Scar Scepticism: what’s the big deal with scarring?

This is a free preview of a paid episode. To hear more, visit mskmag.substack.com You may already be treating scars. You may not. You may have no idea that treating scars is even a treatment. You could have been in your profession for decades and have no reason to believe that assessing or ‘treating’ a scar is required. You may have built your business on the treatment and scarring. You may think scar massage is just ‘the emperor’s new clothes treatment’; another hands-on treatment fad, which will pass in time. You may be scar sceptical. You may not. So let’s have a look at scarring; through a clinical reasoning lens, by reviewing the evidence, understanding anatomy and piecing together what we already know, to see if scar therapy intervention has a place in our treatment tool box… or not. I’m sure we can all agree that scars exist. They are the body’s natural healing response when the skin and surrounding and/or deeper tissues are cut, damaged or traumatised in some way. \[1,2] This has been happening since the dawn of time. We can’t stop the body forming a scar, but can we influence what happens to the scar once it is formed? Before we investigate this question, we need to understand if scars have any impact at all. **A scar is not simply a line on the skin** One reason scar scepticism persists may be the tendency to view the scar as a superficial structure. The visible scar is only one manifestation of tissue injury and repair. Following surgery, the healing response involves inflammation, fibroblast activity, extracellular matrix deposition and remodelling. Tissue properties can change during this process, including pliability, thickness and mechanical behaviour.\[3] **The ‘superficial’ scar may also extend beyond the skin and cause adhesions** In abdominal and pelvic surgery (for example), healing occurs across multiple tissue planes, and postoperative adhesions may develop. Importantly, an adhesion is not synonymous with pain. The existence of adhesions does not establish that they are clinically relevant to an individual’s symptoms. This is where precision in language becomes essential. Instead of saying: “The scar has caused adhesions and the adhesions are causing the patient’s pain” we should distinguish the different hypotheses: