For manual practitioners such as doctors of chiropractic, it makes sense to call out scars more explicitly, particularly their relationship to fascia. They are more than just skin events. So, why should we “read” scars?
Surgical and traumatic scars alter collagen architecture and reduce local tissue glide, contributing to pain, stiffness, or altered movement patterns even far from the scar site.1-3
Manual scar therapies (manipulation, mobilization, IASTM, modalities, massage, cupping, taping, dry needling) have been shown to improve scar elasticity, thickness, pliability, and pain, suggesting we can positively remodel these fascial interfaces rather than simply observe them.
What to Look for in a Physical Exam
- Locate scars relative to symptoms: abdominal, C-section, spinal, joint replacement, breast, thoracic, dermatologic excisions.
- Signs of impaired glide: skin that doesn’t move freely over underlying tissue, “tethered” zones, palpable ridges, patient‑reported pulling with stretch or deep breathing.
- Sensory changes: hypoesthesia, hyperalgesia, itch, or burning along or around the scar can indicate altered neural and fascial signaling.1-3
Practical Treatment Options to Keep Fascia Gliding
I often combine and titrate these treatments to the patient’s tolerance:
Manual scar mobilization and myofascial release – Gentle lifting, shearing, and multidirectional glides across and around the scar (often 5-10 minutes, 1-2x/week early on). In my experience this can improve pain, elasticity and patient‑rated scar quality.
Cupping and soft‑tissue manipulation – I use a negative-pressure machine to lift adherent layers; this is part of an integrated scar protocol that improves pigmentation, pliability, pruritus, and stiffness. I usually need 6-8 weekly sessions when I do this.
Dry needling / acupuncture into and around scars – I refer to an acupuncturist who has helped patients disrupt dense collagen, modulate local nociception, and improve mobility and pain. Many of the patients I see are scheduling acupuncture sessions for postsurgical scars.
Energy‑based therapies (Laser, TECAR, shockwave, etc.) – Low‑level laser can support tissue healing and collagen remodeling; TECAR (capacitive-resistive radiofrequency) can warm, vascularize, and soften a broader scar field and deeper fascial planes; focused or radial shockwave provides a stronger mechanical stimulus for mature, densified scars and adhesions to promote remodeling; and high-frequency pulsed direct current can assist in neuromodulation and promote postsurgical healing.
Movement retraining over the scar – Once basic mobility is restored, integrating the scarred region into loaded, multi‑directional movement (breathing drills, trunk rotation, hip hinges, overhead reach patterning) helps reinforce new glide patterns and prevents re-stiffening.
In practice, I tend to start with TECAR because I want to warm, vascularize, and soften a broader scar and fascia field – especially in sensitive or recently healed areas – and reserve focused or radial shockwave for more mature, densified scars and adhesions where a stronger mechanical stimulus is needed to disrupt fibrotic tissue and stimulate remodeling.
Every surgical or traumatic scar represents a localized fascial reorganization, and over time these zones can lose glide, alter force transmission and contribute to pain or movement dysfunction distant from the original injury.1 Getting a good history and asking the patient about any scars leads me to systematically “read” the body’s scar map – palpating for tethering, densification, and altered sensation – and then prescribing targeted scar mobilization, myofascial release, dry needling, cupping, laser, TECAR, shockwave, and movement reintegration. This offers a practical way to keep these interfaces hydrated, elastic and neurologically “quiet,” rather than accepting them as fixed anatomical facts.
Case Example
Jeff is a 69-year-old male. Although he is a retired attorney, he is very much on the go. In his 20s-50s he played basketball, but no longer does so. He currently enjoys walking, occasional golf, tennis once a week, and working out in the gym a couple of times a week.
He came in with increased low back pain, moving slowly, and guarded. He described it as an overuse injury from golfing and sitting for several hours while driving. His history includes multiple episodes of low back pain, plantar fasciitis, a surgery for “ankle ligament tears and Achilles tendon tear,” Achilles tendinopathy and tennis elbow.
Treatments for these overuse injuries included physical therapy, rest, and over-the-counter medicines such as ibuprofen and acetaminophen. He has many prescribed “core exercises and stretches” that he does not do on a regular basis.
As an alternative for this episode of pain, I offered a natural anti-inflammatory. I get the sense that Jeff worries about non-specific triggers or events that could cause the onset of a low back pain episode. He mentioned that when getting up from being in bed or from sitting in a chair, his first few steps could feel stiff and tight in the feet and low back. That was a message to me to check the bottom of his feet and look upward along his kinetic chain.
He has visible thick scaring around the left ankle and Achilles from surgery when he “tore the supporting ligaments and Achilles.” All of Jeff’s standard range-of-motion testing was associated with stiffness, tightness and some areas of pain. Upon palpation he had irritation and thickening of the plantar fascia, and along the Achilles tendons. Both calf muscles were short and tight. His thoracolumbar region was stiff (hypomobile) and the fascia felt dense. I explained this could be contributing to his low back pain.
I started with manual TECAR therapy along the posterior glutes, thighs, calves, bottom of the feet, and thoracolumbar regions. Then I used targeted extracorporal shockwave therapy (ESWT) on his plantar fascia, Achilles tendons and thoracolumbar area. This treatment worked well for his overall mobility and ease of pain while moving into standard ranges of motion.
The TECAR helps us hydrate the fascia while the shockwave generates pressures to loosen the long-standing fascial adhesions and tendinopathy. TECAR and shockwave therapy work by boosting blood flow to the injured area and stimulating the body to repair damaged tissue. Jeff had five sessions of TECAR, shockwave therapy, SOT prone blocking, and a review of which exercises were appropriate for him. He was able to go on a planned golf trip with his friends.
Clinical Pearls
Not only observing scars, but also actively treating them supports the potential growth of new blood vessels in the damaged areas, interrupting pain signals by overwhelming nerve endings that have grown into the injured tendons or fascia – and destroying nerve fibers in the affected area, which can also lead to long-term pain relief.
References
- Bijlard E, Uiterwaal L, Kouwenberg CA, et al. A systematic review on the prevalence, etiology, and pathophysiology of intrinsic pain in dermal scar tissue. Pain Physician, 2017;20(2):1-13.
- Abd-Elsayed A, Pope J, Mundey DA, et al. Diagnosis, treatment, and management of painful scar: a narrative review. J Pain Res, 2022 Apr 5;15:925-937.
- Lubczyńska A, Garncarczyk A, Wcisło-Dziadecka D. Effectiveness of various methods of manual scar therapy. Skin Res Technol, 2023 Mar;29(3):e13272.
