Transplant Talk: Scar Tissue Massage

Recorded Thursday March, 20, 2025

Are your transplant incision scars tight, inflamed, raised, painful, or overly sensitive? Do you feel like you have a tight band around your chest constricting your breathing?  If so, this Transplant Talk is for you! Learn from Diana Thompson, a highly experienced massage therapist why your scars are acting up, and what you can do at home to help yourself feel better and breathe easier. You’ll hear from Todd Ware, a bilateral lung transplant recipient who is also a massage therapist, as he shares his personal experience before and after starting scar tissue massage on his transplant incision area. If your surgical scars are causing you discomfort, you do not need to tough it out!

Diana Thompson, a licensed massage therapist for over forty years, has a private practice in Seattle, WA treating acute and chronic pain disorders, with a focus on post-operative care.  In addition to authoring three books for massage practitioners, Diana lectures at massage, acupuncture, midwifery, chiropractic, physician and physical therapy conferences internationally. She is also the past president of the Massage Therapy Foundation, a non-profit organization that grants money for massage research.

Our recipient speaker, Todd Ware, received his double lung transplant in the last 3 days of 2020 due to Alpha-1 Antitrypsin Deficiency.  He is a certified flight instructor, international racing pilot, and has been a licensed massage therapist since graduating from Heartwood: California Institute of Natural Healing Arts in 1986.

Outline of Scar Massage

A Guide to Managing Post-Surgical Scars with Massage Therapy

Scar tissue Introduction

Adhesions are more than what meets the eye.

Scar tissue Types

There are three types of pathological adhesions.

• Filmy scars that are web-like and are located around the trauma
• Vascular scars bridging and containing blood vessels and nerves that bind disparate structures
• Cohesive scars that intentionally bind similar structures together. Scars are a common part of
  the healing process but also occur and complicate trauma scars with increased inflammation,
  for example, from infection or repetitive stress.

Surface and deep

• Cohesive scarring includes the binding of the suface skin to close a wound.
• Directly below that scar are additional cohesive scars, binding the deeper layers together that
  cut the viscera and soft tissues to access the targeted organ.
• Vascular scars bridge trauma sites to any variety of surrounding structures
• Filmy scars can be less invasive and problematic

Symptoms of scarring:

Research:
Wasserman, Copeland, Upp, Abraham, collected and analysized massage (STM) interventions on
human subjects, both surgical and non-surgical abdominal adhesion-related symptoms. Findings
found improvements in quality of life and function. The following symptoms improved: scar
mobility, infertility, posture, pain medication, pressure tolerance, postoperative ileus.
(Wasserman, 2019)

Bove and Chapppelle, rat study post surgical visceral abrasion found scarring palapable. Daily for
up to seven days, massage (visceral mobilization) reduced the number and severity of the
adhesions. (Bove, 2012)

Schander A, Downey HF, Hodge LM. Lymphatic pump manipulation mobilizes inflammatory
mediators into lymphatic circulation. Exp Biol Med (Maywood). 2012 Jan;237(1):58-63. doi:
10.1258/ebm.2011.011220. Epub 2011 Dec 14. PMID: 22169162.

Hodge LM, King HH, Williams AG Jr, Reder SJ, Belavadi T, Simecka JW, Stoll ST, Downey HF.
Abdominal lymphatic pump treatment increases leukocyte count and flux in thoracic duct
lymph. Lymphat Res Biol. 2007;5(2):127-33. doi: 10.1089/lrb.2007.1001. PMID: 17935480.

Aysan and Aren, rat study post surgical peritoneal adhesions, found diaphragmatic lymphatics
effective for reducting the number and severity of adhesions after ten days. (Aysan, 2004)

Scar massage:

Research did not describe massage techniques beyond the broad categories of myofascial scar
release, soft tissue manipulation and diaphragmatic lyphatics. As researchers increasingly adopt
the STRICT-M format for reporting massage therapy interventions, this may change. Until then,
you are left with my 45 years of experience and multiple courses on scar massage.

Considerations:

• Surface scars (intentional scars) should be healed before direct application of massage.
• Scars begin to form within two hours of trauma.
• Massage on deeper structures can begin within 24 hours of trauma.
  

Techniques

Acute

• Lymphatic compression – pumping
• Fascial stretching and unwinding distal from and toward surgical incision

Chronic

• Lymphatic compressions and drainage
• Fascial stretching and compressions on and away from surgical incision
• Skin rolling
• Large muscle group stretching

Find massage therapists:

Gentle bodywork, no “deep tissue” work

• Visceral Manipulation (Barral Institute)
  https://www.iahp.com/pages/search/index.php
• Myofascial Release (John Barnes method)
  https://www.myofascialrelease.com/find-a-therapist/
• Lymphatic Drainage (Chikly, Vodder, others)
  https://chiklyinstitute.com/find-a-therapist/all
  https://vodderschool.com/contacts/applied-mld-therapist
  https://www.acols.com/find-therapist/

Citations:

Wasserman JB, Copeland M, Upp M, Abraham K. Effect of soft tissue mobilization techniques on
adhesion-related pain and function in the abdomen: A systematic review. J Bodyw Mov Ther.
2019 Apr;23(2):262-269. doi: 10.1016/j.jbmt.2018.06.004. Epub 2018 Jun 28. PMID: 31103106.

Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent peritoneal adhesions in a rat
model. J Bodyw Mov Ther. 2012 Jan;16(1):76-82. doi: 10.1016/j.jbmt.2011.02.004. Epub 2011
Apr 9. PMID: 22196431.

Hodge LM, King HH, Williams AG Jr, Reder SJ, Belavadi T, Simecka JW, Stoll ST, Downey HF.
Abdominal lymphatic pump treatment increases leukocyte count and flux in thoracic duct
lymph. Lymphat Res Biol. 2007;5(2):127-33. doi: 10.1089/lrb.2007.1001. PMID: 17935480.

Aysan E, Kurt G, Aren A. The effect of diaphragmatic peritoneal lymphatics on peritoneal
adhesions: an experimental study. Lymphology. 2004 Sep;37(3):134-40. PMID: 15560109.