Massage Therapy Journal Summer 2025

66 • Massage Therapy Journal

Manual lymphatic drainage (MLD) is often recommended in the post-operative period to reduce edema. In fact, in a recent study, most plastic surgeons thought that massage worked effectively, and 93% recommended massage. 59 MLD techniques are used, which are delivered slowly, repetitively and with light pressure. The current body of knowledge examining the efficacy of MLD has yielded mixed results largely because most studies combined manual techniques with other concurrent modalities such as breathing techniques, exercise, and/or compression bandages or garments. 60,61 Surgical Scars: Stages of Healing The body begins its healing process at the surgical incision as soon as the incision is closed. As the incision begins to heal, scar tissue can build up and limit the range of motion in the torso or legs, which can ultimately lead to shortness of breath, difficulty moving the body and arms, and pain with movement.

To ensure proper healing, which includes a scar that is flexible and mobile, there are some simple techniques that can be performed during the healing process. 62 Normal wound healing and scar formation happen in sequential and overlapping stages often called the “cascade of healing.” • Stage 1: Hemostasis . Initially, the body responds to a new wound by mechanisms to stop the bleeding from broken vessels. Coagulation pathways are activated and play a role in stopping blood loss. Accumulation of platelets follows arterial vasoconstriction in the damaged endothelial lining. Chemicals are released from the clumping platelets and initiate the process of blood clot formation (called thrombosis ). Vasoconstriction is brief and soon followed by vasodilation to promote the migration of white cells and more platelets. Hemostasis can last only a few minutes to two days to complete, depending on the depth of the wound. • Stage 2: Inflammation . In this stage, the immune system is activated in preparation for the growth of new tissue. Both white cells and platelets release chemicals such as cytokines. Some chemicals promote the transformation of fibroblasts, which synthesize collagen. Other chemicals increase cellular permeability, which promotes swelling. Inflammatory cells (e.g., neutrophils, monocytes) stick to a fibrin scaffold formed by platelet activation during the process of blood clot formation. Neutrophils enable phagocytosis to destroy bacteria and remove any cellular debris to decontaminate the wound. The incision in this stage is swollen, warm, red and often painful. The inflammatory phase of wound healing usually lasts about six days, but can take up to two weeks. • Stage 3: Proliferation (Regeneration) . The body begins to make the components it needs to form new tissue. Collagen is the main building block of wound healing and tissue repair. Collagen is made and deposited in an unorganized fashion to close the gaps between the edges of the incision and fill it in. The wound also begins to contract. The scar is considered immature at this stage and is characterized by the “three Rs”: red, raised (slightly elevated), and rigid (or firm). This stage usually lasts about three weeks but can take up to six weeks. • Stage 4: Remodeling (Maturation) . The body begins to remodel the scar as the scar matures. The deposited collagen fibers reorganize, and excess collagen dissolves. At this stage, there are no open areas, and the scar becomes both strong and flexible, but not as much as normal skin.

Learn . . .

Pain Headaches Fibromyalgia

John F. Barnes, PT International lecturer, author, and authority on Myofascial Release.

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