Scar tissue and fascia: scar massage and movement after surgery or injury

Scars take a year or more to mature

A wound has about half its final strength at 6 weeks and never more than about 80% of the original. Remodelling goes on for up to a year or more, and most scars soften and fade over 1 to 2 years.

Sources 1, 2, 3

Massage may help, but the evidence is weak

Studies of scar massage report less pain, itch and tightness, but they're mostly small, they measured results in many different ways, and much of the evidence is from burn scars. Massage won't make a scar disappear.

Sources 4, 5, 6

Start once the wound has fully closed

Wait until the wound has closed, the stitches or clips are out and there are no scabs: usually 2 to 4 weeks after many operations, and after your 6-week check following a caesarean. Your surgical team's advice comes first.

Sources 7, 8, 9, 10

Little and often

Use unperfumed cream or plain oil, and press firmly enough to whiten the skin but not to hurt, for 5 to 10 minutes, 2 to 3 times a day, for months.

Sources 7, 3, 8, 2

Silicone and sun protection

Silicone gel or sheets reduce raised scarring a little, with weak but consistent evidence. Keep a new scar covered, or use sun cream with a sun protection factor (SPF) of 30 or more, for at least a year.

Sources 11, 8, 2

Keep moving, within your team's limits

In a trial of 392 women, exercise starting a week or so after breast cancer surgery improved arm function at a year, with no more complications. In pigs, restricting movement after a small fascia injury made the layers of fascia glide less.

Sources 12, 13

Fibrous repair, not new skinStrong evidence

After a wound, the body lays down new collagen quickly and in a disorganised way, then realigns and cross-links it. That remodelling can last up to a year or more. A wound has about half its final strength by 6 weeks, and the most it can ever reach is about 80% of the original.

Sources 1, 14

Scars settle over 1 to 2 yearsStrong evidence

A new scar is normally red, hard and raised, and a firm 'healing ridge' under a fresh wound is normal. NHS guidance says most scars fade over up to 2 years, taking up to 18 months to mature and from 3 months to 2 years to become paler, flatter and softer.

Sources 2, 3, 15, 16

In fascia, a scar is fibrosis, not 'stickiness'Emerging evidence

Fascia researchers separate densification, a thickened glide layer that can ease quickly, from fibrosis, in which trauma, surgery, diabetes and ageing change the fibrous layers themselves. A surgical scar is the second kind. Scars can tie skin to the layers below, which is why hand therapists use massage mainly to improve glide: 98% of 116 surveyed in Australia did, though few measured the result.

Sources 17, 18

Stillness makes it worse, at least in animalsEmerging evidence

In pigs, a small injury to the low-back fascia plus 8 weeks of restricted movement cut the glide between fascial layers by 52%, even on the uninjured side.

Source 13

Adhesions inside the bodyStrong evidence

After surgery in the abdomen or pelvis, bands of scar tissue between organs and the lining of the abdomen (adhesions) are common. Across 196 studies, they caused over half of small bowel blockages after abdominal surgery, and about 2 in 100 patients had one.

Source 19

Raised scars and keloidsStrong evidence

A hypertrophic scar is raised and firm but stays within the wound and usually flattens with time. A keloid grows beyond the original wound and doesn't usually settle without treatment. Keloids are more common in people of African, Asian or Hispanic descent and usually appear between puberty and 30. Both are best understood as ongoing inflammation deep in the skin, made worse by tension and irritation.

Sources 2, 20, 21

Pain can lastStrong evidence

After common operations, 10% to 50% of people have pain that persists and 2% to 10% have severe pain, mostly from nerve injury. After a caesarean, wound pain persisted in about 15% of women at 3 to 6 months and 11% at a year or more (15 studies, 4,475 women).

Sources 22, 23

Scar massage: probably helps, weakly shownMixed evidence

A 2022 review of 25 studies of scars after surgery (1,515 people) found every study reported some benefit for pain, movement or the scar itself. But the studies measured results in 45 different ways, ranged from one session to three times a day for 6 months, and 13 added other treatments. An earlier review found 27 of 30 surgical scars improved but called the evidence weak.

Small studies without a comparison group reported softer, less tender caesarean scars and less stuck scars on the limbs. Much of the firmer evidence is from burn scars, below, so it may not carry over to a neat surgical scar.

Sources 4, 6, 24, 25, 5

Burn scars: less pain and itchEmerging evidence

Across 15 trials (780 adults), massage reduced burn scar pain by about 1.5 points on a 0 to 10 scale and itch by 0.4 points, with unclear effects on stretchiness and redness. Other reviews agree on pain and itch, and in 146 people with raised burn scars, adding massage to standard care improved thickness, colour and elasticity. The studies are of low to moderate quality.

Sources 5, 26, 27, 28, 29

Breaking up adhesions: shown only in ratsMixed evidence

Hands-on therapy reduced adhesions inside the abdomen in rats. In people, the studies are small and uncontrolled, and dense tissue needs far more force than hands apply to change shape. Massage may make a scar softer, more mobile and less sensitive; breaking it up isn't shown.

Sources 30, 31, 32, 33

Silicone gel and sheetsEmerging evidence

In a Cochrane review of 20 trials (873 people), silicone gel sheeting roughly halved the risk of raised scars in people prone to them and improved thickness and colour, but the trials were of poor quality and open to bias. After surgery, silicone gel did better than placebo or nothing across 6 trials (375 people), and matched other non-silicone creams. It probably works by keeping the skin covered and moist: a hydrating gel-cream matched it on those measures. Scar guidelines still make silicone the first choice.

Sources 11, 34, 35, 36

Taking tension off a healing scarEmerging evidence

Tension across a healing wound drives raised scarring. In a single small trial after caesarean section, 70 women were randomised but only 39 finished: at 12 weeks, raised scars had formed in 41% of those without tape and in none of those who wore paper tape along the scar. A tension-relieving dressing slightly improved scars after tummy tuck surgery at a year.

Sources 37, 38, 39

Kinesiology tape and cuppingMixed evidence

Stretchy kinesiology tape did no better than the same tape applied without stretch on raised burn scars (22 people), though in 16 people, taped scars were paler 3 months after a small skin graft was taken from the buttock. We found no trials of cupping on scars; one study combined cupping with four other treatments and had no comparison group, so it can't show what helped.

Sources 40, 41, 42

Vitamin E doesn't helpEmerging evidence

In a double-blind trial in 15 people, each with one scar treated half with vitamin E, it had no effect or made the scar look worse in 90%, and a third developed a skin rash (contact dermatitis). A review of 6 studies found too little evidence for it.

Sources 43, 44

After breast cancer surgery, early exercise helpsStrong evidence

In 392 women at risk of shoulder problems, a physiotherapy-led programme of stretching, strengthening and activity, starting 7 to 10 days after breast cancer surgery, improved arm function and pain at a year, with no more wound complications or lymphoedema.

Source 12

Cording in the armpit resolved faster with treatmentEmerging evidence

In 46 women with cording in the armpit after breast cancer surgery (axillary web syndrome), 15 sessions of stretching, hands-on therapy and scar massage helped it resolve faster, with less pain and more shoulder movement than in the comparison group.

Source 45

Desensitising an over-sensitive scarMixed evidence

In a Cochrane review of rehabilitation after carpal tunnel surgery, one small trial of a desensitisation programme found no benefit for hand function. It may still help comfort; the steps are below.

Source 46

Raised and growing scars need a clinicianEmerging evidence

For keloids and raised scars that keep growing, the evidence is for treatments a clinician gives: steroid injections, laser, freezing (cryotherapy) and surgery combined with other treatment. Even after injections, up to half of keloids come back. Self-care can't do their job, so ask a GP early.

Sources 20, 47, 2

Once the wound has fully healed

Start once the wound has fully closed, the stitches or clips are out, and there are no scabs or weeping. Your surgical team's timing comes first; these are typical starting points from NHS leaflets.

• Most operations: 2 to 3 weeks after surgery (one NHS hand therapy unit), or about 4 weeks (one NHS plastic surgery unit).
• Knee replacement: 2 to 3 weeks, once the clips are out or the wound has healed (one NHS physiotherapy leaflet).
• Carpal tunnel surgery: once the wound has closed and the stitches are out, often 10 to 14 days (the carpal tunnel surgery guide).
• Caesarean section: after your 6-week postnatal check, once the scar has healed.
• Old scars: an NHS caesarean leaflet says it's never too late to start, though changes may be smaller.

Sources 2, 7, 8, 9, 10, 48

After a sprain or strain

After a sprain or strain, the scar forms deep inside. NHS advice is to avoid massage for the first couple of days, then keep the area moving gently as soon as you can.

Source 49

Before the wound has healed

Keep the wound clean and dry as your team advises, and move as your surgery guide allows. After a caesarean, gentle activity and a daily walk are encouraged, while exercise, driving and lifting anything heavier than your baby may not be comfortable for 6 weeks or so.

Sources 50, 2

Scar massage, step by step

The steps NHS scar leaflets give, in order:

• Wash your hands. Use a small amount of unperfumed moisturiser or plain oil; one NHS unit advises against vitamin E and aqueous cream, and the caesarean leaflets allow any oil you aren't allergic to.
• If the scar is sensitive, start around it rather than on it, and work onto it as it settles.
• Make small circles with your thumb or two fingers, then move up and down across the scar, then side to side along it.
• Press firmly enough to whiten the skin under your fingertip, but not so hard that it hurts or the skin breaks. Build up the pressure gradually.
• When it's comfortable, gently lift or roll the scar between finger and thumb and move it over the tissue beneath. Don't expect it to free up completely.
• Do 5 to 10 minutes, 2 to 3 times a day. After a caesarean, aim for at least 4 times a week for 5 to 10 minutes, less often as it loosens. Keep going until the scar feels soft and moves like the skin around it, often for several months.

Sources 7, 3, 8, 15, 48, 10, 2

Silicone

Use silicone gel or a sheet on a newly healed wound, never an open one. One NHS trust advises 12 hours a day for at least 3 months. Stop and ask for advice if the skin under it becomes sore, red or blistered or a rash appears (our suggestion, in line with the stop signs NHS units give for scar care). A pharmacist can recommend products.

Sources 8, 11, 2

Sun protection

Keep the scar covered, or use sun cream of SPF 30 or more, for at least a year; one NHS trust says 2 years.

Sources 2, 8, 3

Taping

If your surgeon or midwife suggests it, paper tape along the scar for up to 12 weeks takes tension off it. The evidence is a single small trial in which 39 of 70 women finished. Stop if a rash appears: 4 women using tape had one. Kinesiology tape has its own guide.

Source 37

Desensitising an over-sensitive scar

From an NHS hand therapy leaflet. One small trial found no benefit for function, so use it for comfort.

• Keep massaging, gently at first.
• Rank some fabrics from least to most uncomfortable, such as cotton, silk, wool and flannel. Rub the least uncomfortable over the area for 5 minutes, or until it no longer feels odd, and repeat later in the day. Move on only when it's comfortable.
• Then try tapping, textures such as dry rice or lentils, or gentle vibration for 5 minutes.
• Use the area in everyday tasks as soon as you can: avoiding it can keep it sensitive.

Sources 15, 46

Movement

Move the joints near the scar through their comfortable range every day, within your team's limits: scar tissue and fascia stiffen when kept still, and after a knee replacement the scar tissue tightens over the first 6 weeks. Early on, don't repeatedly stretch the incision hard, because tension drives raised scarring; the postpartum guide explains how to support a tummy wound when you cough or sit up. Once healed, build strength through the full range around the scar (our editorial suggestion; the surgery guides stage it).

Sources 13, 9, 39, 37

Don't massage

• An open wound, scabs, a wound with stitches or clips still in, or one that is weeping.
• A scar that looks infected.
• Over a new lump or bulge near the scar: get it checked, as it may be a hernia.
• A sprain or strain in its first couple of days.

Sources 2, 48, 10, 8, 16, 49

Get an urgent GP appointment or call NHS 111

• The scar is swollen, painful or warm to the touch, or has pus coming out.
• Redness spreading more than 2 centimetres from the scar that doesn't fade within 24 hours.

Sources 2, 16

After a caesarean: contact your midwife or GP urgently

• Severe pain, or the wound becoming more red, painful and swollen.
• Pus or foul-smelling discharge.
• Heavy vaginal bleeding.
• A cough or shortness of breath.
• Swelling or pain in your lower leg.

Source 50

Call 999 (911 in the US) or go to A&E

• Leg pain or swelling with breathlessness or chest pain.
• A hard, painful lump near a scar that won't go back in, with tummy pain that comes and goes, being sick, or being unable to poo or pass wind: possibly a trapped (strangulated) or blocked hernia.

Sources 51, 16, 52

See a GP

• A scar growing beyond the original wound (possibly a keloid).
• A lump or bulge in or near the scar.
• A painful lump in a caesarean scar, especially one that swells or hurts around your period: rarely, this is endometriosis in the scar.
• Pain that is getting worse instead of better, or that stops you doing everyday things.
• After an operation on a hand or limb, severe pain with skin that becomes very sensitive, swollen or stiff, or changes colour or temperature. This can be complex regional pain syndrome, and early treatment helps.
• A scar that is affecting how you feel about yourself or your mental health.

Sources 2, 20, 16, 53, 54, 55

"Massage breaks up scar tissue and adhesions"Mixed evidence

That's shown only in rats. Human studies are small and uncontrolled, and dense tissue needs far more force than hands apply to change shape. Massage may make a scar softer, more mobile and less sensitive, which is a better way to describe what it does.

Sources 30, 31, 32, 33, 4

"Vitamin E oil heals scars"Emerging evidence

It didn't help in a double-blind trial and gave a third of people a skin rash, and a review found too little evidence for it.

Sources 43, 44

"Old scars can't change"Mixed evidence

Reviews included scars treated from soon after the stitches came out to more than 2 years later, and small studies of older caesarean scars reported changes. Expect smaller changes than with a new scar.

Sources 6, 24, 56, 48

"Scar tissue is stronger than normal tissue"Strong evidence

At most, a healed wound reaches about 80% of the original strength.

Source 1

"The harder you press, the better"Emerging evidence

Press firmly enough to whiten the skin, not to hurt. If massage hurts, ease off, or stop for a few weeks and try again.

Sources 7, 8, 48

"Rest the area until the scar has fully healed"Emerging evidence

Movement within your team's limits matters. Early exercise after breast cancer surgery improved arm function without more complications, restricted movement reduced fascial glide in pigs, and knee replacement scars tighten over the first 6 weeks.

Sources 12, 13, 9

"Silicone makes scars disappear"Emerging evidence

It reduces raised scarring a little, with weak evidence. No treatment removes a scar.

Sources 11, 34

"Scraping, cupping or blasting removes scar tissue"Mixed evidence

We found no trials of cupping on scars, and the one study we found mixed it with four other treatments and had no comparison group. We found no scar evidence for scraping tools either. Dense tissue needs far more force than tools apply to change shape, and bruising is damage, not progress.

Sources 42, 33