We have all heard of scar tissue, but not many know what it actually is. We know that it relates to our injuries; sometimes lingering after an injury while other times setting the stage for an injury to occur. But what is it really and why does it affect our healing?
Everything in the body is surrounded by layers of connective tissue. Your muscles, nerves, blood vessels, organs, even your brain are surrounded by different types of connective tissue that support and compartmentalize the different structures in the body. The majority of this connective tissue is made up of different types of collagen fibres – the most abundant being type 1 collagen. This high quality collagen is a very strong tissue that works like a braided rope – it is able to bend and move but is very resistant to stresses along its length. The problem is that it is time consuming for the cells of the body to produce quality collagen, which would significantly affect the length of time for us to heal after injury.
If you tore a ligament in the body, the majority of damage to that area will be to type 1 collagen fibers. Our body is faced with a decision; we need to patch the injured area as quick as we can so we can get back some sort of mobility, but we don’t have time to wait until we can repair it with the good quality type 1 collagen. Instead, the body asks the fibroblasts (the cells that produce most components of the connective tissue) to produce some scar tissue – an immature form of connective tissue that we are able to produce quickly to patch an injured area. This is no different than discovering in the middle of the night that you have a leak in your roof. Chances are that you will not be able to reshingle the roof in the morning, but you may be able to perform a quick patch to stop the leak that you know you will have to replace with a proper job when you have more time.
What is supposed to happen to scar tissue with time is that it slowly gets remodeled to look like the tissue that was there before. It begins as a weak type of connective tissue that is not in an ordered fashion with fibers quickly produced and placed where ever needed. There is no cohesiveness to the structure of scar tissue. With appropriate movement the body begins the process of breaking down the scar tissue and replacing it with stronger type 1 collagen. This process will occur for up to 1 year following an injury – remember, it’s not easy to produce the good connective tissue.
As usual, there can be a couple of areas where the system can run into trouble. Until that scar tissue is remodeled it will be weaker than the tissue that was there before. This is one of the reasons why proper and complete rehabilitation of an injury is required to make sure it does not occur again. If you try to compete on the same injured ligament hat has “healed” (no pain anymore) but is mostly made up of scar tissue, there is a good chance you can hurt that ligament again. Appropriate stress to the injury site at the appropriate time will allow the scar tissue to form in a somewhat organized manner as well as guide the remodeling process.
Another issue is that the production of scar tissue is not just controlled by the nervous system like many processes in the body are. The production of scar tissue is also affected by the tension placed on the scar tissue itself. When scar tissue is placed under too much tension it will stimulate the production of more scar tissue – even if the nervous system is telling the injured area that it is time to move into healing and begin converting the scar tissue to quality collagen. This is the case when you move too early on the injured area.
A common occurrence of scar tissue not forming and remodeling properly is with a cesarean section. Tension in the connective tissue of the abdomen from previous inflammatory processes (view article about inflammation) can cause more scar tissue to be produced. The physical demands of movement can stimulate the fibroblasts to produce more scar tissue than necessary, leading to mobility restrictions in the long term. And that’s not including the stress of having a newborn baby while recovering from an abdominal surgery. This is partially the reason why two people with the “same” surgery can have two completely different healing timelines. One may not have any predisposing factors like previous injuries or inflammation, while the other did. This is not to say that latter scenario cannot be healed. What it means is that the body’s natural healing processes are not able to function as they should and need appropriate guidance (view article about the body as a self healing mechanism).
A final restriction that can happen related to scar tissue has to do with inflammation (view article about inflammation). Connective tissue is made up of a series of collagen fibres – organized woven “ropes” that are surrounded by water molecules. Inflammation causes the water molecules to be released and the collagen fibres begin to degrade. Essentially the ropes begin to fray. These newly exposed frayed ends begin to stick to the structures around them and cause restrictions in the mobility of the tissue. Instead of an area of the body working as a series of separate tissues working in unison, the area begins to move as a block of tissue. There is no separate movement of the layers of tissue; which affects the mobility of the muscles and joints, and also creates something the rest of the body will have to compensate around.
The importance of the mobility of the connective tissue of the body cannot be understated when looking at proper function and decreasing pain. More importantly, we cannot achieve balanced health if we do not have proper mobility of these tissues as all of our nerves and arteries have to pass through them. Scar tissue that has not healed properly presents a significant barrier to proper mobilityhat will affect the body. At Awakening Health our focus is to identify these restrictions in the tissue and remove those barriers so your body can express the health that lays underneath.