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70 m a s s a g e & b o d y wo r k n ove m b e r/d e ce m b e r 2 0 2 3 Visible scars start at the surface, but what we see on the skin may just be the tip of the iceberg. Scars can run deep, affecting multiple tissues at once and influencing their texture, function, and relationship with each other. Scar tissue feels different under our hands, often more fibrotic and palpably distinct from the surrounding tissue; it's not always easy to make sense of what we are touching. Taking a closer look at the anatomy of scar tissue can help refine our understanding of what makes scars and how our massage work inf luences them. REGENERATION VS. SCARRING All animals (including humans) have the built-in capacity to heal their bodies when wounded, but there is more than one way that wounds can heal. The two major biological mechanisms of wound healing are regeneration and scarring. Regeneration occurs when the body can recreate the original damaged tissue. Some creatures, like salamanders, have this ability and can regenerate entire limbs when severed. Humans, however, have very little regeneration capacity (unless you happen to be a mutant character from a popular comic book). Instead, we heal primarily through scarring. While regeneration recreates the original tissue, scarring patches the injury with new fibrotic tissue. Scarring successfully closes the wound, but at a cost: changed tissue architecture. Let's take a closer look at how scar tissue is made. A SCAR IS BORN Whether it's a paper cut, surgical incision, or internal injury like a heart attack, all injuries initiate the body's healing response. The creation of scar tissue both patches the wound and replaces damaged tissue. Scar tissue may look and feel different, but it's made from the same types of protein fibers that naturally exist throughout the body. Some of the fibers in a scar are optimized for tensile strength (collagen fibers) and others for elasticity critical thinking | ANATOMY FOR TOUCH Scar tissue from surface to deep. A cross section of scar tissue that formed at the incision site of a lumbosacral back surgery. Running vertically through the center of the image, the scar is visible at the superficial skin level and deep throughout the subcutaneous adipose tissue. The changes in tissue architecture have been created by the addition of new collagen fibers that healed the wound, providing stability and support from the skin's dermis to the depth of the incision. For a more detailed look at this image, go to for our companion digital extras. Image courtesy of The Anatomy of Scar Tissue By Rachelle Clauson and Nicole Trombley TAKEAWAY: Though bodyworkers can't prevent or eliminate scar tissue, our skillful touch can aim to influence its development, remodeling process, and long-term integration into the surrounding tissue. 1

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