Working with Scar Tissue: Generally, and in the Context of EDS

Estimated reading time: 4 minutesI’m delighted to hear from Jan Trewartha on this blog.  Jan will share her expertise on scars and adhesions. Aside from being an amazing scar worker, Jan is also the founder of The Fascia Hub.

I saw Jan give a talk last year on scars and she had such an interesting perspective on them, that I asked her to come and speak to our Zebra Club members and write a blog about her scar work.

Scars can be both physical and emotional. Scars tell us a story of healing after injury, trauma, or surgery. Scars have a physical appearance but often have emotions tied to them. With EDS and hypermobility, scars may behave differently. Poor wound healing, excessive or fragile scarring, and adhesions could impact our movement. Learning more about scars could help improve our movement and mobility.

Jan: Firstly, let me say that I am not an expert on hypermobility/EDS, nor do I claim to know a huge amount about it. I am a specialist in scars and adhesions, a therapist in practice, and a teacher of Sharon Wheeler’s ScarWork. I have also written a book for the trade on the subject (1).

My interest in EDS has come from meeting and talking to Jeannie Di Bon, primarily through the British Fascia Symposium and The Fascia Hub (2), both of which I founded and direct.

What is a scar?

What is a scar? Those to the skin are caused by surgery or injury which may be from an outside cause or self-harm – a scar forms as the body heals itself and the result is variable and influenced by a number of factors.

The scar could over-heal as in a keloid or hypertrophic scar, where the fibroblastic activity does not stop automatically and creates excessive tissue; in a keloid this overflows the boundary of the scar and can be hugely deforming, while in a hypertrophic scar, there is raised scar tissue which stays within the natural scar boundary.

Or, there could be under-production of scar tissue as in hypotrophic or atrophic scars and the result will be concave, looking lower than the skin level.

Normally, a scar will simply heal in the expected way and be fairly visually acceptable – but not always.

What happens under a scar?

People are often most concerned that it should not be too ugly or attract negative attention. What the majority of patients are unaware of, however, is what can happen under the skin that can lead to minor or major issues in functionality, mobility, and structural stability.

As a ScarWork therapist, I see these are just as important, if not more so, than the aesthetic result because the effect can be so severe or even life-threatening. Internal scarring that may stem from internal surgeries, inflammatory conditions, or infections will also cause problems; I will address these points more fully in The Zebra Club Member Meet-up.

What are Adhesions?

Adhesions: these can form during the healing process and may, for example, simply create a minor area of stuck tissue around the scar, or in serious cases adhere major organs together with bands of fibrous tissue.

They stick structures together that should not be stuck together. They can create distortion and torsion through the abdomen, for example, as when a laparoscopy scar and an epidural scar connect.

Scars feeding into other damaged areas

There needs to be more research on this, but empirically we ScarWork therapists know – and can see on assessment – that scars often feed into each other under the skin, just as a scar will feed into a damaged area of tissue.

An example is where a Cesarean scar feeds into a ‘baby hip,’ where the mother has held the baby on one hip and the fascia, in response to the consistent weight and unusual positioning, has done what it always does in response to internal or external forces;  laid down collagen along the lines of force, in this case creating a hip superbly adapted for the purpose.

Unfortunately, that densified tissue will often feed into the scar and/or other areas of densified tissue, creating further problems. This kind of damage cannot be rectified by normal massage; fascial work is needed to restore mobility and functionality.

Scars and EDS

So much for how a scar might affect us in general, but how do things change when our clients have EDS?

The fragility of the skin, the tendency to haematoma development and keloid scarring, skin hyperextensibility, and delayed wound healing are obviously going to make a difference in how a surgeon approaches surgery for someone with any type of EDS.

Looking at research on the topic, one really in-depth paper recommends (3):

• Wounds to be closed without tension
• Sutures to be left in twice as long as normal
• Wound to be supported with tape longitudinally (helps prevent tearing)
• Silicone-based dressing to be applied along the wound to speed healing
• Be aware of risk of post-surgical bleeding/haematomas.

How I do ScarWork with EDS

There is a lot more to be researched, no doubt, but how do I, as a scar therapist, work with clients with EDS?

I always take a full history but you would be surprised how many clients I have had do not tell me they have the condition. Sometimes I suspect they have not known, and I have consequently worked with them not knowing, however, no adverse responses have been reported back to me.

Sharon Wheeler’s ScarWork is very light anyway so there is, I feel, little risk of causing bruising or damaging skin, unlike the ‘old days’ when I was a State Registered Nurse and we were advised to ‘knuckle’ a scar to break down the scar tissue!

I do a shorter session with an EDS client, with the lightest of touches, and as always add in plenty of integration at the end to help the body adapt to its new internal structuring, then wait to see how they respond. I do check in with them before their next session, to see how they are, and clients are always invited to contact me with any concerns.

Normally I advise a client to rest well and avoid any strain on their body for at least a week and ideally three as it can take that long for the internal rebalancing that occurs when freeing up restrictions in the fascia to settle down.

With a client with EDS, I would suggest it may take longer, but then there is an understanding of what strain the body can take anyway in someone aware of their body’s needs.

I look forward to discussing how scars affect the body in more detail in the member meetup.

Member meet-ups are always recorded and stored in the Resources section of the app!

Jan Trewartha

Originally a State Registered Nurse, now a complementary health professional (since 1992), Jan Trewartha specializes in scars and adhesions, and teaching therapists how to work with them using Sharon Wheeler’s ScarWork. She also teaches Fascial Unwinding & Energy Awareness; the focus of work and teaching is the use of light touch. She is the founder and director of The Fascia Hub. Jan is co-editor and co-author of Scars, Adhesions and the Biotensegral Body, a textbook for hands-on practitioners.

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