Scar Tissue: The Hidden Reason Old Injuries Continue to Cause Pain and Dysfunction
By Karson Mui DC, DACBSP®
Sports Chiropractor | Mui Chiropractic & Sports Medicine | Newton, Massachusetts
Why healing doesn’t always mean you’ve fully recovered
When people hear the words “scar tissue,” they usually think about the scar they can see after surgery or a cut. In reality, some of the most significant scar tissue forms deep beneath the skin—in muscles, tendons, ligaments, and fascia—where it can quietly affect movement, flexibility, strength, and athletic performance for years.
As a sports chiropractor, I’ve spent most of my career chasing down one question:
Why does tissue stop functioning normally after an injury?
Ironically, that journey didn’t begin in chiropractic school. It started years earlier in a biotechnology laboratory.
It Started Long Before Chiropractic
Before becoming a chiropractor, I earned my Biology degree at Northeastern University and spent time working in biotechnology after graduation. During my co-op experiences and early research career, I was involved in studies investigating the transplantation of myoblasts—muscle precursor cells—into patients who had suffered a myocardial infarction (heart attack). The hope was that introducing new muscle cells could improve cardiac function, since heart muscle has very little ability to regenerate on its own.
It was fascinating research.
But there was one constant frustration that every researcher working with muscle cells knew all too well.
Fibroblasts.
They seemed to grow everywhere. They multiplied rapidly, contaminated our cultures, and constantly interfered with what we were trying to accomplish. At the time, they were simply the annoying counterpart to the contractile muscle cells we wanted to study.
I understood what fibroblasts were from a cellular biology perspective.
What I didn’t realize was that they would become one of the most important cells I’d encounter throughout my clinical career.
The Lesson That Changed Everything
Years later, while attending chiropractic school, I had the privilege of learning from one of the profession’s great educators, Dr. David Seaman. His lectures on inflammation fundamentally changed the way I viewed injury and healing.
He taught that inflammation isn’t simply something to eliminate—it’s an essential part of tissue repair.
Following an injury, inflammatory mediators recruit specialized cells to clean up damaged tissue before fibroblasts migrate into the injured area and begin producing collagen. Those collagen fibers become the framework that repairs torn muscles, tendons, ligaments, and fascia.
Without fibroblasts, none of us would heal.
Modern research has shown that tissue healing occurs in three overlapping phases: inflammation, proliferation, and remodeling. During the proliferative phase, fibroblasts lay down new collagen to stabilize the injured tissue. Over the following weeks and months, that collagen gradually remodels itself according to the mechanical stresses placed upon it.¹
At the time, I understood the science.
I just hadn’t connected it to what I would eventually see every single day in clinical practice.
The Athlete Changed Everything
Professional Ironman triathlete Alice Alberts trusted Mui Chiropractic & Sports Medicine during her recovery from a challenging Achilles tendon injury. Through hands-on treatment, progressive rehabilitation, and movement-focused care, she worked her way back toward peak performance. Read more about Alice’s journey in our upcoming blog.
Everything finally clicked once I started treating athletes.
Week after week, I would evaluate patients who had technically recovered from their injuries. The ankle sprain had healed. The hamstring strain was no longer painful. The shoulder injury had settled down.
Yet something still wasn’t right.
The muscle didn’t activate the way it once had. Joint mobility was reduced. Strength had decreased, movement patterns had changed, and the body had quietly developed compensations around the injured tissue. Many athletes could return to competition, but they no longer trusted that part of their body.
They all seemed to describe it the same way.
“It doesn’t really hurt anymore… it just doesn’t feel like it used to.”
That sentence perfectly summarizes what scar tissue often does.
The tissue has healed.
The function hasn’t.
Scar Tissue Isn’t the Enemy
One of the biggest misconceptions patients have is that scar tissue is something bad.
The reality is exactly the opposite.
Scar tissue is one of the reasons your body survives injury in the first place.
From an evolutionary perspective, your body doesn’t care whether your shoulder rotates perfectly six months after an injury. It doesn’t care whether your sprint mechanics are flawless or whether you can squat another twenty pounds.
Its primary objective is survival.
If you tear a muscle while escaping danger, your body wants to stabilize the injury as quickly as possible. Fibroblasts rapidly produce collagen to close the defect and restore structural integrity. That’s an incredible survival mechanism, and without it, we simply wouldn’t heal.
The problem is that your body’s priority is repair—not performance.
Athletes, however, demand much more.
We ask our bodies to sprint, jump, lift, throw, skate, cycle, and generate tremendous amounts of force with incredible precision.
Scar tissue can successfully repair tissue while still leaving behind stiffness, reduced mobility, and altered movement patterns.
Why Early Movement Matters
Our understanding of rehabilitation has changed dramatically over the last several decades.
Years ago, prolonged immobilization after surgery or injury was considered standard practice. Today, the opposite is often true.
Following procedures like total hip replacement, patients are commonly encouraged to begin walking within just a few hours after surgery. This isn’t because the tissues are suddenly stronger—it’s because researchers have learned that controlled movement helps direct the remodeling process.
Collagen fibers respond to mechanical loading by aligning themselves along the direction of normal stress. When appropriate movement is introduced during rehabilitation, healing tissue develops in a more organized fashion. Conversely, prolonged immobilization can contribute to adhesions, joint stiffness, decreased range of motion, and delayed recovery.²
Movement doesn’t simply maintain flexibility.
It teaches healing tissue how it’s supposed to function.
More Than Tight Muscles
Scar tissue doesn’t just create “tight muscles.”
It changes the way the entire movement system works.
Restricted soft tissues often reduce joint mobility. Those stiff joints then alter muscle activation, forcing neighboring muscles to compensate. Over time, those compensations change biomechanics throughout the body, increasing stress on other joints and tissues.
That’s why an old ankle sprain may eventually contribute to knee pain.
A shoulder injury can change the way someone throws.
A calf strain may alter running mechanics months after the pain disappears.
The body is remarkably good at adapting.
Unfortunately, those adaptations aren’t always beneficial.
How We Address Scar Tissue
At Mui Chiropractic & Sports Medicine, we don’t think of scar tissue as something that simply needs to be “broken up.” Modern research suggests that’s an oversimplification of a very complex biological process.
Instead, our goal is to improve tissue mobility, restore normal joint mechanics, influence healthy collagen remodeling, and retrain the body to move efficiently again.
Treatment always begins with evaluating the entire movement system because scar tissue rarely affects only one structure.
Depending on the injury, treatment may include chiropractic adjustments to restore joint mobility and improve biomechanics, Graston Technique® and myofascial release to address soft tissue restrictions, dry needling to improve neuromuscular function, shockwave therapy to stimulate chronic or poorly healing tissue, and progressive corrective exercise to restore strength, coordination, and normal movement patterns.
Instrument-assisted soft tissue mobilization techniques such as Graston® have been shown to improve range of motion and are believed to stimulate connective tissue remodeling through controlled mechanical loading and fibroblast activity, although research continues to investigate the precise biological mechanisms.³
Each treatment plays a different role, but they all share the same objective:
Helping repaired tissue function more like healthy tissue again.
Healing Is More Than Closing the Injury
One lesson has stayed with me from biotechnology to chiropractic practice.
The human body is incredibly good at healing.
But healing and optimal function are not always the same thing.
Modern sports medicine isn’t about fighting the healing process—it’s about guiding it.
Research continues to explore how inflammation, fibroblasts, collagen organization, and mechanical loading interact to determine whether tissue heals with optimal function or excessive fibrosis. While no treatment can erase scar tissue completely, evidence suggests that combining manual therapy, progressive loading, rehabilitation, and appropriate movement can improve mobility, reduce pain, and restore function after injury.⁴
Whether you’re recovering from surgery, returning from a sports injury, or simply wondering why an old injury still doesn’t feel right, remember this:
The tissue may have healed—but that doesn’t necessarily mean it healed well.
Helping tissue heal well is where sports medicine makes the difference.
References
- Jarvinen TAH, Järvinen TLN, Kääriäinen M, et al. Muscle injuries: biology and treatment. Am J Sports Med. 2005;33(5):745-764.
- Franchi MV, Longo UG, et al. Tendon and connective tissue adaptation to mechanical loading and rehabilitation. Journal of Orthopaedic Surgery and Research.
- Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument-assisted soft tissue mobilization: A systematic review. J Can Chiropr Assoc. 2016;60(3):200-211.
- Hinz B. The role of fibroblasts in tissue repair and fibrosis. American Journal of Physiology – Cell Physiology.