing Contracture Scars
For scars that may be causing pain or discomfort after healing, massage therapy is showing real benefit in terms of providing relief. “Clients with scarring tend to favor function over appearance when we work together addressing their scarred tissues,” says Pete Whitridge, BA, LMT, BCTMB. “Surgical scars are common, and we can quickly improve the texture, feel and pliability of the scar. More dramatic scars may never attain a ‘normal’ skin appearance, but the underlying tissues may become more pliable and allow for more glide and function as we consistently work on them.”
A 2023 study1 explored the physical and psychological effects of scar massage for burn patients. This systematic review and meta-analysis of randomized-controlled trials and quasi-experimental trials ultimately reviewed seven studies investigating scar massage for burn patients, comprising a total of 420 patients.
In all of the studies, massage sessions lasted between five and 30 minutes and were delivered by massage therapists between one and three times per week for 12 weeks. Overall, researchers noted that scar massage decreased pain levels, improved scar thickness, reduced pruritus and reduced anxiety (although no significant effect on depression was found). The study concluded scar massage was a feasible and effective intervention for burn patients.
“As a massage therapist, I feel a difference in a client’s scar tissue after two sessions,” says Kate Peck, LMT, owner of Journey to Health, founder of the Massage Burn Scar Therapy Foundation. “It can feel thinner, more pliable and more responsive to the scar work.”
Peck has found myofascial scar release, manual lymphatic drainage, therapeutic massage and craniosacral therapy to be the most effective.
Another study2 explored the effectiveness of various methods of manual scar therapy on postoperative scars (more specifically cesarean section scars). The study included manual scar manipulation, massage, cupping, dry needling and taping, and results showed a significant positive effect on pain, pigmentation, pliability, pruritus, surface area and scar stiffness. Improvement of skin parameters—such as scar elasticity, thickness, regularity and color—were also noted.
Related: Helping Patients After Surgery
One vital caveat for massage therapists working with clients who have scars: Scars may be painful or tender, but scar massage should not cause pain. “I explain to my clients that the work should not be painful and that they should tell me if they feel any pain or discomfort, or if they just don’t like what I am doing,” Peck says.
Similarly, Whitridge notes, “Massage in general should never be painful. This is especially important for people who have experienced any type of scarring.”
There is no one-size-fits-all approach to scar massage because no two scars or clients are the same. As such, a thorough intake is especially important when working with clients who have scars.
“I have a specific intake form for my burn survivor clients,” Peck says. “I want to know where they’ve been burned, how long ago their burn injury was, details of their last surgeries, if they have any prostheses, where I can touch them, where they do not want to be touched, what areas they are most concerned with, and if I can work gently with those areas.”
Whitridge also notes the importance of communication. “There is a need for a lot of communication with clients about what scar massage should feel like, how long you’ll be working on the area, and how the scar might feel after the massage session,” he notes.
For Peck, the massage process usually begins with putting her hands gently on the client’s body to feel how they respond to touch. She looks for things such as flinching and guarding. From there, Peck will usually do some manual lymphatic drainage to check their lymphatic system, as the superficial lymphatic system is often damaged with a burn injury.
Myofascial scar release, mobilizing and restoring slide and glide, and getting the scar tissue “unstuck” from the underlying tissue comes next. “The last step is to massage with a moisturizing cream or oil,” says Peck. “The intent is to hydrate and soothe the skin and increase blood flow to the area.”
Related: Updates in Research: Manual Lymphatic Drainage
Whitridge emphasizes the importance of starting slowly with any scar massage client. “People with scars are generally skeptical about receiving scar work because they are afraid that the area around the scar will rupture,” he says. “This population needs to be introduced to scar work in small doses (two to five minutes) to build confidence that the area can take touch, movement and manipulation.”
So the client isn’t receiving touch on just one region of the body, Whitridge usually includes scar work as part of a longer massage session. In subsequent sessions, Whitridge performs a general assessment of the tissues (pliability, color, texture and mobility) before pushing and pulling the area in the cardinal directions of the body to assess restrictions and ease of movement.
“Then I pull or push the area into the direction of restriction and hold the area steady for 30 to 90 seconds, and sometimes up to two minutes,” he says. “Then, I will return the tissue to its natural state and reassess the area.” He ends the session with some light lymphatic strokes toward the heart.
Peck has seen firsthand the benefits massage has on burn scars. These success stories include a client who could finally smile and feel comfortable eating in public after not being able to open her mouth wide enough for seven years. Additionally, clients with foot and ankle burns experienced increased range of motion for better walking, as well as boosts in mood and quality of life.
Whitridge also has clients who have experienced drastic changes in their scars through massage therapy. The most profound success story he has witnessed involved a client who was burned over 80 percent of his body in a fuel tanker fire. After receiving regular massage and attention to his scars for years, his scars dramatically improved. “In some areas you could not tell the burned skin from the unburned skin,” says Whitridge.
One thing that can help clients see even more improvement to their scars is learning some self-massage techniques they can use between regular massage sessions. Peck teaches clients how to do self-lymphatic drainage, self-myofascial scar release, and stretching to improve their range of motion without causing pain.
“Clients who understand the wound healing process and apply the idea of working slowly and gently with their own tissues can have excellent success when working on their own scars,” Whitridge says. “This empowers them to become more whole, embodied and confident that the area can fully heal and that they can live full, productive lives without pain and with complete range of motion.”
Scar Tissue and Massage
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1. Lin TR, Chou FH, Wang HH, Wang RH. "Effects of scar massage on burn scars: A systematic review and meta-analysis." J Clin Nurs. 2023 Jul;32(13-14):3144-3154.
2. Lubczyńska A, Garncarczyk A, Wcisło-Dziadecka D. "Effectiveness of various methods of manual scar therapy." Skin Res Technol. 2023 Mar;29(3) Jan;180(1):207-215.