Whether from an acquired injury or post-surgery, most of us inevitably encounter situations that cause injuries and leave physical scars on our bodies. Depending on the severity, length, and depth of the wound, scars take varying amounts of time to heal. In general though, it takes on average one year for a wound/scar to be considered “healed” from the outside AND the inside no matter the size! Why is this?
Open wounds go through a whole healing process that has 3 different stages: an inflammatory stage, a proliferation stage, and a maturation stage. In the inflammatory stage, our body works to stop the bleeding, bring in all the cells needed to repair the wound, and prevent infection. This process normally lasts one week on average, but can be longer with bigger wounds! In the proliferation stage, the wound is “rebuilt and new blood vessels and collagen begin to lay down and form the callus that replaces the opening in the skin. This process takes an average of three weeks. The last phase, the maturation phase, the wound is “remodeled” and the newly laid collagen turns into a strong material that is arranged in the necessary direction for full wound closing. This phase is the longest and takes from three weeks to one year!
The reason for the prolonged completion of the maturation phase is that despite the wound being closed on the outside, the inside is still healing. It takes a lot longer to complete than the outside since there’s a lot more layers and tissue underneath the skin to repair (especially with deeper wounds). So, despite a wound being “closed” on the outside, the inside is more likely not healed yet, that’s normally why people will still feel tenderness or discomfort when pushing down on their wound whether there is still a scab or not.
The residual scar that is found once the scab comes off is all made of scar tissue that took the place of skin during the repair process. This is why it has a different color and texture than the surrounding skin. Sometimes, when scars are very dense, they may limit the amount of movement that area has. Usually we want to prevent this movement restriction since it can impair muscle contraction and joint mobility if the scar tissue extended more deeply. We want to prevent these limitations because if they remain, then our functional abilities will be limited for the rest of our lives!
If you go through rehabilitation while your wound is healing, a physical therapist will teach you about scar mobility and the safe and correct way to improve movement and extensibility of the scar. Anyone who goes through any type of surgery will require scar rehabilitation to prevent future scar tissue limitations. Say you went through a knee replacement or some type of muscle repair surgery, scar tissue will develop deep in your joint/tissues. This type of scar tissue is extremely limiting if not removed. For this reason, a physical therapist will encourage you to move more (as tolerated) and “bend the knee” or “raise the arm” more to break down that deeper scar tissue and prevent it from becoming a permanent limitation once it goes through the maturation phase.
In all, scars and healing are more detailed than we suspect. We want the outside scars to heal naturally but we also want to prevent deeper scar tissue from forming and becoming a permanent tissue inside our body. It’s a delicate game!! Regardless, keep in mind that healing takes a long time and you may still feel sensitivity or discomfort around your scar a year post injury or surgery. At Least now you know why and can work with your therapist to achieve optimal scar healing!
By Jennifer Santamaria PT, DPT