The best people all have some kind of scar.” ― Kiera Cass, The One

I found this quote the other day and it could not be any truer. We all have scars of some sort or another whether they are emotional or physical scars. Some scars are physical but internal and still not visible. Scars are a sign that a transformation has occurred on the way to being who we are today, a transformation coming at some personal cost. The bigger the scar the bigger cost and often the bigger the lessons learned.

Why do we scar? Why can’t things go back to the way they were before? How are we effected by scars? The fundamental purpose of scar tissue is to seal the hole as quickly as possible. When injury occurs, physical or emotional, there is usually damaged tissue, a hole from the cut or torn tissue. Our body immediately jumps into repair mode, starting with inflammation to send out the news that there’s an injury, and certain chemicals are dumped into the area to start the healing process, including the formation of scar tissue. The scar tissue’s job is to seal the hole as quickly as it can with long, spindly fibers that crisscross in all sorts of directions and will tack one layer of tissue to another. The trouble is that the layers of the body (skin, fascia, fat, fascia, muscle, etc.) are suppose to glide over each other. When scar tissue forms and tacks one layer to another, the layers no longer will glide over each other: they will be stuck together and move as one.

Maybe this would be a good place to describe fascia and what it does for us. Fascia is an elastic fabric just below the skin, covering and going through all of our muscles, wrapping around our arteries and veins and even our nerves. It is literally everywhere and connects from head to toe in a diagonal pattern. Our right arm is connected to the left leg and the left arm is connected to the right leg via the fascia network. This allows us to glide from one motion into the next by winding up and stretching the elastic fibers of the fascia, and using that kinetic energy to move into the next motion. This is why we walk in opposition.

What happens when we put a kink in this fabric? Doesn’t really matter how we got the kink/scar tissue, but it has an effect. Last month I wrote about changes in sensation after a mastectomy, trans or otherwise. Scar tissue shrinks as it matures and settles in. Now the network of fascia has not just an anchor but also a pull where it should not. This can manifest in knee pain, ankle pain, hip pain. I am reminded of a few cases recently in which I saw two trans men with foot problems, and when I looked at their mastectomies, we discovered some issues with the scars – they were not moving as well as they should. Not only can this create a restriction in which things don’t glide the way they should but it can also trap nerves in the scar and become painful. Ironically enough I was also working with a cis-woman who had double mastectomies, breast implants, then radiation to one side. Again, we go back to the scars and connect the dots for why the woman was having chronic knee pain on the side opposite the radiation. Radiation scars behave differently than traumatic injury scars by developing problems many years later. Traditional scars will become problematic fairly quickly, well within the first year.

What can be done? Lots! The main thing is to massage the scar. Unlike the neuro re-education I mentioned last month, where we were updating the brain’s GPS, this time we are re-aligning the scar tissue so the fibers line up with each other, lay flat, and look better, move better. It’s like taking a box of toothpicks and dumping them onto the counter in an unorganized heap. The fibers are going in all sorts of directions and it is lumpy. Roll your hand over the toothpicks back and forth. Eventually the toothpicks all are laying flat, in the same layer, and line up in the same direction. Scar tissue is the same way. Massage it perpendicular to the incision, back and forth, rolling the tissue under your finger thus encouraging the fibers to line up with each other, in the same direction and the same layer. The same thing holds true for emotional scars too, even the old ones we have hidden for many years. We can confront the scar and the injury from a place of forgiveness which allows us to process what has happened and get our life moving again, often in a new direction.