Massage Tutorial Video: Working with Mature Scar Tissue

How do you work with a client with older scar tissue? Here’s a video about my strategy:

I talk about some myofascial-inspired techniques for working with scar tissue, but mostly I discuss my general approach.

When I work with an area with extensive scarring, my primary concern is with the client as a whole. When someone has a visible/palpable area of past trauma, it can be easy to become hyper-focused on the region. While plenty of direct work may be warranted, this can leave the client feeling dissected, and it can feed into the narrative that this is their “bad leg” or “bad shoulder.” Certainly focus in, but always integrate the area back into the bigger picture.

Conversely, it can be tempting to avoid an area of past trauma. With a burn scar, or hip replacement, or amputation, we might feel like treating the area carefully. While I like this impulse (I think we should always approach the body with kindness and care), it can also unconsciously feed into a stigmatizing narrative where the site of past injury feels like “that thing” rather than “me.”

When I have a client with past injuries/surgeries, I try to have a conversation about their expectations, as well as their feelings about receiving direct contact in those areas. While some clients will be gung ho about you diving right in, others may express some trepidation. If they have fear surrounding the area, or if they’re concerned that you might cause pain, then ask about starting with some brief, gentle contact. By communicating before, during, and after, you may find that you can approach the area more directly as time goes on. Do keep in mind that some clients may prefer to keep areas of past trauma “off limits” indefinitely!

Newer massage therapists, how do you feel about working with sites of past surgery or injury? Massage veterans, do you have any illustrative stories that might encourage your fellow MTs to work with these areas more directly?

I’d also love to hear from those of you who receive work for your own scar tissue. Did it take you a while to receive contact? Did your massage therapist do anything to help you accept massage in that area, and has it had positive effects?

4 thoughts on “Massage Tutorial Video: Working with Mature Scar Tissue

  1. I love your work and your approach. I once had an instructor in massage school put someone on the table for me to work on who due to structural formation issues during fetal development only had part of a foot. I was to do a full body massage for this person for my final. When I came to the foot, I was suprised but not worried. I massaged the foot as I would anyone else’s. The instructor made the comment that I should have skipped the foot. I disagreed. It was a functional part of her and should have been treated as such!

  2. Thanks so much for sharing that story, Jen! Needless to say, I’m completely on board with how you handled that 🙂

  3. Try to TEACH and be informative by using knowledge, proper terminology, and most of all demonstrate with ur hands. And yes, scar tissue hardens over time due to lack of circulation/blood flow that brings the nutrients into the area. However, with extra work increasing blood flow to the area can definately work wonders so dont tell the client its too far gone. A good therapist should always instill hope and faith in healing. Its amazing what healing is done when the body AND mind work together!

  4. The instructor that Jen had should be ashamed (or struck off) well done Jen. I have a client who had polio as a child, many children in The U.K. had it in the 1950’s. This resulted in her having a noticeably smaller deformed foot, which is always colder than the other one. She loves her foot massaged and the warm Chakra stone I use to hold on it in Winter is most welcome.

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