On October 2, 2014, in Active Release, Massage, Uncategorized, by Dr. Dino Pappas


Over the past several months we’ve had a couple patients present into the office with past history of surgery or trauma, inevitably leading to scars and adhesions.  As trivial as this sounds, every scar has a story.  Some scars have multiple stories.


Every scar has a story..

Every scar has a story..Some scars have multiple stories

Scars require a little more time and attention than just glancing over them in the history part of the exam.  Some scars cause physical limitations (strength deficits, range of motion deficits, muscle facilitation, muscle inhibition, etc.) and some scars have psychological limitations (anxiety, depression, fear, pain, etc.).  Some scars can cause both.  Any way you slice it, a scar is not just a piece of  fibroblastic tissue.  A scar can be a serious pathological entity and should not be taken for granted.  When treating a scar, make sure you are sensitive to both the physical and psychological as both do matter.

Below are the top 5 scar tips:

1). Scar Tissue Mobilization: Physical scars  and adhesions can be superficial or deep and therefore seen or unseen and palpable or unpalpable. It is important to have in your toolkit treatments that affect both superficial and deep scars.  For the average person (non health care practitioner) reading this blog, simply put you have to find a practitioner that possesses the right tool for the right problem.  Patients, your outcome will suffer if you don’t find a practitioner with the right tool/treatment for the right problem at the right point in time.

It is our opinion that treatments such as IASTM – Implemented Assisted Soft Tissue Mobilization (Graston, FAKTR, Sound Assisted, Gua Sha, Hawk Tools, Ellipse Tools, Fibroblaster, Edge Tool, Smart Tools, etc.), needling (acupuncture) and suction based treatments (vacuum based cupping, traditional cupping, etc.) are  best utilized for superficial (close to the surface) based scars.  It is also our opinion that deeper scars and adhesions can be affected with hands on methods such as Active Release Techniques, deeper and targeted soft tissue and myofascial release methods (ex. Fascial Distortion, Functional Range Release, etc). and visceral(organ) manipulation methods.

2). Education/Self Treatment: Scars require patient participation via self treatment.  Educating the patient is imperative  in this process.  Strategies such as frequent soft tissue mobilization (self massage/self myofascial release), compliance with home exercises (frequent lengthening/remodeling of tissues), nutrition (vitamin C, vitamin E, Vitamin A, increased protein intake, zinc, magnesium and anti inflammatory enzymes) and hydration (increased water intake) all become integral in managing scars.  You can treat a patient for 30 minutes in your office but unless they understand that they control the other 23.5 hours then treatment has less chance of working.  The other 23.5 hours may be more important than the 30 minutes they they are in your office.  For the average person reading this blog, we need your help!  Your compliance for the remainder of the day matters more than the time in office you spend with us.

3). Look Above and Below: Scars and adhesions can be created by abnormal movement patterns leading to injury OR lead to abnormal movement patterns after the initial injury.  For the average person reading this blog, abnormal movement can both lead to a scar/adhesion or result from a scar.  Find an expert in your area that not only can treat the scar but that can assess the areas and movement above and below the scar/adhesion.

4). Recognize Your Limitations: Get help!!!  Sometimes scars have a strong psychological component.  Seek counseling if you note in the history that the psychological component outweighs the physical.  It is not a sign of weakness to ask for help.  It is a sign that  you’ve taken the first step on the journey to truly heal.

5). Patience:  Remodeling a scar takes time, patience and diligence.  Getting too aggressive in trying to remodel a scar/adhesion can be counterproductive with bruising, pain, and swelling.  This could encourage non-compliance and lead to poor outcome.  Also psychological scars can sometimes be more difficult to heal than physical scars.  Be patient!

We’ve hoped you enjoyed our top 5 scar tips. Contact Dr. Dino Pappas at 708-532-2346 or at for more information or to schedule an appointment to evaluate your scar.

*** About The Author — Dr. Dino Pappas, DC, MS, ATC, CSCS, CKTP, cert MDT: Dr. Pappas is a chiropractic physician, certified athletic trainer and certified strength and conditioning specialist. Dr. Pappas blends the best of physical medicine with the best of integrated medicine to help patients and athletes of all shapes and sizes. He utilizes tools such as chiropractic manipulation, soft tissue work (Graston, Active Release, Myofascial Release and joint mobilization), biomedical acupuncture, functional movement based assessment, the McKenzie Method,  strength training and conditioning, customized nutrition and specialty laboratory testing (blood, saliva, urine, and stool) when needed.  Dr. Pappas’ clinical focus is sports medicine, conservative orthopedics, rehabilitation and integrated medicine. His sports medicine interests are endurance athletes, overhead athletes (pitchers, throwers, volleyball players and tennis players), contact sports athletes (football, rugby, lacrosse, field hockey, soccer and basketball) and Crossfit athletes.  He reads and interprets the medical literature daily to stay abreast of cutting edge advances in his field. The doctor is currently the team chiropractor for the Windy City Thunderbolts minor league baseball team and a sports medicine volunteer for Andrew High School in Tinley Park, IL. He is an avid runner and aspiring triathlete having completed 4 marathons, 3 half marathons and numerous 5 and 10k races. The doctor is also active in the local, suburban Chicago running scene. He has goals of qualifying and competing in the Boston and New York Marathons, the Ironman in Kona, Hawaii, and climbing Mt. Kiliminjaro in Kenya, Africa. One day he hopes to serve his country as a team chiropractor for the United States Olympic teams and serve as a team chiropractor for one of the professional teams in Chicago.  His mantra is “Why Put Off Feeling Good?”  He can be reached by email at or at 708-532-2346. ***

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