Whilst scarring is natural, many patients don’t realise that they can do something to help reduce the impact. In fact, 47% of patients are unsure about how to care for their scars.1
Dr Ioannis Goutos, plastic surgeon with specialist interest in scar management and British Skin Foundation spokesperson advises, “There is evidence to suggest that massaging a scar can aid the healing process and relieve itching, however it needs to be done with care.”
In the following blog we discuss the why, when and how of scar massage, helping healthcare professionals to explain to patients the value of massaging their scars with care.
Why massaging scars is important, both physically and psychologically
Offering advice to patients on how to correctly massage can help improve a patient’s physical and psychological wellbeing.
The physical benefits of scar massage:
There are a number of factors that can affect wound healing, however scar massage can help speed up the healing process and provide the below physical benefits:2
Reduces the build-up of scar tissue – the scar itself is a growth of new collagen fibers that the body forms to repair any damage caused by a wound. Excess tissue that forms can make a patient’s muscles feel weaker and stiff. Regular massage helps prevent the build-up of this excess tissue, leaving skin feeling suppler.2
Relieves itching – when a wound forms, the nerve fibers close to the skin detect the difference and send signals to the spinal cord – this can result in a feeling of itchiness.3 When massaging, the body’s soft tissue structures are manipulated4 and a number of studies have found that massage can help to reduce the itchiness.5 6
Stimulates blood flow – massaging stimulates the flow of blood in the body and this in turn:
Improves flexibility, allowing the skin to feel less rigid
Helps reduce redness and swelling – making the skin appear less aggravated and hence creating a flattened appearance
Helps decrease numbness and regain feeling in the area.2
What is the psychological impact of scarring? And how can massage help?
In an image-conscious society that places immense pressure on how we look, scars can cause some people to experience a loss of confidence and self-esteem. A recent survey revealed that 9% of people with scarring feel that they are being judged by others, and 22% are often openly questioned about their scar. Some experience feelings of isolation (9%) as a result of their scar, and the same percentage feel that their scar has become more visible than their true self.1
Jo Hemmings, Behavioural Psychologist explains, “It is often difficult for patients to be impartial about their scars and they may feel embarrassed, ashamed or socially inhibited as a result. They may feel that scars remind them that they are no longer who they used to be, or that other people judge them or see them differently because of a scar.”
As a healthcare professional, you play an important role in helping patients to have a positive relationship with their scars. This can be achieved by encouraging patients to spend time caring for their skin by engaging in techniques such as scar massage. Although there is a need for more research, a number of studies have found that massage can help the body to release tension and relax.4 Additionally, research has found massage can also lead to increased feelings of positivity.6 Nevertheless always take care to reassure patients that scarring is normal and not something to be ashamed of.
When to advise patients to massage their scars
If a patient massages their scar prematurely it could cause the wound to tear or reopen, risking an infection.2 It’s therefore important to advise them to not begin massaging until the wound is fully healed. In other words, they can start massaging when the skin no longer appears broken and new skin has formed, covering the scar.2
It’s advisable to instruct your patients to massage for at least six months following surgery as the more time spent engaging with the skin, the more likely they are to gain the benefits.7 If the patient is finding massage helpful, continuing to massage for longer than six months is not harmful for the scars and can be encouraged.7
Remember to let patients know that they should stop massaging if the skin feels warmer than the skin around it, they experience bleeding or more pain than usual.7
How to massage a scar with care
Once wounds have healed, patients can massage their skin two to three times a day for around 10 minutes to hydrate the skin, help promote skin elasticity and make it supple.8 Advise your patient to use the tips of two of their fingers, trying a combination of circular, vertical and horizontal motions.7 They should start with a light pressure and progress to a firm pressure, stopping if it’s causing them pain.7 Each patient scar is unique and what is best for them will depend on a number of factors. It’s worth working with the patient to develop a massage plan suited to them.
Dr Ioannis Goutos, explains, “Traditionally, patients have been universally advised to massage scars vigorously and frequently, but there is emerging evidence that this practice can be counterproductive in fresh, red scars. It is now recommended that a qualified healthcare professional provides a tailored assessment and management plan regarding scar massage.”
In summary, scar massage plays a vital role in wound recovery. Though the skin can never form back to its original state completely, when performed correctly, massage can help aid flexibility in the skin, prevent itching, reduce the appearance of the scar and hence also play a part in reducing any psychological impact a scar might have on the patient.
Resources for healthcare professionals:
Bio-Oil Professional has several free resources for healthcare professionals on the topic of scarring, free to download:
Resources for your patients:
1 Survey of 1,000 UK people with scarring conducted by Opinion Health on behalf of Bio-Oil. Feb 2016
2 McClure, G and Dr. Tiberi, M.D., OS (2018) “Scar Tissue Massage: When & How To Massage Scar Tissue After Surgery”, Accessed 23.09.19, https://www.peerwell.co/blog/2018/06/27/scar-tissue-massage-after-surgery/
3 Advanced Tissue (2014), “Understanding Wound Healing and the Itching Dilemma” Accessed 18.10.19 https://advancedtissue.com/2014/10/understanding-wound-healing-itching-dilemma/
4 PennState Hershey, Milton S. Hershey Medical Center, (2015) “Massage” Accessed 18.10.19, http://pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000354
5 Gurol et al (2010) “Itching, pain, and anxiety levels are reduced with massage therapy in burned adolescents.” J Burn Care Rehabil
6 Field et al (2000), “Postburn itching, pain, and psychological symptoms are reduced with massage therapy.” J Burn Care Rehabil
7 Patient Education Department, Moffitt Cancer Center and Research Institute (2008) “Managing Your Scar”
8 Bio-Oil, Evans, D, Gutteridge K and Dr Hextall, J (2016) “A-Z Scars” P26