Can massage therapy be used to reduce scar tissue and promote wound healing?

Massage Therapy for Scar Tissue Reduction and Wound Healing

Massage therapy is not strongly supported by evidence for reducing scar tissue or promoting wound healing, despite its common recommendation in clinical practice. While some small studies show potential benefits, the overall evidence quality is low and inconsistent 1, 2.

Current Evidence on Massage for Scar Management

Effectiveness for Different Scar Types

• Surgical scars: Limited evidence suggests massage may be more effective for surgical scars than traumatic or burn scars, with 90% of treated surgical scars showing improvement in appearance or assessment scores 1
• Burn scars: Conflicting evidence exists regarding massage for hypertrophic burn scars
  • Some studies report improvements in scar thickness, vascularity, pliability, and height 2, 3
  • However, a high-quality randomized controlled trial found no long-term benefits when comparing massage to control scars 4

Potential Benefits

• Short-term improvements in:
  • Scar elasticity (temporary effect)
  • Pain reduction
  • Decreased pruritus (itching)
  • Improved mood and psychological outcomes 3

Limitations of Current Research

• Weak scientific evidence with high risk of bias in many studies 1
• Lack of standardized massage protocols (treatment duration varies from single sessions to 6 months)
• Inconsistent timing of intervention initiation (ranging from immediately after suture removal to 2+ years post-injury)
• Heterogeneous outcome measurements 1, 3

Clinical Application

Recommended Approach

If considering massage therapy for scars:

1. Timing: Begin after wound closure is complete and sutures are removed
2. Technique: Combined approaches may be more effective:
   • Manual scar manipulation
   • Friction and oscillation massage for improving function
   • Effleurage and petrissage for improving visibility and pain 5, 2
3. Duration: Most studies showing benefit used protocols of:
   • 10-30 minutes per session
   • 2-3 times weekly
   • For at least 8 weeks 5

Cautions and Contraindications

• Avoid massage on:
  • Open wounds
  • Infected tissue
  • Unstable skin grafts
  • Areas with compromised circulation
• May temporarily increase erythema (redness) during treatment period 4

Comparison to Other Modalities

The American College of Rheumatology conditionally recommends against massage therapy for conditions like osteoarthritis, citing high risk of bias in studies, small patient numbers, and lack of demonstrated benefit 6, 7. This suggests caution in extrapolating potential benefits to scar management.

Summary

While massage therapy is commonly recommended for scar management, the scientific evidence supporting its effectiveness is limited. The most recent and highest quality study found that while massage produces immediate changes in scar properties, these effects don't translate to significant long-term benefits compared to control scars 4. Clinicians should consider this limitation when recommending massage therapy for scar management and set realistic expectations with patients regarding outcomes.