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 like tendons and cartilage. After injury, collagen fibers are laid down in a sporadic and disorganized pattern to prevent recurrence of injury. If you’ve ever mended 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 variation in the type of scar they create. For example, a snap injury would be a cut from surgery, or a cut from barbed wire, or you often see them on a horse’s forehead from a trailer loading incident (sound familiar?) in In this case, the tissue is cut, never to match perfectly again.
A compression injury is caused by forceful trauma. An example of this type of injury would be getting kicked from another horse which causes a large round swelling under the skin that will leave a hard mass of scar tissue resembling 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 tissue and the hardest to get through.
Lastly, in a repetitive motion injury, the tissue is worn away by 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 hardening of soft tissue 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 bone buildup cannot be removed by massage therapy, the surrounding soft tissue can be mobilized and possibly detached from the bone growth.
There is no guarantee that manual therapy will break tissue, and you should understand that by mobilizing tissue that has grown as a scar, you will need to create a new lesion by removing adhering tissue from surrounding 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 on 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 it takes as long for scar tissue to break down as it takes to build up. This might give you an idea of what you are dealing with.
Second, assess the injury. If there is still heat in the area, it has become chronic and could still be forming scar tissue. You should not massage an inflamed area. You should discuss this with the horse’s vet. It may be necessary to administer anti-inflammatory medications or an icing program to stop the chronic process before moving forward. Also, assess whether the knight has been compensating by not using the piece. In the event that the injury is to a limb, a horse will sometimes stop using that particular limb and may overdevelop muscles in other parts of the body. If this is the case, you may need to incorporate some additional bodywork into these areas as part of your healing therapy.
Be careful here. A long-term painful injury can have the horse nervous because you are handling this sensitive area. Do not perform these techniques unless you have consulted with your vet and the vet trusts 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, 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;
Begin by effleuraging (gentle stroking) on the surrounding areas towards the heart. Place an ice cup (a paper cup of frozen water that you can tear off like a popsicle) or rub the area with an ice cup before you begin. This will desensitize the area.
Once the area is desensitized, begin to rub your thumbs across the scar 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 rib cage, 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 movement chain.
