Scar Tissue

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 This article by Dr. Ian Nurse originally appeared in our October 2012 edition, issue #10.

“Scar tissue” is a term that is becoming more and more popular throughout the endurance sports world. As it’s hard to find a runner who isn’t dealing with some sort of nagging injury or everyday pain, many are seeking the help of trained professionals that deal with endurance overuse injuries. What are we learning to be the root cause of most of these injuries? You guessed it: scar tissue.

So what is scar tissue and how can it be prevented or treated once it cozies up in your body? Simply put, scar tissue is the body’s version of a Band-Aid. However, this Band-Aid isn’t the type that seems to only last a few days and comes off with a few leg hairs. Rather, it’s one that literally and figuratively puts a clamp on the surrounding soft tissue structure (a collective term for muscle, tendon, ligament, fascia, and nerve) to prevent any more damage. How does it do this? This kind of Band-Aid is made of a super substance called collagen. This special connective tissue protein is the body’s version of duct tape with Gorilla Glue as its adhesive. In other words once it’s applied, it aint budging easily. So while the body has an amazing way of protecting itself, it doesn’t seem to understand the runner’s psyche that says to get out there and run “an easy 10” the day after “tweaking” one’s calf.

scar tissue pull quotes nurse 12.7.14

As a sports chiropractor treating many endurance athletes, I am addressing that stubborn scar tissue with every patient. While many patients can understand the Band-Aid analogy, some are still confused as to why the scar tissue has formed in the first place. “I don’t remember straining my hamstring” is a common reaction I hear when I explain to the patient that there is a build-up of scar tissue creating that tugging sensation at the back of her knee. Scar tissue isn’t always the result of an acute pulled muscle. Many times scar tissue is laid down in defense of the daily activities that we put our body through both at work and at play. Running thousands of steps each day even at a slow pace can create an overuse or repetitive action injury involving micro-tears of the soft tissue structures. Eventually, over time a cumulative injury cycle starts creating more and more scar tissue to the point where that “easy 10” is nothing but a painful limp. This cycle looks something like this:

 Some sort of injury to the soft tissue: acute, repetitive, or constant tension

Tear or Crush

Inflammation/Decreased Circulation and Swelling

Adhesion/Fibrosis = Scar Tissue

Weakness and Tightness


Further injury to the soft tissue and the start of the cycle again

How can you prevent and treat this dreaded scar tissue? Last month, I described one treatment option in the form of Graston tools. This month, I will explore another popular method being used by physical therapists, chiropractors, and massage therapists called Active Release Technique, commonly abbreviated to ART. Originally founded by a chiropractor who treated numerous endurance athletes, ART is a patented, state-of-the-art method of both healing and preventing injuries to soft tissue. With more than 500 specific treatment protocols unique to ART, the technique targets scar-tissue injuries whether the injury is acute, chronic, traumatic, or overuse related. ART practitioners must complete three extensive training seminars covering the entire body in order to be fully certified. Some common conditions alleviated by ART include: runner’s knee, IT band syndrome, headaches, shoulder pain, tennis elbow, carpal tunnel syndrome, back pain, sciatica, and plantar fasciitis.

Each treatment session is a combination of examination and treatment. The practitioner uses his hands, as opposed to the stainless steel tools of Graston, to evaluate the texture, tension, and movement of the tissue. Abnormal tissue is treated by combining precisely directed tension along the tissue fibers and very specific patient movements to elongate the fibers through their natural full range of motion. In contrast to typical massage where the muscles are treated in a stagnant position and thus only exposing a limited number of muscle fibers, ART involves the patient moving the involved tissue through its full range of motion maximizing the amount of tissue treated.

Like Graston, ART is not for the faint of heart. In fact, it can be quite uncomfortable at times. As a patient myself, I often find myself escaping to my “happy place” [Editor’s Note: We love the Fight Club reference.] in the midst of some ART passes over my calves. Most of my patients describe it as a “good pain” that actually feels good simply because it feels effective. However, a few minutes of pain in the hands of a trained professional is well worth it in comparison to running miles and miles with that pesky Band-Aid causing more pain than good. Like we all know, no matter how you remove a Band-Aid, a little pain is to be had.

Ian Nurse is an avid member of the Boston running community having competed in hundreds of road races within the New England area. Ian is a licensed chiropractor and a certified provider of Active Release Technique (A.R.T.) and Graston Technique at his Boston practice, Wellness in Motion. 

If you would like to read more from our October 2012 issue, click here.

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