Scar Tissue’s Role in the Stages of Healing

Scar tissue formation is the beginning stages of internal healing after an injury, surgery, or disease has occurred.   It is the body’s way of repairing itself when tissues have been damaged.  This scar tissue is formed to act as a protective barrier, but does not have the quality of the healthy tissue it has replaced.

Scar tissue is part of the body’s natural healing process.  The healing process of an injury or surgery can be divided up into three main stages.  These stages are:

  1. Acute Inflammatory Stage
  2. Repair
  3. Remodeling


Scar tissue begins to form in the very first stage of healing.

Healing Stage #1 – Acute Inflammatory Stage

During this stage, inflammation begins to develop almost immediately up to four days.  In this instance, inflammation is not the enemy.  In fact, inflammation after a back surgery will help to defuse toxins to allow the repair process to begin.

The acute inflammation stage is where swelling, redness, heat, and pain will occur.  When the inflammation diminishes, the repair process can begin.  Instead of brand new tissue being formed, the body will heal with scar tissue formation.

Healing Stage #2 – Repair

This stage will occur between the 4th and 21st day after the injury or surgery.  During this stage, damaged structures begin to become repaired by the new growth of connective tissue and capillaries.  Scar tissue keeps growing during this stage.  These scar tissues are fragile; therefore, it is not recommended that anyone touch this area except for a qualified therapist or doctor.

Inflammation will begin to decrease during this stage; however, pain associated with damaged tissue may occur.  At this point in time, physical therapists and doctors will recommend a gentle stretching program to help elongate the tissue.  Doing these stretches will expand the range of motion of the scar tissue, which will result in less pain.  The pain is not a result of the actual tissue, but of the tethers that are formed over the nerve root to connect the tissues together.  Once a movement goes past the end range, pain or discomfort will occur.

It is important to start mild and build up to a higher intensity.  Activity is still restricted during this stage to prevent further injury of the original injury.  Stretches are an excellent way to expand the scar tissue.  Mild isometric exercises are recommended.  These types of exercises are similar to strength training in that the joint angle and the muscle length will not change during contraction.  Isometric exercises are performed in a still position rather than a full range of motion.

Healing Stage #3 – Remodeling

This is the stage where the patient will take a more active role in the healing process.  Generally, this stage of healing begins on the 21st day.  During this stage, scar tissue is “remodeled” through the exercises and ranges of movement that are placed on it.   Scar tissue will develop where it is useful for protecting the injured area.

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