Key Point

• Scarring can hide the depth of an injury. Start with assessment to better understand that depth.

Disney’s The Lion King is one of my favorite stories. The tale of a boy confronting his devious uncle in an attempt to avenge his father’s death (a theme borrowed from William Shakespeare’s Hamlet) evokes the pain in each of us that grows when wounds don’t heal. Yes, it’s about the anguish of a son who lost his father and the ache of a community after their noble leader has fallen. But it’s also the story of a man who stands in the shadow of his brother and the hardness that develops when that darkness suffocates him. In my opinion, the uncle in the story is one of the most intriguing characters; not only because he is complicated and dark, but also because his name is Scar.

It’s the perfect name, really. Scar is the embodiment of what it feels like to harden and stiffen in the aftermath of insult and injury. He is angry, unbending, and demanding of attention. That is exactly how a scar acts in our anatomy. No matter the injury, the basic process of wound healing applies: a painful incident, a protective reaction, and then the downward spiral of gripping tension and stifling restriction. Granted, if a wound is handled with proper care in the immediate aftermath, a lot of that anger can be avoided. But, as we know, this isn’t always how things play out. 

The Tricky Scar

Whether an injury has healed well is complicated. There are a lot of opinions about what to do and a lot of variables dictating what actually gets done. Ultimately, what a wounded human does for self-care and to promote healing is entirely out of your hands. Often, an injury takes on a life of its own, its lifespan facing a plethora of possibilities.

Scar, the character, has a shining moment in The Lion King in which he rallies his tattered hyena gang. (He does this, of course, in a song.) Gearing them up for the maliciousness they are about to enact, the point he drives home is “be prepared.” And this, my fellow caretaker of scar tissue, couldn’t be more on point. There are many methods for approaching an injury and the havoc it has wreaked on anatomical tissue. But being prepared for what lies on your table is by far the best starting point. 

What was the injury? How long ago did it occur? How severe was it? How healthy was the client when it happened? How have they managed it since? There are so many questions to ask that help you better decide your approach. But remember: Whether your client has clear answers to these queries is one thing. Their tissues, most likely, still don’t know what hit them. An injury—be it a sprain, a strain, a break, or any of the -itises—disorients the anatomy it has taken over. It’s your job to reorient them. 

Connect at the Start

Assess the site of the injury before getting your client on the table. Use real-life movements, like standing, leaning, or lifting, to get a greater understanding of not only the range of motion but also proprioception. Don’t hesitate to palpate as your client moves through these actions. Get a stronger sense of what the calf feels like after an Achilles strain in combination with a slight squat. Or, gather information on what the rotator cuff feels like after a shoulder dislocation while it attempts to lift a water bottle. The forces and loads that shift the way muscles and fascia act are huge pieces of information. 

With your client on the table, shift your work away from breaking things up to guiding them back together. Isolate a muscle or combined muscle grouping, ask your client to fire said muscle or muscles, and move your work with the action. Use one hand to slide up the peroneal as it everts the foot and your other hand to encourage the eversion. Or use one hand to slide along the forearm extensors toward the elbow as they extend the wrist and hand and your other hand to assist in the extending. Work with the flow, not against it.

Being prepared for the work you do with wounded clients is expansive, but don’t get overwhelmed by it. Remember, a scar is the body’s way of protecting itself. Left unattended, though, that protection can become destructive. Don’t isolate the scar more. Reintroduce it to the body it belongs to and help the scar remember that it’s a part of something bigger. This is, after all, a powerful tactic in preventing an uprising. 

To read more about massage therapy and treating scars, read “The Anatomy of Scar Tissue” in Massage & Bodywork magazine, November/December 2023, page 70.