By Jennifer Lang
As soon as I got out of bed, I knew something was wrong. My left foot felt fine, but my right one hurt each time I took a step. I did a quick mental check of potential causes: a bike ride with kids—OK. A vigorous yoga class—maybe. A 30-minute jump-roping session in my lightweight, snazzy sneakers—ouch!
For the following two weeks, I winced when I walked. An orthopedist, who X-rayed my foot, discovered a bone spur and the beginnings of mild arthritis in both feet. He concluded that I'd pinched a nerve jumping rope in non-supportive shoes. Prescription: time, patience, and no more strenuous yoga.
A week later, still in pain, I went to a chiropractor. After reviewing the doctor's report, he felt my right foot, then left, then right again. New diagnosis: scar tissue. It's normal, he said, but because of a severely sprained ankle 13 years ago, I had a lot of it.
Hearing about everyone else's aches, my guess is I'm not alone. Many people walk around with vague pain in their shoulders or backs thinking they've got tendonitis or arthritis. What if it's not one of those catchall "itises," but really scar tissue? And what if healing requires a more hands-on approach and some yoga-like stretching instead of an anti-inflammatory and a sling?
Moving the matrix
"The reality is if you've ever had an injury, you have scar tissue," says Natalie Nevins, a medical doctor and a certified yoga instructor in Hollywood, California. Scar tissue forms as the body's natural response to trauma, such as sprains, strains, and repetitive stress injuries to muscles and joints. It consists primarily of collagen, which is a type of connective tissue that assists healing of the damaged tissues. "We often think of it as bad, but without it our bodies would never heal," says Nevins.
But scar tissue formation isn't always problem-free. Unlike soft tissue—which has fibers running alongside each other in the same direction—scar tissue can form randomly, potentially causing pain and limiting function. "Think of a game of pick-up sticks where you stand the sticks upright in your hand and then gently let go, allowing them to drop any which way," says Nevins. "That's what scar tissue can do if you don't help your body heal properly." Meaning? Say you sprain your wrist. Most likely, your instinct is to immobilize it based on the RICE theory—rest, ice, compression, and elevation. But what you really need to do is keep moving. "Rest doesn't mean immobilize," says Nevins. "It means do what you can do—gentle, pain-free, range-of-motion, non-weight-bearing exercises—and slowly work your way up each day." If you keep proper motion going and strengthen the surrounding area, slowly working to rehabilitate the injury and stretch the surrounding areas that are tight, scar tissue will lay down in the same pattern as the original tissue.
Easy does it
Because scar tissue takes years to form and is created any time you damage skin, tendons, ligaments, fascia, muscle, and joint capsules, you may not realize you've developed a problem with it until it's too late. "It's a process that occurs over a long period of time, and you won't even know it," says Robert Inesta, MD, a chiropractor in Eastchester, New York, with a focus on soft tissue treatment. That's why knowing how to treat an injury in the days and months following it becomes so critical. Once heavy scar tissue has formed improperly, you may get into a situation where more aggressive treatment—chiropractic or physical therapy—is needed to break the tissue down so it can heal the right way. Gentle motion at the time of injury encourages a more natural healing process and prevents you from having to break up troublesome and impeding scar tissue years later.
That said, moving an injured knee, wrist, or ankle can cause significant pain and discomfort. Your first instinct might be to mask the pain with medications. Don't. "Pain is your body's way of communicating with you," says Nevins. "If you don't listen to your body's warning signs, you continue to cause micro-trauma to an area, which leads to further inflammation and disorganized scar tissue formation." Thus, there's a delicate balancing act between moving an injured area and causing more damage to it. Pain is at the fulcrum. Pay attention to its signals, and you'll know when to say when.
The body as a single unit
With any injury, it's important to assess not only the place of pain, but also all the tissues that can affect that area. "You have to look at the entire body as a continuous biomechanical unit," explains Inesta. With repetitive stress injuries, for example, such as lateral epicondylosis (tennis elbow), you feel pain in your elbow, but the origin of that pain may come from the shoulder or wrist. The shoulder may not rotate properly because of a scar tissue adhesion in the rotator cuff. Or, the muscles that extend the wrist may be overworking to compensate for weak wrist flexors, creating stress that will lead to the formation of scar tissue in the elbow. The same goes for nerve entrapments such as carpal tunnel syndrome. If the nerve is restricted in the carpal tunnel, it will develop scar tissue adhesions in other surrounding areas such as the elbow, shoulder, or neck because it isn't sliding properly. Backaches or strained necks from sitting at a desk all day are no different. "We aren't designed to sit straight for eight hours every day," says Nevins. "If you stop moving an injured joint or soft tissue that long it interferes with the normal healing process, causing scar tissue to be laid down randomly." The result: pain and loss of mobility.
Yoga to the rescue
Any kind of stretching can help ease scar tissue buildup. "Yoga can be especially effective because it's based on motion, which is precisely what the body needs," says Nevins. Hatha, or physical yoga, works every joint, stretches key areas of the body, strengthens weaker muscles, and balances the body out. "Any pose can be good to do, depending on where the scar tissue is," says Nevins. You should never go to the point of pain, no matter what. That means modify and keep it gentle. Don't bend as deeply or hold as long as you usually do, and use extra props. For example, when my right foot was hurting and I couldn't sit in Virasana (Hero Pose), I rolled a blanket up and put it underneath the tops of my feet. That little lift made the pose pressure- and pain-free, enabling me to stretch my feet and legs.
It doesn't matter whether you're an avid yoga practitioner or a newcomer—you need to work within your limitations and condition your body properly. Also, try finding an instructor who understands injury and knows how to modify poses based on a person's physical restrictions. "Even if you set out with the best of intentions to exercise," says Inesta, "if you do motions incorrectly or don't have proper body alignment, you can hurt yourself and cause scar tissue to build."
As for me, the pain in my foot is long gone. Twice a week for one month, the chiropractor kneaded his thumb into the sole of my foot, into the outer ankle, and up into the calf muscle to break down the old scar tissue buildup. I found myself wishing I'd known about keeping my injury mobile 13 years ago. Over time, the pain lessened—and contrary to the orthopedist's advice about yoga—I found the poses and intense stretching actually helped. This time, I knew that movement, rather than rest, would lead me toward ultimate healing.
11 Exercises to Heal Scar Tissue
The following exercises can help bring movement back into areas of the body most commonly affected by scar tissue adhesions. Practitioners recommend stretching twice a day, holding stretches for 10 to 20 seconds with 10 repetitions. Break up your workday by doing the ankle and neck exercises at your desk.
Ankle
- Ankle alphabet (not shown): Sit on a chair and let your legs dangle. Using right (then left) ankle and foot only, trace the letters of the alphabet from A to Z in the air.
- Ankle/calf stretch (below): Stand on a doorway sill with your heels on the floor and your toes on the sill. Rise up on your toes until you feel a stretch through both calves.
Wrist & Elbow
Since the majority of the muscles that move the wrist in all directions come from the medial and lateral sides of the elbow (inside and outside), any wrist stretch will affect the elbow.
- Wrist flexor stretch (above): Sit with your elbows splayed on a table until your forearms rest on the table. Begin to press your palms together until you feel a stretch.
- Wrist extensor stretch (not shown): Extend your left arm in front of you, grasp your fingers, thumb included, with your right hand and gently pull your wrist back until you feel a stretch. Hold for 20 seconds, then change sides.
Back
- Cat/Cow (above): Kneel on all fours with hands under shoulders and knees under hips. As you inhale, slowly lift your head and your tailbone toward the ceiling, arching your back and reaching your collarbones forward (main photo). On an exhale tuck your chin and tighten your stomach as you round your back and look at your navel (inset).
- Spinal Twist (not shown): Sit on a chair and put your hands on your shoulders with your elbows out to the sides, parallel to the floor. Slowly twist your torso left, then right.
Lower back
Pelvic Tilt (not shown): Lie down on your back with your knees bent and feet flat on the floor. Tip your pubic bone toward your navel as you move your navel up and back toward your spine. Release your tailbone back to the floor, relax, and repeat.
Bridge Pose (below): Repeat pelvic tilt, but this time raise your buttocks off the floor as high as you can comfortably go, engaging your stomach muscles and lifting your sternum. Don't tuck your chin.
Neck
- Neck rotation (above): Sit up straight. Turn your head slowly to look over one shoulder, come back to center, and look over the other.
- Neck extension (not shown): Lie on your back, knees bent, and lift your chin gently toward the ceiling. Come back to center. Repeat.
- Lateral neck flexion (above): Slowly tilt head toward left shoulder, using your right hand to guide. Repeat on right side.
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