Scar Tissue 101

Flexibility

Who do you know that stretches consistently yet doesn't gain additional flexibility or relief from tight muscles? Stretching helps maintain and improve flexibility of healthy muscle; however, a lack of flexibility with consistent stretching indicates the muscle being stretched is NOT a healthy muscle.

Soft Tissue Injuries

Soft tissue injuries are a result of imbalance between your body's capacity and the load placed on it; where the load exceeds the body's capacity.

Fractured bones, sprained ankles and torn ligaments are examples of acute injuries. Such injuries arise if a single specific event causes trauma to healthy tissue as a result of excessive load over a short period of time sufficient enough to cause damaged tissue.

Cumulative trauma disorders, also known as repetitive stress injuries or overuse syndromes, are major problems in the workforce, athletic population, musicians, as well as the general population. These syndromes are more commonly known as rotator cuff syndrome, tennis elbow, tendonitis, plantar fasciitis, carpal tunnel, and chronic low back pain, to name a few. Health care costs for these cumulative trauma disorders in the United States is the largest health care expenditure exceeding low back pain and is estimated to cost above $110 billion yearly.

It is sometimes a shock when pain arises for no apparent reason without a known or specific cause. The concept of having pain after something "breaks" is difficult to understand when nothing changes past performing regular routine tasks. In fact, how does something "break" when nothing has changed in your everyday tasks and activities that you've always done with no prior significant problem(s)? The answer is weakness and or inhibition from repetitive cumulative trauma. Gradual long standing musculoskeletal issues from repetitive tasks can weaken tissue, which is sometimes completely unknown to individuals until the onset of pain. That being said, it is not usually one thing, but the accumulation of many things that injure us. If it wasn't bending over to pick up your tooth brush one day it would have happened tying your shoe the next day. This is an example of normal load and decreased capacity, which is a common and major problem.

Here are a few reasons why tight muscles do NOT respond effectively to JUST simple stretching and how decreased capacity, weakness, and inhibited soft tissue develop with repetitive trauma:

Sticky Muscles

Muscles are layered in the body and need to glide past one another to shorten and lengthen efficiently. As a result of repetitive motions and cumulative trauma disorders, adhesions accumulate formed initially as a protective mechanism serving to limit the motion of the affected tissues to allow the damaged tissue to heal slowly. Unfortunately, the body does not always read its owner's manual and the resulting adhesions are often laid down in different directions not following the direction of muscle action, which ultimately causes restrictions in free movement of your tissues. The other problem is that adhesions form sticky abnormal bands of tissue that grow together in an abnormal way. Adhesions develop between joints and stick or attach to muscles, ligaments, tendons, nerves, and blood vessels, resulting in restricted motion and or numbness or tingling if nervous structures are obstructed. As the tense soft tissue structures rub against each other, eventually, an injury occurs, which heals with inflammation and scar tissue formation (8).

Mechanical Limitation of Length

Areas of scar tissue do not lengthen as normal muscle does, which results in limited range of motion ultimately changing the axis of rotation of a joint. This is often the culprit in people who stretch all the time and don't increase in flexibility.

Slow Speed of Elongation

Scar ridden muscles may still reach full length with stretch depending on the matrix orientation and flexibility of the scar; however, the time required to achieve full length is increased. This is because scar tissue has an increased coefficient of friction, haulting its speed of flexibility. What this means is if one muscle contracts at a normal speed and its opposing muscle lengthen slowly one and or both of the muscles are more likely to tear.

Slow Speed of Contraction

The speed of muscular contraction can be affected by the coefficient of friction, which is increased causing slower contraction and or neuromuscular inhibition due to pain or improper joint position. Lack of fluid muscle contraction can affect stability.

Decrease Maximum Strength

When scar accumulates it sticks strongly to surrounding muscle fibers resulting in inability to shorten when the muscle contracts. Besides pain, strength can be affected simply by decreasing the amount of functional muscle. As a result the other portions of the muscle will require a higher relative percentage of muscle fiber recruitment. This can result in earlier fatigue and failure.

Muscular Tightness

Healthy muscles can become irritated and tight with continued use when adhered to scar tissue resulting in a protective contraction or muscle spasm. This is often the case when people obtain temporary relief from massage or manipulation.

Pain

Scar tissue has been shown to have pain nerve endings, thus, presenting the ability to produce pain. Depending upon how the scar affects function, pain can be felt at the site of scar, at the involved tendon attachment, or in the structure that must compensate for any deficiency.

Nerve Entrapment

Nerves travel through, under, and around other structures. Where they lie close to or travel through muscles, they can become entrapped. Nerves need to be able to slide past the muscles they are next to. This motion can be limited by the development of scar tissue. The scar effectively glues the nerve to the muscle, so when you move the nerve develops tension instead of sliding. This can cause weakness, numbness, pins and needles, burning, and aching sensations.