What is scar management?
Systematic desensitization of a surgical/wound site when tissue healing is complete and stitches removed.
When to use scar management?
When the incision site is tender to the touch, has a general ache or pain, or restricts activities (using a pillow, wearing a hat, hair styles, hair cuts… ).
What to do?
There is a continuum of activities. Repetition should work up to 5-6 times a day, not before bed as they can be irritating. Each session should also increase in duration though there are no set time amounts.
Imagine that you are moving the skin/incision over the skull or tissues underneath. It is not rubbing the skin as that will give skin irritation. Imagine pushing into the skin then moving forwards and backwards. You will be moving up and down the incision, perpendicular to the incision, and diagonally. It is a very small movement overall.
A physical therapist who deals with post-surgical scarring, can walk alongside you if you are uncertain on how to go it alone. Those who deal with mastectomies or more serious/violent injuries and surgeries can have more experience in dealing with scars. It is not necessary to work with someone who has experience with Chiari folk as a scar is a scar regardless of its location. Research their skill set before you go. A chat with the receptionist is not enough. Talk with an actual therapist before booking an appointment. Do not accept modalities (plug-in machines) as an acceptable form of treatment. Ask if they provide something else.
Type of touch in order of difficulty
Light … medium…hard pressure using fingers.
if you are unable to use your fingers for whatever reason, a series of soft to medium balls is effective. Laying on your back on your bed then moving to harder surfaces (plush rug to thinner rug). The dollar store, toy store, or pet store offer a selection
Harder balls in a sock for better control then going to a variety of spiked and ridged balls. Again, on the floor ( with different levels of hardness) gives good control. Against a wall can also work.
Last is more sharp or defined surfaces. Chair back edges (plushy upholstery to less to none), sofa arms, books, toys, boxes…Your imagination and surroundings will provide what works for you.
Once past the initial stages of desensitization with light touch and small amounts of time, you will build up to touch/pressure coming from all different directions and going in different directions. Building up comfort levels is important . Start with small amounts of time, even 10 seconds 3 times a day then 4 than 5, then increasing the time, then increasing the pressure. Be careful of thinking that you are tough and can handle the max. Being aggressive and creative is for when you have already put in the work of creating a base that your scar tissues can handle.
Time frames can vary from person to person. Expect a few weeks to a couple of months of daily work to get to a pain-free incision site.
Caution: If you are taking it easy and are flaring up pain or not progressing, other concerns may be in play. Lay off and there are other strategies that can be used.
Make sure that you are moving over the tissues under the skin and not rubbing the skin itself when using your fingers.
Good luck with getting incisional pain under control