So what's the deal with "Scar Tissue" ?

You may have heard your Physiotherapist, Sports Therapist or another medical professional talk about scar tissue…“what on earth are they talking about?”

So…what is scar tissue? Why does it form? And how does it affect my rehab and performance?

These images show how muscle tissue appears pre and post injury.

Scar tissue is a fibrotic tissue and is part of the body’s natural healing response after a soft tissue injury. For example, let’s say we tear a Hamstring, scar tissue is then formed to fill the void and replace the injured tissue. Note that, muscular tissue has the ability to contract and relax, where its extensibility and strength are key properties- scar tissue is tough and is not pliant! 

Following an injury, soft tissue will undergo a bleeding phase; the quantity, depends on the severity of the injury, and usually occurs within the first 4-6 hours. Subsequently, soft tissue will experience a period of inflammation, lasting between 1 to 3 days. Scar tissue often forms within the Proliferative phase of healing, which ranges from day 1 to 4-6 months, where the majority of scar tissue is deposited 2-3 weeks post-injury (but will start from day 1).

Fibrotic scar tissue, mainly consisting of Type III collagen, is deposited and laid down to the injured tissue in disarray. This means that, instead of the fibres running parallel in conjunction with the muscle fibres (this can also be any soft/connective tissue- e.g. ligaments, tendons, visceral, blood vessels), they are disorganised and weak. As the tissue matures, type III collagen develops into type I collagen, where the cross-links of its foundations and scaffolding are much stronger.

What happens when scar tissue is disorganised?

Scar tissue will always present itself in a disorganised manor. It is then down to the Therapist and the athlete to re-organise these fibres as much as possible through therapeutic interventions. If one were to immobilise the injured tissue for a prolonged period of time, scar tissue will remain disorganised and adapt to the length of the immobilised tissue, reducing the extensibility of the muscle. This is a recipe for re-injury!

So how does Sports Therapy and injury rehabilitation help deal with scar tissue formation?

When it comes to Sports Therapy and injury rehab, timing is key! There are a variety of interventions a Sports Therapist/Physiotherapist can implement to aid the orientation of the fibrotic tissue and return the muscle back to its pre-injury state. However, interventions introduced to early can re-open the weak scar tissue and cause tissue bleeding- once again!

Early ambulation is a great start for the injured athlete to keep the tissue active, introduce weight-bearing load and contractile stress to the scar tissue- helping to reorganise the tissue alignment. Light stretching, soft tissue treatment and isometric (static contractions) exercises are other ways to promote lengthening of the tissue without re-injury.