Scar Remediation Guidelines by Gregory Lawton

SCAR REMEDIATION GUIDELINES

A Holistic Approach

ABSTRACT

Scars tell a story, one of healing, survival, and renewal. However, not all scars fade gracefully, and some become reminders of trauma, causing discomfort or affecting conﬁdence. Whether from surgery, injury, or other skin conditions, scars can be unsightly or troublesome, leading many to seek ways to prevent or reduce their appearance.

Dr. Gregory Lawton

SCAR REMEDIATION GUIDELINES, A Holistic Approach

Copyright 2024, Dr. Gregory T. Lawton All rights reserved. No part of this book shall be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from Dr. Gregory T. Lawton. American Health Source, Inc. 2040 Raybrook SE, Suite 104 Grand Rapids, Michigan 49546 888-375-7245

Dr. Gregory T. Lawton

Scar Remediation Guidelines, A holistic Approach

Elevate your practice with our comprehensive post-surgical scar and tissue healing program, tailored for manual therapists looking to expand their expertise in scar remediation therapy. This advanced training program equips you with the full spectrum of knowledge and techniques needed to facilitate optimal healing, minimize scar tissue formation, and help your clients regain full range of motion.

In addition to mastering manual therapy techniques such as lymphatic drainage, scar mobilization, and myofascial release, you’ll also learn how to incorporate nutraceuticals, supplements, and herbal remedies into your clients’ healing protocols. You’ll be able to recommend targeted nutritional support, such as collagen-boosting supplements, antiinflammatory herbs like turmeric and ginger, and vitamins that accelerate tissue repair. Understanding the role of internal health in scar healing allows you to offer a more holistic approach to your treatments.

Our training also emphasizes the use of topical infused oils, medicated herbal formulations, and essential oils as part of a comprehensive scar care plan. You’ll gain hands-on experience with infusing oils using healing herbs such as comfrey, calendula, and lavender, which work synergistically to reduce inflammation, soften scar tissue, and improve skin elasticity. You’ll also learn how to blend and apply essential oils like frankincense, rosehip, and tea tree to reduce scar visibility and enhance healing at every stage.

By integrating controlled range of motion exercises and gradual weight-bearing activities into your therapy sessions, you’ll guide your clients through a balanced recovery process. The program empowers you to use both internal and external natural remedies alongside manual therapy techniques to promote deeper healing. With this holistic, multidisciplinary approach, you’ll become a trusted expert in post-surgical scar remediation, helping your clients achieve not only visible improvements in their scars but also enhanced overall well-being.

Introduction

Scars tell a story, one of healing, survival, and renewal. However, not all scars fade gracefully, and some become reminders of trauma, causing discomfort or affecting confidence. Whether from surgery, injury, or other skin conditions, scars can be unsightly or troublesome, leading many to seek ways to prevent or reduce their appearance.

At the heart of these guidelines lies a natural and holistic approach to scar remediation. Conventional treatments like invasive procedures and pharmaceuticals, while effective, often come with side effects. In contrast, the principles outlined in these guidelines emphasize gentler, integrative methods designed to support the body’s innate healing processes.

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The holistic approach to scar care outlined here involves a combination of natural remedies, therapeutic practices, and lifestyle adjustments to:

1. Prevent scar formation after surgery or injury by optimizing tissue healing.

2. Treat existing scars, including hypertrophic, keloid, or atrophic scars.

3. Improve the texture, color, and flexibility of unsightly scars.

4. Address pain, itching, or discomfort often associated with scar tissue.

Our strategies combine time-honored traditions from herbal medicine, medical massage, and advanced paramedical skincare with modern research. You will find recommendations for topical treatments, manual therapies, and nutritional support to promote skin regeneration and reduce scar tissue.

Guidelines for Scar Remediation (General Recommendations)

1. Pre-Surgery and Injury Preparation

Preparing your body for optimal healing starts before the scar even forms. Before their surgery patients should be instructed in how to support and nourish their skin and body with hydration, collagen-supporting foods, and key supplements that promote skin elasticity and resilience. Vitamins like A, C, and E, along with minerals such as zinc and antioxidants, play critical roles in tissue repair.

You should educate your patients regarding the benefits of herbs like comfrey, calendula, ginger, rose, helichrysum, comfrey, and others that can be applied to the skin or taken internally to speed up wound healing and reduce inflammation.

Patients should be trained in the use of relaxation techniques such as guided visualization, meditation, and breathwork that prepare the body for surgery or injury recovery by reducing stress and promoting a healing state.

2. Natural Topical Treatments

Many natural oils, salves, and herbal-infused remedies have been used for centuries to help heal scars. Helichrysum, comfrey, calendula, lavender, rosehip, and frankincense essential oils can reduce inflammation, improve skin texture, and promote regeneration.

Learn to make and apply castor oil packs to soften scar tissue, break up adhesions, and stimulate lymphatic flow for better healing.

Master formulations for making scar-healing infused oils or ointments with calendula, chamomile, comfrey, aloe vera, ginger, and plantain, which soothe irritated skin, promote cellular turnover, and fade scars.

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Silicone sheets are well-known for reducing scar visibility and you can also use herbal gels made with natural ingredients like aloe vera and onion extract, which help heal and flatten scars.

3. Manual Therapy (CPT - 97140)

Manual therapy can make a significant impact on the flexibility and appearance of scar tissue. Techniques like myofascial release, lymphatic drainage, and scar massage can help soften scar tissue, improve circulation, and prevent adhesion to underlying muscles. You may also utilize use fascia-releasing tools or techniques to work through tight or restricted scar tissue that may be causing pain or discomfort.

4. Nutritional Support for Healing

Diet can influence the body’s ability to regenerate healthy skin and minimize scar formation. Recommended supplements and herbs include:

• Zinc, vitamin D, vitamin K2, vitamin C, and omega-3 fatty acids are essential for wound healing and skin regeneration.

• Turmeric, Boswellia, Ginger, Licorice root are potent supplements for reducing inflammation, stimulating collagen production, and improving blood flow to damaged areas.

Proper hydration and supporting the body’s detox pathways through diet and herbs can aid in scar healing by improving skin clarity and function.

5. Lifestyle Practices for Optimal Healing

Beyond topical treatments and nutrition, lifestyle changes can support the healing of both new and old scars.

• Gentle stretching, yoga, and fascia exercises can help improve mobility around scars, reducing stiffness and improving circulation to the area.

• Quality sleep and stress management are often overlooked aspects of skin healing. Learn how restorative practices like meditation, Tai Chi, and deep breathing can accelerate the body’s ability to heal.

• Advise patients to protect scars from UV damage to prevent hyperpigmentation and ensure proper healing.

Guidelines for Scar Remediation (Specific Therapy Goals)

Support the skin’s healing process to reduce the likelihood of excessive or abnormal scar tissue formation. Consider the following strategies:

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Deliver scar massage techniques around but not direct on the scar

Use Bioptron light Therapy

Apply herbal infused oils and essential oil blends

o Calendula flower infused oil with ginger essential oil

o Comfrey leaf and calendula flower blend with rose essential oil

Avoid harmful or irritating chemicals

o Use infused oil and essential oil blend spray on scar

o Avoid smoking or the consumption of alcohol

o Avoid UV radiation

Reducing Local Tissue Tension and Inflammation (Hyperemia and Edema)

Reducing skin, fascia, tissue tension and edema around a scar is crucial for preventing excessive scar tissue buildup, such as hypertrophic or keloid scars. When skin and fascial tension and edema is not properly addressed, it can cause the body to lay down more collagen fibers, which leads to thick, raised, and rigid scars.

Use scar remediation massage therapy techniques to reduce or eliminate skin and facial tension around the scar. Gentle scar massage is a critical technique to help break down adhesions, improve circulation and fluid drainage, and reduce tension in the scar and surrounding tissues:

Technique: Begin with light circular motions around the scar using fingers or a gentle massage tool. Gradually increase pressure as the scar matures (see the treatment schedule below) and becomes more resilient. Avoid applying pressure directly on fresh scars (until at least 2-3 weeks after surgery when the wound is fully closed). Regular massage helps reorganize collagen fibers, making the scar more pliable and preventing excessive buildup.

To reduce skin and tissue tension and inflammation in the tissue surrounding the scar, you can incorporate the use of lavender into your comfrey -infused oil. Lavender is an excellent choice for this purpose due to its multiple benefits in scar remediation:

Lavender helps to relax the skin and underlying muscles, reducing tightness and discomfort around the scar. It soothes tension in the tissue, which can prevent the scar from feeling rigid or pulling on surrounding areas.

1. Like comfrey and calendula, lavender has strong anti-inflammatory properties that help reduce swelling and irritation, which can contribute to tension and discomfort in the scarred area.

2. Lavender promotes healthy blood flow, which helps bring more oxygen and nutrients to the scar tissue, aiding in healing and maintaining flexibility in the surrounding skin.

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3. Lavender's analgesic properties make it useful for reducing pain, tenderness, and itching in and around the scar, helping to relax the area and promote better tissue mobility.

4. It helps to lighten scars and smooth the skin’s surface by encouraging cell regeneration, which synergizes well with comfrey’s and calendula’s healing effects.

By combining comfrey, calendula, and lavender in an infused oil, you create a formulation that not only supports tissue regeneration but also actively reduces skin tension and discomfort, promoting a more flexible, comfortable healing environment around the scar.

Wound Healing and Tissue Strength

Wounds and post-surgical scars begin to heal the moment that skin damage occurs, and bleeding starts. Here are key healing milestones:

First 24 – 48 hours: The wound begins closing, and the scab starts forming.

• At this stage use Bioptron light therapy.

• Keep the wound moist and hydrated with infused oil and essential oil spray.

7 – 14 days: The wound typically closes completely, and sutures may be removed. Early scar formation begins beneath the surface.

• This is the stage, once the superficial sutures are removed that we can begin massage remediation techniques. Exercise care!

• At this stage the underlying tissue is only 2 to 10 percent of its normal strength and integrity.

2 – 3 weeks: The wound enters the proliferative phase, and the early scar becomes more noticeable.

• The deeper tissues and stitches are still weak and fragile.

• The tissue strength is approximately 15 to 30 percent compared to the normal tissue strength.

• Avoid aggressive or deep tissue manual therapy techniques.

1 – 3 months: Scar tissue becomes stronger but may remain red, raised, or discolored during this phase.

• Hyperemia is an indication of inflammation, and this will increase scar tissue build up.

By 3 - 6 months: The wound approaches its maximum tensile strength, which typically reaches around 80% of the original tissue strength.

6 – 12 months: The scar continues to mature, flatten, and fade. In most cases, this is when the scar reaches its final form.

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Manual Therapy and Physical Activity Schedule

The timing for resuming normal physical range of motion (ROM) and weight-bearing activities as well as receiving manual therapy treatments after surgery depends on the type of surgery, the location of the wound, and individual factors such as the patient’s overall health and healing rate. However, in general, here are some guidelines based on the stages of wound healing:

General Timeline for Resuming Physical Activities:

1. Initial Phase (0 – 2 Weeks Post-Surgery)

Activity Level: Minimal to no physical activity, especially in the area of the surgery. The primary goal is to protect the wound and prevent tension or stress that could cause wound dehiscence (reopening) and increased scar tissue formation

Range of Motion: Limited range of motion (ROM) is typically allowed only in unaffected body parts to prevent stiffness and promote circulation. Gentle movement around the surgical site may be advised, but it depends on the surgeon’s instructions.

Weight Bearing: Weight bearing activities are generally not allowed on weightbearing areas like the lower extremities if the wound is near joints or muscles involved in movement.

Manual Therapy: No manual therapy directly on or around the surgical site at this stage to avoid disrupting the early healing process.

Recommended Manual Therapy:

• Use Bioptron light therapy,

• Use non-irritating herbal sprays

• Use kinesiotape edema fan technique around (not on) the scar.

• Gentle lymphatic drainage massage (away from the surgical site) may be introduced by a qualified therapist to help reduce swelling and improve circulation.

• Light to moderate massage on distant body areas can promote relaxation and general circulation without affecting the wound.

2. Early Healing Phase (2 – 6 Weeks Post-Surgery)

Activity Level: Light activities, such as gentle stretching or range of motion exercises, may be introduced at this point to avoid stiffness and muscle atrophy. However, activities should not place direct stress on the wound site.

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Range of Motion: Controlled, limited ROM exercises may begin, but only under guidance. Movement should not pull at the wound or cause discomfort.

Weight Bearing: Partial weight-bearing may be allowed after about 4 weeks, depending on the type of surgery and the location of the wound. Supportive devices like crutches or braces may still be necessary for lower limb surgeries.

Manual Therapy

Manual Therapy Schedule

You can continue to use the therapeutic modalities listed above through all the weeks and months to come.

Weeks 2 – 3:

• Manual therapy may begin once the wound is closed (usually 2-3 weeks post-surgery). Gentle scar massage around the periphery of the scar can help prevent adhesion to underlying tissues.

• Lymphatic drainage massage can continue to reduce swelling and improve tissue healing.

Weeks 4 – 6:

• Gentle, circular scar massage can be applied directly on the scar to encourage collagen alignment and prevent hypertrophic scar formation. Use light pressure initially and increase as the scar matures.

• Begin gentle myofascial release around the scar to reduce tightness and improve mobility in surrounding tissues.

Manual Therapy Frequency

2 – 3 times per week (initial sessions should be shorter, gradually increasing as healing progresses).

3. Proliferative Phase (6 – 12 Weeks Post-Surgery)

Activity Level: Moderate physical activities can typically resume, depending on the surgical area. Light exercises, like swimming or stationary biking, are often recommended to enhance circulation and improve healing without overloading the tissues.

Range of Motion: Full ROM exercises are usually allowed by 6 – 8 weeks as the tissue is regaining strength (about 50–70% of its pre-surgical strength).

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Weight Bearing: Full weight-bearing activities may begin around 6 – 8 weeks but should be gradually increased. The surgeon, doctor, or physical therapist may recommend specific guidelines based on the individual’s healing progress.

Manual Therapy:

Manual Therapy Schedule

• Scar Massage: Continue deep tissue scar massage to help flatten the scar, reduce tension, and prevent further adhesion to underlying tissues.

• Myofascial Release: Perform more focused myofascial release on deeper layers of tissue to relieve tightness and prevent the formation of restrictive scar tissue. This can also help improve ROM and mobility around the surgical site.

• Cross-fiber friction massage: This technique can be applied to the scar to further break up adhesions and promote optimal collagen alignment.

• Lymphatic Drainage Massage: Continue to perform lymphatic drainage once or twice a week to manage any residual swelling.

Manual Therapy Frequency: 2–3 times per week for scar and myofascial release; selfmassage with oils or creams can be done daily at home.

4. Remodeling Phase (3 – 6 Months Post-Surgery)

Activity Level: By 3 months, most patients can resume normal activities, including those that involve full range of motion and weight-bearing, assuming the healing process has been smooth.

Range of Motion: Full range of motion should be restored by this stage, and scar remodeling (to increase flexibility) is still ongoing.

Weight Bearing: Full weight-bearing and more strenuous activities, such as running or strength training, may be resumed after clearance from the surgeon. High-impact activities should only be reintroduced after the wound has reached sufficient strength.

Manual Therapy

Manual Therapy Schedule

 Deep tissue scar massage and myofascial release should continue to maintain tissue flexibility. As the scar matures, manual therapy can focus on improving mobility and reducing any remaining adhesions.

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 Self-myofascial release tools (foam rollers, massage balls) can be used to maintain fascia health and reduce tension in the surrounding tissues.

 Weekly sessions with a manual therapist or self-administered scar care at home. Continue daily self-massage and stretching of the scar.

Full Return to Normal Activities (6 – 12 Months)

By 6 – 12 months, most patients can safely return to all physical activities, including weight-bearing, strength training, and high-impact exercises. The scar is typically mature and strong enough to withstand normal physical forces. It's important to monitor for any signs of discomfort, swelling, or changes in the scar during this time.

Manual Therapy Schedule

Occasional manual therapy sessions (once a month or as needed) can help maintain scar flexibility and ensure no restrictive adhesions form. Regular manual therapy combined with appropriate physical activity will promote better scar healing and optimal tissue strength. Self-administered techniques like fascia stretching, foam rolling, or scar massage can also continue.

If necessary, non-invasive techniques like microneedling or laser therapy may be explored for cosmetic improvement.

Individual Considerations:

The guidelines provided in this booklet are general. Surgeries involving joints (e.g., knees or shoulders), muscles, or tendons may have stricter protocols to protect against re-injury. Always follow the surgeon’s instructions Individual healing rates vary, and complications or additional surgeries may delay full recovery.

Signs

that Full Activity Can Resume:

• The wound is fully closed with no signs of infection.

• There is no significant pain or discomfort around the wound during or after activities.

• The scar appears mature (flattened and lightened) without signs of reopening.

• The surgeon, doctor, or physical therapist has provided clearance to return to specific activities.

Normal physical range of motion and certain weight-bearing activities can generally begin to be resumed in a limited fashion around 6-8 weeks, with full return to activity typically occurring between 3–6 months, depending on the surgery and individual healing progress.

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Conclusion:

Mastering the art of post-surgical scar remediation therapy goes beyond traditional manual therapy techniques. By integrating a holistic approach that combines nutraceuticals, herbal supplements, and topical treatments with advanced scar and tissue manipulation, you can offer a transformative healing experience for your clients. The thoughtful application of scar massage, myofascial release, and controlled range of motion exercises ensures that physical recovery is accompanied by improved tissue health and mobility.

Incorporating infused oils, medicated herbal formulations, and essential oils into your practice allows you to address the skin and fascia on a deeper level, providing relief from inflammation, reducing tissue tension, and preventing excessive scar formation. Meanwhile, nutritional guidance and supplements promote internal healing and strengthen the body’s ability to regenerate healthy tissues, ensuring a more complete recovery.

As a manual therapist, these tools empower you to create a comprehensive treatment plan that not only addresses the external scar but also supports your clients' overall health and recovery. By offering this full-spectrum approach, you position yourself as an expert in the field of scar remediation, helping clients not only heal physically but also feel confident and supported in their recovery journey. With these techniques, you can elevate your practice and deliver results that go beyond skin-deep healing.

Gregory T. Lawton, D.C., D.N., D.Ac.

Dr. Gregory T. Lawton

We recommend the following FastTrack workshops to accompany this training booklet:

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