Surgical scars and movement: what can happen months after surgery

After surgery, attention is inevitably focused on the first few weeks: the wound needs to heal, the pain needs to decrease and normal activities need to be gradually resumed. When the skin appears healed and the scar becomes less visible, it is easy to think that the recovery process is also complete. This is not always the case.

A scar continues to change for months. The tissues undergo a remodelling process that can affect elasticity, sensitivity and their ability to glide over the underlying layers. In some people, everything progresses without any particular consequences; in others, stiffness, discomfort during certain movements or a feeling of tension in the operated area may persist.

Post-operative scars should therefore not automatically be considered problematic, but neither should they be assessed solely on their appearance. When they interfere with movement or are associated with persistent symptoms, a physiotherapy assessment can help determine what is actually happening.

The visible part is only one of the elements involved in healing. Surgery can affect several layers of tissue, and each one must go through its own repair process.

During healing, the body produces new connective tissue to restore continuity in the affected area. In the early stages, this tissue has different characteristics from the original tissue and subsequently continues to organise and mature.

This is why a scar may appear closed externally while the tissues are still changing their characteristics.

This does not necessarily result in a limitation. Many scars develop without causing any problems. However, when gliding between the different tissue layers is reduced, some movements may feel less free or may be accompanied by tension.

One of the sensations most frequently described after surgery is a feeling of tightness in the area during movement.

This can occur, for example, after abdominal surgery when fully extending the body, after knee surgery during flexion or near the shoulder when raising the arm overhead.

This sensation does not necessarily mean that the scar is causing damage. It may be related to the characteristics of the scar tissue, local sensitivity, a temporary reduction in movement or simply the fact that the area is not yet being loaded in the same way as before surgery.

A thorough assessment is useful precisely to distinguish a normal stage of recovery from a limitation that may benefit from treatment.

During the first few weeks after surgery, there are specific precautions established by the surgeon and healthcare team. Once this phase has passed, movement is generally reintroduced progressively.

Recovery, however, does not end when a person is able to walk, work or carry out everyday activities again.

A person may regain good independence and only realise months later that certain movements remain difficult. The problem may become apparent when returning to the gym, resuming a sport, lifting a weight or trying to achieve a range of motion that was not necessary in everyday life.

It is at these moments that post-operative scars may become relevant again, particularly when greater demands are placed on the operated area.

Not all the effects associated with a scar involve mobility.

After surgery, changes in sensitivity may occur in the surrounding area. Some people report reduced skin sensitivity, while others experience tingling, burning, itching or particular discomfort when the area comes into contact with clothing or objects.

These sensations may also be related to the involvement of small superficial nerve structures during surgery and their subsequent healing.

In many cases, sensitivity gradually changes over time. However, when the problem persists, increases or limits everyday activities, it is useful to discuss it with a professional to determine whether further investigation or specific rehabilitation may be necessary.

When discussing scars, the word "adhesion" is often used to explain any sensation of stiffness or pain.

This is an oversimplification that is not particularly helpful.

Adhesions between tissues can indeed develop after surgery, but not every symptom can automatically be attributed to the scar. Pain may also be influenced by reduced strength following a period of inactivity, joint mobility, tissue sensitivity and the way a person has resumed using the operated area.

Attributing everything to the scar risks overlooking other important aspects of recovery.

Physiotherapy should therefore begin with function: which movements are difficult? When does the pain occur? How much load can the area tolerate? What has changed compared with before surgery?

There is no rule stating that all post-operative scars need to be treated.

However, an assessment may be useful when, some time after surgery, there is:

• tension that limits certain movements;
• pain during specific activities;
• persistent local sensitivity;
• difficulty fully recovering mobility;
• a feeling of stiffness in the operated area;
• difficulty returning to sport or physical activity;
• fear of loading or moving the affected area again.

The appropriate time for an assessment also depends on the type of surgery and the instructions provided by the surgeon. Respecting the biological healing process always remains a priority.

The treatment of post-operative scars is sometimes reduced to the concept of scar massage. Rehabilitation can be much broader than this.

When indicated, the physiotherapist may work on local mobility and tissue gliding, but must also assess what happens during movement.

The rehabilitation programme may include:

• progressive mobilisation of the area;
• work on sensitivity;
• restoration of range of motion;
• strengthening exercises;
• gradual exposure to movements that cause tension;
• progressive loading based on everyday or sporting activities.

The goal is not to make the scar "perfect", but to restore function so that the person can move without avoidable limitations.

After surgery, it is normal to protect the operated area. The problem arises when this caution continues even after medical restrictions have been lifted.

Avoiding a movement for months because of the fear that it might "open" or damage the scar can contribute to a loss of strength and mobility. Returning to movement must, of course, respect the type of surgery and medical advice, but once clearance has been given, it is important to progressively rebuild confidence.

Physiotherapy can also support this stage by gradually increasing the difficulty of exercises and showing the person what their body is once again capable of doing.

At TI-FISIO in Lugano, the scar is assessed as part of the overall recovery process following surgery. The assessment does not focus solely on the mark on the skin: mobility, sensitivity, strength, quality of movement and the activities the person wishes to resume are also considered.

Based on the assessment, the rehabilitation programme may include:

✔️ manual techniques when appropriate;

✔️ progressive restoration of mobility;

✔️ personalised therapeutic exercise;

✔️ work on sensitivity and confidence in movement;

✔️ progression towards everyday, work-related or sporting activities.

The scar is therefore considered for what it actually represents: one part of a system that needs to regain the ability to move, adapt and tolerate load.

Having a scar months or years after surgery is normal. What deserves attention is the possible presence of pain, stiffness or limitations that continue to interfere with the activities a person wants to perform.

Even when surgery took place a long time ago, it may still be useful to determine whether there is room for improvement in function. The problem does not always depend directly on the scar, and an individual assessment is precisely what helps avoid oversimplified interpretations.

If you have one of the post-operative scars that continues to be associated with tension, pain or difficulty with movement, contact TI-FISIO in Lugano. The team can assess your situation and, when indicated, develop a personalised physiotherapy programme to help you regain mobility, strength and greater confidence in the activities you want to return to.

+41 91 940 10 20

info@ti-fisio.ch

Via Ceresio 42, Pregassona.

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+41 (0)91 229 69 80

mendrisio@ti-fisio.ch

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