Scar tissue can restrict movement in adjacent joints, eventually creating injury to the joint itself. This type of restrictive tissue can become stronger and as non-elastic as connective tissue like tendons and cartilage. After an injury, collagen fibers are laid down in a sporadic and unorganized pattern in order to prevent the recurrence of injury. If you have ever patched a hole in a pair of jeans with the zig-zag stitch on your sewing machine, you know how this works.
Scar tissue occurs as a result of injury, surgery, or repetitive motion. These are very different types of injuries that will create a variation in the type of scar that they create. For example, a shear injury would be a cut caused by surgery, or a barbed wire cut, or you often see them on a horse’s forehead from a trailer loading incident (sound familiar?) In this case, the tissue is severed, never to be matched up perfectly again.
A compression injury is caused by force trauma. An example of this type of injury would be getting kicked by another horse causing a large, round swelling under the skin that will leave a hard clump of scar tissue resembling a hard mass. The injured part becomes resistant to movement due to pain, so the non-movable area begins to lay down scarring to the bruised cells. Even though this is not the worst type of injury, it can become the thickest and most difficult tissue to break through.
Lastly, in a repetitive motion injury, tissue wears down from constant friction. The body builds scar tissue as the muscle or joint continues to break down by defying the body’s signals. This type of scar buildup can be in the form of hardening of soft tissue, or bone spurring due to Osteoarthritis. If you have ever seen a horse with a giant, non-movable knee, this is a long term result of the body trying to heal a chronic condition by sending more and more bone to the site. Although this bony type of buildup cannot be removed by massage therapy, the adjoining soft tissue can be mobilized and possibly become unstuck from the bony growth.
There is no guarantee that manual therapy can break up the tissue, and you must understand that by mobilizing tissue that has grown over like a scar, you will be required to create a new injury by pulling the adhered tissue from the adjoining tissue. This can be painful, and requires a new healing process attended by more therapy.
In many cases, where an athletic horse has been retired due to an old injury, it is quite worth the time and effort. I have worked with many cases of scar tissue, and to see the benefits of my efforts has been worth the long process.
Be sure that you understand the physiology of the tissue and bone in the body part that you are working with before beginning this type of therapy, and I always recommend consulting with the horse’s vet so that they can approve of your plan.
First, try to find out the exact etiology of the injury. Most importantly, how old is the scar? If an old injury carries chronic inflammation, there could be several months and maybe years of tissue built up. A rule of thumb is that it takes as long to break down scar tissue as it has to build. This might give you an idea of what you are facing.
Secondly, evaluate the injury. If there is still heat in the area, it has become chronic and might still be building scar tissue. You should not massage an inflamed area. You should discuss this with the horse’s vet. It may be necessary to give anti-inflammatory medication or an icing program to stop the chronic process before going forward. Also, evaluate if the horse has been compensating by not using the part. In the event that the injury is in a limb, a horse will sometimes stop using that particular limb, and may be over developing muscles in other parts of the body. If this is the case, you may have to incorporate some additional bodywork to these areas as part of the scar therapy.
Be careful here. A long term, painful injury might have the horse on edge that you are handling this sensitive area. Do not perform these techniques unless you have checked with the veterinarian and they are confident in your ability as a handler. This can be a dangerous undertaking. Remain open to changing your plan according to how the horse responds. Remember, you will be creating a new injury by working through scar tissue. You may have to work in short sessions, mobilizing the adjacent joints, icing, then letting it rest for a day or so. As the scar begins to release, you will need to keep the area mobile while the damage that you create heals properly. Never force an adjacent joint. Release the soft tissue, then gently stretch the area while mobilizing the skin and fascia involved.
Here is an example of how to use manual therapy on adhered tissue;
Begin by Effleuraging (gentle stroking) the surrounding areas towards the heart. Either place an ice cup (paper cup with frozen water that you can tear away like a popsicle) or rub the area with an ice cup before beginning. This will desensitize the area.
Once the area is desensitized, then begin transversely stroking the scar with your thumbs back and forth and up and down to mobilize the tissue in each direction. If it is on a limb, you can use your hands to “wring” the tissue back and forth. Follow this mobilization by Effleuraging the area again towards the heart to move the blood through. You can alternately stroke the tissue in a transverse fashion, followed by Effleurage towards the heart a few times.
Mobilize the area. You can do this by walking or gently stretching. If the scar is not in a limb, but maybe a compression scar in the rib cage, you can perform “carrot” stretches by inviting the horse to bend away from the scar. This mobilization will remind the brain to re-incorporate this area back into the chain of movement.