Scar tissue can restrict movement in adjacent joints and eventually create injury to the joint itself. This type of restrictive tissue can become stronger and less elastic than connective tissue such as tendons and cartilage. After an injury, collagen fibers are deposited in a sporadic and disorganized pattern to prevent recurrence of the injury. If you’ve ever repaired a hole in a pair of jeans with the zig-zag stitch on your sewing machine, you know how this works.
Scar tissue occurs as a result of injury, surgery, or repetitive motion. These are very different types of injuries that will create a variation in the type of scar they create. For example, a shear injury would be a cut caused by surgery, or a cut from barbed wire, or you often see these on a horse’s forehead from a trailer loading incident (sound familiar?) in In this case, the fabric is cut, never to match perfectly again.
A compression injury is caused by forceful trauma. An example of this type of injury would be being kicked by another horse causing a large, round swelling under the skin that will leave a hard mass of scar tissue that resembles a hard mass. The injured part becomes resistant to movement due to pain, so the immobile area begins to scar the bruised cells. Although this is not the worst type of injury, it can become the thickest and most difficult tissue to break through.
Lastly, in a repetitive motion injury, the tissue wears away from constant friction. The body builds scar tissue as the muscle or joint continues to break down in defiance of the body’s signals. This type of scar buildup can be in the form of soft tissue hardening or bone spurs due to osteoarthritis. If you’ve ever seen a horse with a giant, immobile knee, this is a long-term result of the body trying to heal a chronic condition by sending more and more bone to the site. Although this type of bony buildup cannot be removed by massage therapy, the surrounding soft tissue can be mobilized and possibly detached from the bony growth.
There is no guarantee that manual therapy will break down the tissue, and you must understand that by moving tissue that has grown as a scar, you will need to create a new lesion by removing the attached tissue from the adjoining tissue. This can be painful and requires a new healing process accompanied by more therapy.
In many cases, when an athletic horse has been retired due to an old injury, it is well worth the time and effort. I have worked with many scar tissue cases and seeing the benefits of my efforts has been well worth the long process.
Make sure you understand the physiology of the tissue and bone in the body part you’re working with before beginning this type of therapy, and I always recommend consulting with the horse’s veterinarian so they can approve your plan.
First, try to find out the exact etiology of the injury. Most importantly, how old is the scar? If a previous injury leads to chronic inflammation, there could be several months and perhaps years of tissue buildup. A general rule of thumb is that scar tissue takes as long to break down as it does to build up. This might give you an idea of what you’re up against.
Second, assess the injury. If there is still heat in the area, it has become chronic and may still be forming scar tissue. You should not massage an inflamed area. You should discuss this with the horse’s veterinarian. Anti-inflammatory medications or an icing program may be necessary to stop the chronic process before moving forward. Also, assess if the knight has been compensating by not using the piece. In the event that the injury is to one limb, a horse will sometimes stop using that particular limb and may over-build muscles in other parts of the body. If this is the case, you may need to incorporate some additional bodywork in these areas as part of your healing therapy.
Be careful here. A long term painful injury can make the horse nervous because you are handling this sensitive area. Do not perform these techniques unless you have consulted with your veterinarian and the veterinarian is confident in your ability as a handler. This can be a dangerous undertaking. Be open to changing your plan based on how the horse responds. Remember, he will be creating a new injury by working through the scar tissue. You may need to work in short sessions, mobilizing adjacent joints, applying ice, and then letting it sit for a day or so. As the scar begins to break free, you’ll need to keep the area mobile while the damage it creates heals properly. Never force an adjacent joint. Release the soft tissue, then gently stretch the area while mobilizing the involved skin and fascia.
Here is an example of how to use manual therapy on attached tissue;
Start by Effleuraging (gentle stroking) in the surrounding areas towards the heart. Put down an ice cup (paper cup of frozen water that you can pluck like a popsicle) or dab the area with an ice cup before you begin. This will desensitize the area.
Once the area is desensitized, begin rubbing the scar crosswise with your thumbs back and forth and up and down to mobilize the tissue in each direction. If it’s on a limb, you can use your hands to “twist” the tissue back and forth. Follow this mobilization by again spraying the area towards the heart to draw blood through. Alternatively, you can stroke the tissue crosswise, followed by Effleurage towards the heart several times.
Mobilize the area. You can do this by walking or gently stretching. If the scar is not on a limb, but perhaps a compression scar on the ribcage, you can perform “carrot” stretches by inviting the horse to lean away from the scar. This mobilization will remind the brain to bring this area back into the chain of movement.