| First off, let me congratulate you that you are trying | | | | and getting regular massage. Most recreation/fitness |
| to do your own healing! So many people go to their | | | | centers now offer Yoga classes. If yours doesn't |
| MD/DO/physical therapist/chiropractor/massage | | | | offer Yoga or another kind of stretching program, |
| therapist, etc. and expect that that person is going | | | | ask them why they don't, and consider joining one |
| to be able to heal them completely. I often tell my | | | | that does. |
| clients who have chronic conditions (health related | | | | Also, consider getting regular scar tissue massage for |
| issues which last a long time) that even if they come | | | | a while. If you don't know a good massage therapist, |
| for massage three times a week, they won't see the | | | | ask a friend who gets regular massage, or even look |
| kinds of improvements they want until they're willing | | | | up a CMT in the phone book. You can find criteria for |
| to do their own work to improve (be that stretching, | | | | selecting a massage therapist by clicking here. You |
| doing their own massage, eating right, ice/heat, etc.). | | | | may have to take some time researching, but it will |
| So congratulations on your willingness to do your | | | | be worth it when you find a therapist with whom |
| own healing! | | | | you feel comfortable, and schedule an appointment. |
| While I have never had multiple surgeries on the | | | | Massage can range from $20 to upwards of $300 |
| same area, I had four surgeries in a 6 year time span | | | | hour. The cost doesn't necessarily determine the |
| (including an ACL replacement in my right knee), and I | | | | quality of the massage, so don't think you have to |
| understand the pain that often accompanies scar | | | | pay an arm and a leg to get a great massage. Let |
| tissue. | | | | the therapist know your wants with regard to |
| I was fortunate with my ACL injury in that I had a | | | | getting your scar tissue broken up, and they should |
| surgeon who believed it was important to keep the | | | | be able to help you. |
| knee moving and stretching. When I came to (from | | | | Another thing to consider (when getting massage for |
| surgery), my knee was already moving in a machine | | | | a trauma area) is that the muscles around the area |
| called a CPM unit (Continuous Passive Movement - | | | | will be tightening up in protection of the injury. In the |
| delivered by Colorado Professional Medical), which | | | | case of a knee surgery, this would be the |
| allowed me to set the speed and degree of the | | | | quadriceps, hamstrings muscles, calf muscles, and all |
| angle which my knee was moved to. It constantly | | | | the muscles on the anterior (front) side of the lower |
| moved my leg up and down, bending the knee each | | | | leg. A therapist should know to work these muscles, |
| time. When I got home, I automatically started using | | | | and you can rub them yourself as well to help keep |
| the CPM unit again, which had been delivered to my | | | | them loose. |
| house and which the delivery person had taught me | | | | On to the level of scar tissue in the muscle that you |
| how to use prior to surgery. I increased the speed | | | | can work yourself, cross-fiber technique can be very |
| and angle of degree every day and stopped using | | | | effective. If your scar tissue is right over the knee |
| the CPM unit one week after surgery, because I had | | | | cap you'll probably have to lift it up off of the knee |
| gotten back the full range of movement which the | | | | and squeeze it between your thumbs and forefingers |
| CPM unit allowed for (120 degrees). It was about 6 | | | | to get to it. However, if it is in a more substantial set |
| months after my knee surgery when I learned that | | | | of muscle (lower quads), you will be able to work |
| some orthopedic knee surgeons believe in keeping | | | | your fingers across the muscle and use a cross-fiber |
| the knee immobile for up to a month after ACL | | | | technique on the muscle (or have someone do this |
| surgery. I was surprised and disappointed to hear this | | | | for you). |
| because keeping the knee immobile for that long of a | | | | Cross-Fibering |
| time is setting the person up for a longer (and often | | | | Start by using a cream, lotion, or oil (I personally |
| more difficult) recovery. | | | | recommend Lotus Touch cream, available from and |
| Scar tissue develops all the time in muscle. When you | | | | use it on the area you want to work. also sells a few |
| pull muscles, some amount of scarring can occur. | | | | creams and gels, which have been reported to help |
| That scar tissue can be gotten rid of through normal | | | | considerably to diminish the tightness and the overall |
| stretching and activity. However, when serious scar | | | | thickness of scar tissue. Remember that you are |
| tissue develops (as is often the case in whiplash and | | | | using the massage cream to allow your hands or a |
| surgery) it can take a lot more to get that tissue to | | | | tool to more easily move across the skin, so if the |
| be reabsorbed into the body. If it is not gotten rid | | | | skin soaks all of it up, you may need to reapply. You |
| of, it can cause numbness of the nerves in an area, | | | | will then want to work across the muscle fibers. In |
| decreased flexibility, and ultimately, pain. | | | | the case of the muscles around the knee: as you are |
| Many people think that scar tissue will simply go | | | | standing, most of the muscle fibers go up and down, |
| away after time, but most often, it does not. It is an | | | | so you will want to work across the leg. You can use |
| injury which needs to be worked with in order to | | | | massage tools and/or implements to get into the |
| re-heal as effectively as possible. | | | | muscle deeply and work across the muscle, or you |
| Healing, depending on whom you talk to, is a complex | | | | can use your hands. One good hand position is to |
| process. Some people believe that prayer alone will | | | | bend the middle and ring fingers and use the second |
| heal, while others believe that only pills and western | | | | knuckle (closest knuckle to the hand-but not the |
| medicine will heal. Some have great success with | | | | knuckle joining the hand) on the middle and ring |
| acupuncture, others with chiropractic, and others with | | | | fingers, to get into the muscle fibers of the quads |
| nutrition. I believe that healing is a combination of all | | | | calves, while the second and pinky fingers are |
| of these things. | | | | straight and glide across the leg. Move up and down |
| What I offer here is advice on how to massage scar | | | | the muscle, making sure to focus on areas where it |
| tissue, with the hope that you will be able to use it | | | | feels like there is more binding of the tissues. You |
| and effectively break up your scar tissue. I hope this | | | | can finish by doing a gentle massage on the area to |
| works for you, and hope as well that you will let me | | | | calm it down. This is one possibility for cross-fibering. |
| know your results. I hope you'll incorporate whatever | | | | Whatever hand position or tool you use with |
| else works for you, as that will help speed up your | | | | cross-fibering, remember that your goal is to break |
| healing. Also, a point I'll make is that massage is all | | | | up the scar tissue by going across the muscle, and |
| hands-on, so describing it using a non hands-on | | | | remember that this isn't going to happen overnight. |
| medium like email or the Internet is a bit difficult; I'll | | | | By using cross-fibering, you are actually causing minor |
| do my best, but if there's something you don't | | | | traumas to an area which promote the healing in that |
| understand, please email me. | | | | area. You don't want to re-injure the area to the |
| There are two levels of scar tissue which you can | | | | point where more scar tissue develops because of |
| address with massage. One is the skin level, and the | | | | your working on it. A generally good way to know |
| other is the muscle level. I will first address the skin | | | | how much pressure is enough is that it should be on |
| level, and then address the muscle level. | | | | the level between uncomfortable and painful. So it |
| When scar tissue develops, the brain/nerve | | | | should be uncomfortable, but not overly painful. As |
| connections, which have to happen to detect touch, | | | | far as the time it takes for healing, a good general |
| never develop or develop very weak. This is because | | | | guideline is that you should give the scar tissue as |
| scar tissue develops primarily to heal and protect, and | | | | long to break up (if you're working on it daily) as it |
| only secondarily to feel sensation. In other words, the | | | | did for it to be created. In other words, if you had |
| tissue naturally develops a weak ability to notice | | | | surgery two years ago, and you just started working |
| sensation while it is being created. Because most | | | | with the scar tissue yesterday, large improvements |
| people don't use or touch a part of the body which | | | | could take up to two years from yesterday. Healing |
| had a kind of trauma to it, (like that which comes | | | | doesn't have to take this long, but this should give |
| from surgery or a car accident,) the tissue doesn't | | | | you an idea of how patient you should be. |
| receive any stimulation. This means that in many | | | | In summary: |
| cases (after surgery or other trauma), the secondary | | | | Work with the scar as often as you think about it. |
| function of scar tissue, sensation, never or barely | | | | It is possible to overwork an area, but not likely that |
| develops. Over time, this lack of sensation causes an | | | | you will with the scar tissue. |
| area to be touched less (after all, why would a | | | | Use heat to bring blood to an area, cold to take |
| person touch an area that had no feeling?). It | | | | blood away from an area. |
| receives less touch, and because of this, it receives | | | | Generally speaking, you will want to take the blood |
| less stimulation, which means that the nerve endings | | | | away from an area before you work with scar tissue |
| and connections develop less, which means that the | | | | so that it will hurt less to work with it (the cold of ice |
| area has less feeling, so it is touched less; and the | | | | will also numb the nerves so you can work with the |
| process goes on until there is a thick mass of | | | | scar tissue). You will then want to work with the |
| non-sensory tissue, most of it probably scar tissue. | | | | tissue that is deeper in the muscle, using |
| I have larger scars on two of my fingers (from | | | | cross-fibering, while it is cold. When you are done, |
| surgery). While sitting in class or somewhere where I | | | | you will want to heat the area to bring blood in and |
| only need to listen to what's going on, I will take a | | | | carry away the toxins which are released as you |
| sharpened pencil, paper clip, nail file, or even a needle | | | | break up the scar tissue and open up the area. (Too |
| (something with a small point), to see what kind of | | | | much time with the heat can cause an abundance of |
| feeling I have in a specific spot on the scar. I will | | | | blood in an area, which can cause swelling and a |
| really pay attention to what kinds of sensations I'm | | | | different kind of pain. Generally, 20-30 minutes with |
| having in the spot that I'm touching. I don't pierce the | | | | the heat is a safe bet.) You will want to use moist |
| skin, as that would only cause further injury to a | | | | heat if possible (i.e. a wet washcloth warmed up in |
| healing area, but I do test to see how much | | | | the microwave or something comparable), as it will |
| sensation I have. I have done this since having | | | | draw more fluids to the area and encourage the |
| surgery over 8 years ago. Over time, the sensations | | | | muscle to return to its natural state. (Don't get the |
| have become stronger and more definite in the scar | | | | heat so hot that it burns you.) |
| tissue itself, and as the sensation has come back, the | | | | Working with the scar tissue may hurt initially. |
| scar tissue has been reduced (not gone away), and | | | | Pain should decrease over time, but may not fully go |
| become much less painful. It probably also helps that | | | | away. Be prepared for this, but don't psyche yourself |
| I am a massage therapist, and while working on a | | | | out. It does get better. |
| client, I use the sensations coming from my hands to | | | | You can do the work yourself |
| understand when a muscle is tight, or when it has | | | | You can have great results just from working on the |
| knots, etc. I pay a lot of attention to the sensations | | | | scar tissue yourself. You will be most successful if |
| coming from my fingers. | | | | you will work on it yourself because you are the only |
| For the skin level on a knee, you will want to work | | | | one who is with you 24 hours a day, so you can be |
| on the scar itself. Touch it with an object with a small | | | | there all the time to work on it. However, just like it |
| point in several specific spots on and around the scar. | | | | feels better to get a massage from someone else |
| Can you feel the sensation? If not, start by going | | | | than it does to give yourself one, you may |
| around the edge of the scar. Can you feel that | | | | experience good results from someone else working |
| sensation? Notice what it feels like. Does it make a | | | | on you as well. Just make sure that you |
| difference if you press hard or light? What about if | | | | communicate with them (and that they are willing to |
| you move it around a little? | | | | listen) when there is too much pain, or not enough |
| Set an intention that you want to feel sensation in | | | | pressure, etc. Also, there may be cases where you |
| that specific point you are touching. By doing this, | | | | can not reach the scar tissue (i.e. back surgery. If this |
| and focusing your attention on it, you are forcing | | | | is the case, have someone else work with you, and |
| your brain and your body to focus in on the sensory | | | | get into a regular stretching program). Caveat: Make |
| information you should be receiving from those | | | | sure you say thank you to the person who is helping |
| nerves. Just like working to develop more flexibility | | | | take care of you. They're much more likely to help |
| by stretching the same muscles over an extended | | | | again. |
| amount of time, you are working to develop those | | | | Nutrition is important. |
| nerves on a daily basis by using different kinds of | | | | Eating well can have a huge impact on how quickly |
| touch. Over time, you will redevelop more feeling in | | | | the body will heal. With regard to scar tissue, nutrition |
| the area than you previously had. | | | | plays an important role in how quickly the body will |
| Moving on to the deeper layers, it is important to | | | | be able to develop feeling in an area and breakdown |
| know that just as scar tissue develops on the | | | | the scar tissue. It needs the vitamins and minerals to |
| outside layers of the skin, it develops in the muscle. | | | | build tissue, create chemical connections, and carry |
| Muscle can be divided into two groups with regard to | | | | away toxins. |
| scar tissue; areas which can be worked through | | | | Be patient. |
| direct massage, and those which are much more | | | | The human organism is amazing in what it can do, if |
| difficult to work with using massage. Most massage | | | | given the time and resources it needs to do so. If |
| therapists have developed an ability to work at a | | | | you re-injure the area by doing more than it can |
| deep level within the muscle that most non massage | | | | handle (i.e. bungee-jumping two weeks after |
| therapists have not. For the areas which are difficult | | | | surgery), don't expect your body to respond well. |
| to get to when doing massage yourself, I would | | | | Be patient! |
| recommend getting into a regular stretching program | | | | |