Those who have suffered from a knee injury know how debilitating it can be—especially if too much scar tissue has built up over time. Soreness in the ligaments, swelling in the joints, instability, lack of mobility and incessant aches are all common issues when dealing with scar tissue in your knee. Adhesions can be located in the knee joint or in its surrounding soft tissue structures. It can affect only part of the knee joint, or even the whole knee itself. So, what methods and techniques are used in ways to break up scar tissue in the knee? First, let's look at the signs you may have scar tissue build-up.
Signs You Have Scar Tissue in Your Knee
Sometimes scar tissue takes years after an injury to show signs of build-up. When scar tissue or adhesions build up in the joints, tendons, and soft tissue, you may experience aches and pains, as well as a loss of stability and a full range of motion.
Aches and pains in the knee from scar tissue may be felt during normal daily activities like walking or squatting. Other cases of knee pain from scar tissue may arise from more strenuous activities like working out or running.
If you're experiencing pain, stiffness, or a diminished range of motion in your knee joint, then you most likely have scar tissue in or around your knee. Other signs of scar tissue in the knee may include an inability to straighten your leg, walking with a limp, an inability to bend your leg, swelling in the joint, or a grating sound or sensation when moving the knee joint.
Cause for Scar Tissue in Your Knee
Scar tissue forms in the body after the healing of a wound. It is the body's natural response to trauma. In the knee, this could come from a surgical procedure or some traumatic injury. Unlike healthy skin, scar tissue is fibrous and dense and is not very elastic. When scar tissue forms in abundance around a healed injury in the knee, it can cause the joint to "stick". This can prevent your joint from its full range of motion.
Arthrofibrosis of the knee, or commonly known as "frozen knee", is caused by inflammation and excessive scar tissue build up in the knee joint and surrounding tissues. This can be scar tissue inside the knee joint, or around the surrounding tissue of the knee. Arthrofibrosis in the knee is very common to experience after arthroscopic knee surgery or replacement procedures.
Is Scar Tissue Permanent?
Although scarring may never completely go away after an injury or surgery, it can be remodeled to have a full range of motion, strength, and mobility. The remodeling of scar tissue is achieved through various forms of massage, applications of oil or ointments, mobility exercises, and sometimes lightweight exercises.
The purpose of remodeling scar tissue is to restore normal functions to inflexible tissues by normalizing cellular and organ metabolism. Generally, it takes about six to eight weeks to fully remodel injured tissue within the body.
Breaking Up Scar Tissue or Scar Tissue Mobilization
Scar tissue mobilization is a technique used by physical therapists to help break up and remodel scar tissue in the knee. This involves various methods of massaging scar tissue—or its surrounding tissue, such as muscles, tendons, ligaments, or fascia.
Massaging scar tissue is often performed by trained physical therapists. However, correct techniques can be taught and learned so that the patient may perform scar tissue mobilization on themselves. Learning how to break up scar tissue in the knee is important to maintaining healthy knees after an injury or surgery.
Cross Friction Massage
Cross friction, or transverse friction, is an effective technique that involves using one or two fingers to massage scar tissue that has fully healed. It is done by massaging the adhesion or scar tissue in a perpendicular direction to the line of the scar.
This helps to remodel the scar and allows the collagen fibers to align properly. Cross friction massaging helps to breakdown scar tissue in the knee into normal, flexible, and pliable healthy soft tissue.
To perform this technique, gently rub back and forth over the inflamed tendon in your knee where it is most tender. Be sure to keep your strokes perpendicular to the fibers of the tendon—similar to how you would strum a guitar string.
Do not use excessive pressure as moderate pressure from the pads of your fingers or thumb will suffice. You can increase the pressure every one to two minutes. Finish your cross-friction massage by icing your affected area for a couple of minutes, or until numb.
It is normal to feel discomfort with a gentle friction massage as you're rubbing an inflamed tendon. The pain might feel like a burning or even a clear sharp painful sensation.
This technique is often used when treating tendonitis, muscle strains, and ligament sprains. Perform this technique for five to ten minutes at a time, two to three times per day. One may also use small amounts of oil or vitamin E lotion to help soften scar tissue while massaging and prevent friction burns to the skin.
Myofascial tissue is the tough membranes that wrap and intertwine our muscles. It is the thin and strong fibrous connective tissue that connects throughout our body and helps provide support and protection to our muscles and bones.
Oftentimes injuries and scar tissue buildup in the knees can cause pain and tightness in the surrounding fascia. Tight and inflexible fascia restrict muscle and joint movements and can contribute to joint and surrounding muscle pain. Myofascial release therapy is a way to loosen stiff and fixed fascia by applying light but steady pressure on the affected area.
A good technique for locating and performing myofascial release therapy is to lie down on your stomach and place a tennis ball or roller under your thigh. Support yourself with your hands or elbows and begin moving your leg slowly over the ball or roller.
Once you've located a tender or painful spot, keep the pressure on it while breathing deeply into it. This should help alleviate the tension. Roll the ball around the area until the worst of the pain subsides.
You can continue moving the ball or roller around all areas of your leg muscles in order to find any other sore or tight fascia. Maintain slow motions combined with deep breathing to find and release those tight, sore trigger points.
You may need to repeat this technique regularly or after workouts in order to see results. A good time to perform myofascial release therapy is before you go to bed, or before and after a workout.
Assisted Soft Tissue Mobilization
Another technique used in myofascial release therapy is instrument-assisted soft tissue mobilization—also known as the Graston Technique. It is a fairly new treatment involving the use of metal or plastic tools to massage muscles, fascia, and tendons. The idea is the same with all myofascial release therapy, which is to improve soft tissue mobility in your body through massage.
A physical therapist using IASTM will rub an ergonomically shaped metal tool over the skin of an affected or sore area, looking for tight fascia. The tool is then "scraped" along the skin until the fascia feels loosened.
Muscle Strengthening for Healthy Knees
Weak muscles surrounding the knee joint can perpetuate and overstress the knee. Strength training the muscles in the leg, especially the quadriceps and hamstrings is crucial in maintaining healthy knees where scar tissue is present.
Make sure to warm your leg muscles up before performing any strength training—you can do some jumping jacks, or go for a light jog. Once you begin to sweat or breath more heavily, you're plenty warm. After you've warmed your muscles up, proceed with a light stretch.
There are many different types of exercises that help build your leg muscles for optimal knee support. Always start with light weights, and increase weight gradually over time. A basic muscle strengthening program might include the following exercises:
. Leg press
. Hamstring curl
. Knee extension
. Straight leg raise
. Short-arc lift
. Wall slides
. Roman chair
. Side-lying abduction
. Standing hamstring curl
. Toe raises
. Chair squats
. Calf raises
. Hip abductions
It is best to perform these exercises two to three times per week. You can do them in sets of three with ten to fifteen repetitions each set. Make sure to get plenty of rest in between workout sessions for optimal muscle recovery.
Stretching for Healthy Knees
According to the Arthritis Foundation, knee stretching and strengthening are considered highly effective non-drug treatment for osteoarthritis and other knee pains. To help alleviate knee pain from scar tissue, perform stretches that target your calves, quadriceps, hamstrings, and hip flexors.
Standing Calf Stretch
You can perform a standing calf stretch by facing a wall and standing about two feet away. Next, extend your arms in front of you at shoulder height and place your hands flat on the wall.
Step forward with one of your legs, slightly bending the knee. Keep the opposite leg straight back. With the leg that's stretched back, push down with your foot until you feel a good stretch.
You can move deeper into the stretch as your calve begins to loosen by moving farther away from the wall. Maintain this stretch for at least 30 seconds, with deep and steady breaths. Switch legs and repeat.
A good way to stretch your quadriceps is to stand next to a wall or chair. Bend one of your legs back behind you so your heel is touching your butt.
Grab your ankle with your hand and pull your leg up and back while keeping your torso and head aligned. The more you pull back on your leg the deeper the stretch you'll feel.
You can use your opposite arm to hold on to a chair or wall for balance. Once you've held this stretch for at least 30 seconds, you can switch legs.
Stretch out your hamstring muscles by lying down on your back. Extend a leg in front of you while bending the opposite leg.
With the leg that is bent, wrap your hands around the back of the thigh and pull the leg slowly toward your chest. Hold this stretch for at least 20 seconds, then switch legs.
Lunging Hip Flexor Stretch
An effective way to stretch out your hip flexors is to kneel one leg, keeping your shin on the ground. With one leg back and the other leg forward in a kneeling position, push forward on the knee that is facing up and closest to you.
It is important to keep your torso and head aligned during this stretch. Note, this might be painful to do on a hard floor and is often best done on a yoga mat. Hold this stretch for at least 20 seconds and then switch legs.
How to Get Rid of Scars
When surgical procedures are involved, there are often visible scars left on the knee. Although modern knee surgery procedures have advanced in ways to minimize visible scarring on the skin, it is almost impossible to be left with none.
How deep your scar tissue is and the type of surgery involved will affect how your scar heals over time. Maintaining a healthy diet full of foods rich in nutrients essential to scar healing—such as copper, zinc, and vitamin A—will help the healing process. Foods rich in vitamin C can help with the production of collagen as well.
Of course, getting plenty of rest and drinking lots of water to hydrate your skin is essential to your body healing properly over time. You can also try applying certain essential oils that have been found to promote healthy skin regeneration. Essential oils such as helichrysum, lavender, frankincense, geranium, and tea tree oil are touted to have skin healing properties.
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