Scar Tissue: Where and how?

Why do I have scar tissue?

Scar tissue is simply a body response. Our bodies are constantly busy breaking down or regenerating itself, even during our normal daily activities.

Can you believe that the epidermis regenerates itself every 28-30 days! This is vital for the growth processes of your body.

Every small action causes micro-tears in muscle and connective tissue, after which the body rushes the needed chemicals and cells to the area to do the repair job! Our bodies are so vibrant, clever and adaptable, what an amazing work of artful engineering...

If we take care of our bodies, they function in ways that engineers can scarcely imagine. Enough exercise, healthful eating, good clean air and growing our minds will keep the regeneration going, as also in the case of healing scar tissue.

A Case Study

This time, exactly a year ago, I had a very big operation on my leg. I broke the top of the femur bone, right under the knee cap, shattering it into little pieces. My leg got caught and was twisted, after slipping on a flight of stairs, between two open ended steel steps.

Major surgery followed, and then a very long and painful rehabilitation process, being left with a knee that cannot bend more than 55 degrees and lots of...guess what? Inner scar tissue.

The busy bees in the body

Millions of tiny, tiny cells in the body are constantly working to help the body to grow and develop. Other cells are the “supervisors”, creating the systems for the millions to do their work. All of these work on scar tissues to heal trauma to the body.

What exactly is scar tissue?

According to Merriam-Webster, (the online version), scar tissue is: the connective tissue forming a scar, and composed chiefly of fibroblasts in recent scars and largely of dense collagenous fibers in old scars. defines a scar as:

A mark left on the skin after a wound heals. Cells called fibroblasts produce collagen fibers, which form bundles that make up the bulk of scar tissue. Scars have a blood supply but no oil glands or elastic tissue, so they can be slightly painful or itchy. Hypertrophic scars grow overly thick and fibrous but remain within the original wound site. Scars can also develop into tumor-like growths called keloids, which extend beyond the wound's limits. Both can inhibit movement when they result from serious burns over large areas, especially around a joint. Scars, especially those from unaided healing of third-degree burns, can become malignant... As part of the healing process, specialized cells called fibroblasts, in adjacent areas of skin, produce a fibrous connective tissue made up of collagen. The bundles formed by these whitish, rather inelastic fibers make up the bulk of the scar tissue.

Let’s talk about Fibroblasts

These cells let out proteins, mostly collagen. Collagen builds connections, particularly over the scar, which helps connective tissue to grow. When the scar has healed, it will have regular nerve pathways, blood flow and elasticity and movement.

The importance of fibroblasts is, well, very important.

They're involved in normal growth, healing, wound repair, and the day-to-day activities of every tissue and organ in the body. The fibroblast does everything.

Interference with their activities causes a vast array of clinical problems. The deficiency affects a specific pathway in collagen creation, with consequences like skin sores, anemia, edema, ulcerated gums, loosened teeth, and hemorrhage of mucous membranes. Restoration of the vitamin allows the fibroblasts to work normally and cures the problem.

Let’s talk about Collagen

Collagen is the structural protein of bones, tendons, ligaments, and skin. About one quarter of all of the protein in your body is collagen.

Collagen is a major structural protein. It forms cables that strengthen the tendons. It also forms large, resilient sheets that support the skin and internal organs. Bones and teeth are made by adding mineral crystals to collagen. Collagen provides structure to our bodies, protecting and supporting the softer tissues and connecting them with the skeleton.

Vitamin C assists with oxygen in the process of modifying some amino acids into hydroxyproline, which is critical for collagen stability. Vitamin C deficiency slows the production of hydroxyproline and stops the construction of new collagen, ultimately causing scurvy (Loss of teeth and easy bruising are some of the symptoms).

When the body needs to go into healing mode, and builds any new cellular structure, collagen is most important. It controls all sorts of tasks undertaken by cells, and causes broken bones and wounds to heal.

The collagen mesh provides the plan for what the tissue will look like, the road map for the cells to find where they need to regenerate and grown, and the way for the body to be able to re-grow damaged or broken tissue.

REMEMBER: Scar tissue is what we need for the body to regrow itself.

Let’s talk about MUSCLES

We tend to say "Push your arms together." This is a totally inaccurate statement. Muscles never push, they only pull. In other words, you don't get any force from your body when your muscles relax, you only get force from your body when muscles contract. This is the only movement they can do – strange but true... And they can also relax.

Skeletal muscles are usually attached to bone by tendons composed of connective tissue. This connective tissue also covers the entire muscle & is called epimisium.

Skeletal muscles consist of numerous bundles, called fascicles. Fascicles are also surrounded by connective tissue (called the perimysium) and each fascicle is composed of numerous muscle cells). Muscle cells, which are wrapped by endomysium, consist of many myofibrils, and these myofibrils are made up of long protein molecules called myofilaments.

The cell membrane of a muscle cell is called the sarcolemma. So, impulses travel along muscle cell membranes just as they do along nerve cell membranes. However, the 'function' of impulses in muscle cells is to cause the muscle to contract.

In the human body, the muscle fibers are made up of muscle cells.

That means that inside each muscle fiber are muscle cells. Each muscle cell needs fresh blood (with new clean oxygen), needs to have waste carried away, and needs to be able to receive and transmit electric impulses. Each of the muscle fibers also has to be able to carry materials and messages in both directions.

Trauma can prevent the movement of blood through the the muscle fibers. It can be a cut, bruise, or any other trauma that causes the flow of blood to be slowed or stopped. If the fibroblasts cannot create the necessary pathways (due to distance or lack of movement), these tissues harden and turn into scar tissue.

Lets talk about your SKIN

Skin is an amazing organ in the human body.

It is made up of two main layers: the epidermis on the outside and the dermis on the inside. The epidermis is the barrier, while the dermis is the layer containing all the nerve endings, sweat glands and hair follicles. In the subcutaneous layer you can see the blood vessels.

The epidermis is your contact with the world: It has two main layers, the inner of which is living and the outer of which is dead. The dead skin cells of the outer layer are what we can actually see, and they are constantly flaking off and being replaced by new cells being pushed outward. This happens every 30 days or so.

The living, inner layer is called the malpighian layer. The malpighian layer creates the dead cells that we can see. It is in direct contact with the dermis, which feeds and supports it.

Next up is something called the stratum corneum. This is the outer layer of dead cells - the cells that we see as our skin. The cells in this layer are filled with a protein called keratin. Keratin is a very strong and solid protein. Horns, hair, hoofs, fingernails and feathers all gain their strength from keratin. The same stuff that your fingernails are made of actually forms your visible skin!

How is scar tissue formed? explains the forming of scar tissue in the following way:

"When a nerve is severed, provided that the schwann cells are able to reconnect (they can grow over small distances) then regeneration and complete healing takes place. But when the wound or cut or damage is quite bad and no electrical conductivity can be re-established between the cut nerve and the neuroepidermal cell into which it "plugs", then regeneration cannot take place and the rapid build up of collagen is necessary to plug the hole.

"Because collagen is produced in abundance by fibroblasts, it invariably forms a domed layer over the wound and this domed layer is the scar which is often disfiguring and large.

"There are few, if any, neuroepidermal junctions in scar tissue so it has very little touch sensation. Because of this, the mind, which perceives the body as a hologram of nerve endings, doesn't send much blood to the area of scar tissue, so it doesn't stay very supple and doesn't grow. This means that it doesn't regenerate like the rest of the skin, otherwise it would fall off and renew like the rest of the skin."

In the body, often the cut or damaged nerves re-route to the nearest area of normal skin and connect to the healthy skin cells there. This can make the skin around any scar more sensitive and often quite painful for longer periods of time. This is also what leads to the strange feeling that often accompanies scars when you touch them.

How can I help heal the scar tissue?

The forming of serious scar tissue, as with whiplash and surgery, can take more than normal stretching and activity to heal. It does not go away with time, but has to be worked on.

1. Scar tissue on the skin:

Because people don't normally use or touch a part of the body which had some kind of trauma, the tissue doesn't receive any stimulation. The nerve endings and connections develop less, it therefore has less feeling, and gets touched less, and so it goes on and on. Eventually a thick mass of non-sensory tissue develop, most of it scar tissue.

Touch the scar, on a daily basis, with an object with a small point (pencil, nail file, needle, etc.) on several spots on and around the scar to stimulate the nerve endings. In time feeling will return.

2. Scar tissue in muscles:

Scar tissue in muscles can either be worked on through direct massage, or become areas that are deeper and more difficult to work on directly.

Remember that the muscles around the scarred area will tighten up in protection of the injury. A trained therapist will be able to work on these muscles, and they can be rubbed by yourself as well.

The best way to work on your own muscles is through a technique called cross-fibering.

Say for instance, like me, you had surgery on your upper leg and knee. You would use your hand to go up and down the muscles vertically when standing. Use the second knuckle, closest to the hand, on the ring and middle fingers, to get into the muscle fibres, while the second and pinky fingers glide across the leg. Finish by doing a gentle massage on the area to calm it down.

Remember also that the breaking up of scar tissue does not happpen overnight! Give the tissue as long to break up, working on it daily, as the time it took to form initially. Bottom line: be patient and persistent...

And finally:Jonathan Kraft, CMT, has written a book about this issue. This article has been researched from his book. Find the info here.

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