Introduction
The work on scar tissue is my original work. I learned it from working on the scars of my Rolfing® Structural Integration clients over the years. By 2005, I was able to identify, define, and teach to other practitioners the various techniques I was using to integrate scar tissue. This article is an excerpt of “On Scar Tissue” which was written for Structural Integration: the Journal of the Rolf Institute and published in the September 2008 issue. The original article also includes a short story about the first scar I worked on with details of my initial discovery of how to integrate scar tissue back into the fascial web. You can read the full article on the Ida P. Rolf Library of Structural Integration at https://novo.pedroprado.com.br. After signing in, search Article Title for “On Scar Tissue.”
Scar tissue quality changes quickly and easily. Lumps, gaps, ridges, holes, bumps, knots, and strings in the tissue all smooth out. The amount of change in one intervention is extensive. Between 15 and 30 minutes of work can make a recent scar look and feel like it is years old. Very often work on a scar contributes significantly to whole-body release and integration. Historical memories and emotions are often recalled. The improvements are permanent, with scars continuing to improve rapidly for some time after a session. Although the techniques are a bit different from Rolfing, almost like speaking a different language (thank you for this insight, Caroline Widmer), the guiding principles are quite similar to those of Rolfing.
One question that comes up is: How soon it is safe to work on a new scar? Scars that have been there awhile are fair game. Brand-new scars need consideration regarding how soon work can safely begin. One thing that you don’t have to factor into your decision of when to work is being afraid of causing too much discomfort. Scar work is not painful, even for new scars.
I prefer the scar to be closed over, as I am the most concerned about how to avoid introducing infection. The tissue should be thick enough to withstand moderate pressure and stretching without splitting open. Gloves would be necessary to work any earlier, but wearing gloves for scar work does not work as well for me as waiting a few more days. I don’t sense as well through the gloves and have not had the need or the patience to learn.
From a structural perspective, there should be no sense of urgency about working with a scar right after surgery. No matter when you start, the work seems to get to the same place in the end. There is no loss of end results; however, there is the consideration of the probable benefit of the work shortening the duration of pain and suffering.
For new clients, as to liability and absolute safety, I might want to wait until the doctor will prescribe regular massage before starting work on a scar. For family, and for dear friends who are in pain and out of spirits, I will do mercy rescue work ASAP. It does feel good at heart to be able do something to improve their situation, and scar work usually helps the pain and soothes and restores order and function to a traumatized system. Work on the scar seems to speed the healing process for awhile immediately afterwards.
For me, ASAP is as soon as the scar is healed over enough to be dry, and thick-skinned enough to take some light pressure. I find that starting with delicate, light work on the surface for a few minutes produces a better-quality of tissue. This better quality tissue can then take stronger and more casual pressure and you can go on and work with good results. For the less-experienced scar worker, waiting a little longer, another week or so, to start work on family and dear friends might be a good comfort and safety margin.
Scar work fits seamlessly into a standard ten-series or advanced series. Some of the factors in deciding how to work with a scar are: where it is, how extensive it is, how much it impacts the rest of the structure, if it has an emotional history, and how well it responds to work.
You may add the scar work into the session whose line it most affects. As examples, scars from facial plastic surgery may be worked on in session seven, or a C-section scar in session five. Some scars do well with shorter amounts of work over several sessions. This way you give time a chance to aid the situation. For example, you could do small amounts of work on a badly adhered appendix scar in sessions one, three, five, eight, nine and ten, and you could work on a big toe bunion surgical scar in sessions two, four, and six, in the “lower“ session of either eight or nine, and in session ten.
Some scars are slight and only require a few minutes work. At the other end of the spectrum, the more involved, larger scars may take a up to an hour and may have whole-body releases with their associated historical, emotional content. These more significant scars may deserve more complete integration in the context of a full session. Most people say it feels in the range of three to five on a scale of one to ten. My Rolfing is higher on a sensation level, mostly between four and seven.
There is never a scar that is exactly like another … each scar is unique. Typing and generalization for the sake of shortcuts or formulaic learning is a waste of time.
Attitudes towards scars are interesting. Recipients do not usually love their scars. Many people seem to have an aversion to their own scars. Some have not touched the scar since their surgery and have no idea what it feels like. This probably is some form of denial. I almost always have folks feel a scar before I change it so they can appreciate the change.
When I inquire about scars at first, many folks don’t give me much information. Instead, they say diverting things like, “that was a long time ago.” I like to hear their stories, and I inquire for two reasons. One, it can help the physical release when they express their feelings, and two, hearing the story of the scar helps me to figure it out.
Unresolved history and emotion often become conscious with work around scars. While some of this is rather hair-raisingly intense, thank heavens I have never had anyone relive their surgical procedures.
People will describe everything they consciously remember, right up to the anesthesia. What happens during the surgery under anesthesia never has come up in a session. Every now and again, however, I do hear about a most intriguing journey of the spirit. I hear lots about the recovery: when the stitches came out and the good and bad luck of the healing process, and how they can now tell when the weather is changing. I think of reverse engineering the scar. The surgical report, which details what was done for that particular surgery, is somewhat useful. Some general knowledge of common surgical procedures is good to acquire. Videos of surgeries are available to see in medical school libraries and on the web.
Extreme positions that patients are sometimes put in for the suregeon’s convenience can be a part of their structural troubles afterwards. Deep surgical cuts allow for things to slide further away from each other than was possible in their connected state. Things get stuck where I would have never imagined it possible. Following scars has led me into finding some fascinating surgically related structural distortions. Scar work usually progresses from the surface all the way into the interior reaches of the surgery, including the internal organs. If I don’t resolve the adhesion from the scar, I can’t have optimal placement or function in any involved internal organ.
One of the more interesting aspects of scar work is observing the whole-body changes that can result from it. Because of the possibility of whole-body changes, scar work is best received by people who are receiving Rolfing. However, most scar work does not need a whole session to integrate what is released. It is usually enough to do back work, neck work, and a pelvic lift for balance. This allows for the use of scar work outside a Rolfing series as a “stand-alone intervention” with good success.
I don’t think of scar tissue as stuff to break up or material to get rid of. I think scars are made up of valuable stuff you want to liberate to become vital tissue again. It feels like you use all of it to the good with nothing left over when you are done.
There are many different techniques that change scar tissue. Each technique looks and feels different from the others, and each one works a little differently. The names that we are using are “in-house” and still evolving as we come up with amusing names that “stick.” Here is a list of techniques:
“The Eraser”—For this one, I use mostly my index finger. I hold my finger curled with the tip pointing down and brace the first finger from the palmar side with my thumb. I often brace from the dorsal side with the middle finger. There is some squeezing in the bracing. Staying at the same depth in the scar, I rub with the fingertip forward and back with a motion similar to using an art eraser. I use my other hand to stabilize the surrounding tissues. Erasers can be made with the medial edge of the thumb braced by the first and second fingers. For a large area, sometimes I use my three middle fingers with the thumb and little finger squeezing to brace. I use the heel of my hand as an eraser on large, rough-textured burns.
“Scraping”—This consists of bracing by pushing away from the scar with one hand, while using a clawing motion with my index finger through the tissue into the gap. I pick up and do this again in the same direction rather than flip back through the tissue to the starting place. On a larger scale (for example, on a long and large hip-replacement scar), I use all my fingers at the same time. I usually scrape both sides to the middle to fill in scar gap. I use all my fingers for scraping forwards and backwards for some cross-fiber work in some of the more ragged “natural” scars—a little like using a brush with an arcing, lifting motion.
“Filling In”—This is good for gaps and holes. Using one hand to hold and stretch the area a little so you have something to pull against, work all around a hole or gap, sweeping the tissue into the area. One finger starts and before the first is finished the second starts over and over. I use two, three or four fingers, one after the other in sequence. It looks a little like “drumming the fingers.” I have found that if the hole is due to the loss of tissue, it does not fill in very well. It seems you need all the pieces to really complete the job, and if something large enough is gone, the hole won’t fill in.
“Drawing”—This has some of the look of scraping, but instead of pushing the tissue ahead of your finger, it is pulled along deep behind the finger. I don’t do much bracing with this, as I want the pressure to run deep. It is kind of like using the trailing wake of a boat to do the work. I used this recently on a table-saw cut into the tips of a client’s last three fingers. I ran up the cuts, from the palm side to the end of the finger, the opposite way from where the saw blade went. At the same time I was lifting and hooking the tissues straight back into the spin of the blade, drawing wake off the nail side of my finger. I don’t have a big version of this one.
“The Sewing Machine” (zigzag)—This one works well for tiny striations left within the wide, white part of a scar. These are possibly generated by the stitches as the scar pulls apart. The striations feel a little like tiny splinters embedded in the scar and usually go crosswise to the long cut. I hold my stabilizing hand in the area to be worked using a spanning, spreading motion with the thumb and fingers while I move with a superficial fast zigzag motion through the surface of the scar with the grain of these splinter-like scars. I brace the index finger, squeezing with the thumb on the thumb side and the third finger on the other side.
“Dropping”—This can be done on a small scale and on a large scale. A small scale would be with a fingertip working into a piled-up scar. Relaxing the hand and arm, the fingertip drops into the tissue just to the depth of working and takes a little of the scar down. This is done over and over in the scar, taking it on down until the scar is smooth. I don’t use any bracing with the other hand. On a large scale, it can be done with the whole hand to break those odd adhesions resulting from an overexpansion, like the too-soft poofy feel of abdominal tissue after pregnancy that won’t go away with exercise or the strain left from the swelling due to an infection. Whole-hand dropping will also release a pattern of being stuck in overexpansion, like a drowning episode where the diaphragm is bulging out with the strain of not breathing. Shayna Alexander, a structural integrator from Israel who also teaches karate, agrees with me that dropping has something in common with karate’s soft break.
“Skidding”—This takes a whole plane of tissue and repositions it. Sometimes in surgery, the doctors take a large flap of skin and fold it back. When this large piece of tissue comes back into contact with the tissue from which it was severed, it adheres, usually slightly out of place. I use a flat contact to as much of the whole tissue surface, push down to the depth of the scar, and skid sideways in the direction of the most resistance. The whole sheet comes loose at once and will reposition. I use the palmar surface of both hands sometimes with a touch of torque. When the sheet hits home, I “moosh” it a bit to set it in place.
“Mooshing”—This one works well for a deep ragged scar. I compress the tissue from above so the torn edges meet up and then “smush and mush” the edges together, fitting and tucking. It looks somewhat like wiggling under pressure. I will brace into my own pressure from the other side if I am not using both hands and can reach that far.
“Compression”—This consists of pushing things back together on both large and small scales. I usually use flat fingers or flat hands with quite a bit of force.
It has the feel of gathering things together towards each other, of fitting parts together. I usually do it with both hands at the same time from complementary angles. I usually find many compressions from many angles effective. In surgeries, sometimes tissues are retracted and held with quite a bit of force over a long time. Compression will release the surgery retraction pattern.
“Rolling”—On the small scale, this is a pinch- and-shear motion with thumb and first finger, or the first two fingers. The shear or roll is done within the limits of the tissue, gradually increasing the range of the shear as the tissue lets go. I have used this for ear piercings that were badly done, a dog bite on the lip, or on a scar on the ends of the fingers. For anything larger, one hand on top and the other on the bottom can be used for surfaces the size of fingers and forearms. The larger-size body area limits the use of this one for me.
“Combing”—This is good for long strands along the edges of long scars. On a long cut, there is retraction over time. The longer the time before closing, the longer the surgery takes, the more distinct both edges of the scar become. I usually brace a section of scar stretched between thumb and fingers with one hand and with a thumb or finger edge, (sometimes backed closely by a nail for a little stiffness), and use long sweeps up and down along the fibers along the direction they run with the idea of separating out the strands, like combing. Sometimes it feels a little like scrubbing for the some of shorter strands. I put quite a bit of tension on some of these edges with both the bracing hand and the combing hand.
“Knitting” or “Matching Layers”—This is for both small and large scale. Knitting uses a flat contact. On the small scale, use two flat index fingers with most of the pressure in the distal section of the finger. Put one finger down flat on either side of the scar parallel to the scar. Push down until contact is made. Wiggle forward and back in the horizontal plane, one hand going forward, the other back, as well as up and down, looking to match the layers combined with pushing together with some torque. When a match is made the layer feels like it disappears and I pick up the next layer to work. I work through the layers in the scar.
This meshes the layers in C-sections together and bridges big gaps. It can be done with the whole hand as well for big scars. With the whole hand, I sometimes use a touch of torque to aid in the meshing. Impaired nerve function often resolves in the course of using this one.
Burns
Burns have their own requirements and seem to be among the more difficult scars to restore.
Burns from fire are the most common, often with large areas of damage. If the healing of a large burn is not carefully managed, there can be extensive scarring. Burns seem to heal quite slowly, leaving time for further damage and infection, which makes the surface rough, often crisscrossed with raggedy strands. The hollows are delicate and seem to damage especially easily.
Irradiated tissue (from x-rays or other high- energy sources like synchrotrons, cyclotrons, or linear accelerators) is one of the most difficult burns to restore. These burns seem to lack the long fibers we rely on for directional vector. Their thick denseness is probably a form of atrophy and can feel like leather. Sometimes they feel like some of the surface fat cells have “melted,” leaving the deeper granular layer exposed. If the tissue gets a high radiation overdose, it can get puffy, fragile, and subtly weepy for many years after the radiation.
I don’t have very much experience with electricity burns. The two linemen I worked with who suffered electrical shock and survived had fine ripples and ridges in the gum line. The one person I worked on who got hit by lightning also had ripples in the gum line. None of these clients had any burn marks—entry or exit—to work with.
Most burns will respond to short applications of fingertip “scraping” and “dropping.” The motions are often extra-small, light in pressure, and of short duration until some resiliency is established. The “eraser” works for some of the surface crosshatching and roughness. “Drawing” and “sweeping” over the surface while smoothing with fingers or a broad flat hand surface seems to work reasonably well.
Overall, I do not get the same level of resolution from burns that I do from other kinds of scar work. Burns take more time for work. They often have profound emotional residue. They probably do best with many moderate interventions over time.
Plastic Surgery
Plastic surgery has its own unique considerations. Plastic surgeons will bevel the edges of cut before stitching, which gives a cleaner join, but with tissue trimmed away, the resolution is not going to have the feel of “home and done” that other scars that are not trimmed will have. Plastic surgeons are better at matching internal layers and they use more internal dissolving stitches. I look for places where stitches can leave odd little knots through the tissue. Plastic surgeons match up the cut edges of an incision more evenly with less excess tissue to “tuck” in at end of the scar. The usual procedure of stitching a scar is to start at one end and go to the other. This often leaves extra tissue to deal with. Devices like medallions are used to take up the extra tissues from joining the two unavoidably mismatched edges of a tummy tuck. Medallions look like a circle, an inch or two in diameter, with the tucks done around them. These medallions are sometimes surgically removed at a later date.
Plastic surgeons mostly do their cuts with one hand, which means the arcs they cut are not a mirror image from side to side. Using only one hand to cut with creates an interesting asymmetry to be aware of and to work with.
The long arcing cuts of plastic surgery at the hairline may be helped by scraping a shallow plane along the line of the cut with the little finger edge of the hand or the first finger side. Bracing the tissue behind the scraping with the opposite hand helps. Running a ripple ahead of a flat surface through the flat scar, like running a wrinkle through the carpet to reposition it, can also help. Huge stiff areas like tummy tucks, where the whole top sheet of abdominal tissue is cut loose and pulled down like a window shade and reattached, are helped by whole-hand dropping. I drop in to where the layers are joined, and then sometimes I will use a little “mooshing” to reconnect the top layer to the layers below so it feels soft and bouncy like a tummy again. Sometimes there are mistakes that end up as knotted-up places. Often at the eye corners you find a piled-up hard knot that feels like it was perhaps improperly stitched together. Plastic surgeons will schedule another surgery to take care of these knots. Dropping is particularly effective for reducing these knots and flattening the tissue out again.
Integrating Scar Tissue into the Fascial Web[:]
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