ScarWork: What Happens When We Stop Fighting Scars and Start Listening

I recently attended a Zoom lecture that was an introduction to the Foundations of Sharon Wheeler’s ScarWork. Til Luchau of AdvancedTrainings.com hosted the lecturer, Wojtek Cackowski, a physical therapist and certified ScarWork instructor. I went into the lecture curious. I came out with clearer language for things I’ve already been seeing on my own massage table with clients.

Wojtek began the lecture by emphasizing that dead scar tissue isn’t the problem. Disconnection is. He taught us that when Sharon Wheeler created ScarWork, she changed the way we think about scars by refusing to treat them like dead tissue. Her ScarWork practice doesn’t try to erase scars or destroy scars. It treats scarring as an active, living, adapting process. Scars continue to influence muscles, bones, skin, tendons, ligaments, nerves, as well as your fascial system even after they have healed. ScarWork gave me a framework for what I was already experiencing with my clients: when pain doesn’t behave like inflammation, arthritis, or nerve irritation, it’s often about fascial restriction, altered load distribution, and long-term over-compensation. Our bodies don’t fail in isolation. They adapt to stressful conditions. This intro class to Sharon Wheeler’s work was about how scars behave, how bodies communicate, and why force is often the thing that gets in the way of healing.

Scars Are Not Static, They Are an Ongoing Process

One of the most important shifts Sharon Wheeler brought to manual therapy is this idea:
a scar is not a finished product. Yes, scars are made of fibrous connective tissue. Yes, they form after surgery, injury, burns, acne, inflammation, or intentional medical procedures (like C-sections, laparoscopic surgeries, or carpal tunnel release). But scars are active.

A scar becomes clinically relevant when one or more of its layers can’t move in harmony with the surrounding tissues. That’s when resistance shows up. That’s when movement quality changes. That’s when pain, tone changes, numbness, or compensation patterns appear.

An “ordinary” scar, whether it’s fresh or old, behaves like normal tissue only if its layers still slide, stretch, and respond normally. When they don’t, the scar begins to influence the entire fascial web.

How Scars Form: The Body’s Intelligent (and Imperfect) Repair System

We spent time reviewing the stages of scar formation, not just biologically, but mechanically:

Scar formation is not a failure of healing, it is healing. But like any repair done under pressure, it can leave behind imperfections. Wojtek’s lecture outlined the stages of scar formation as a dynamic process:

1. The Clotting Phase (Hemostasis) - 
Immediately after injury, the body forms a clot and scab to stop bleeding and protect the area.

2. Inflammatory Phase - 
Heat, swelling, fluid migration, and immune activity dominate this phase. Liquids flood the area to support cell migration and cleanup. This phase is essential. And it is easily disrupted by overly aggressive intervention.

3. Fibroblastic Phase (Proliferation) - 
Fibroblasts produce collagen to rebuild tissue. This collagen is laid down quickly and efficiently, but not always neatly.

4. Remodeling Phase (Reconstruction)
 - Over time, collagen reorganizes. Ideally, layers regain their ability to slide, adapt, and distribute forces evenly. When this doesn’t happen, however, scar tissue becomes dense, irregular, and restrictive.

Problems arise during remodeling when collagen density, alignment, and layer-to-layer glide don’t achieve balance. A scar becomes problematic not because it exists, but because one or more of its layers can no longer move in harmony with surrounding tissues. Scar tissue isn’t bad, it’s connective tissue that has healed under stress. Massage can help.

Types of Scars Matter

Not all scars behave the same, and ScarWork practitioners don’t treat them the same way.

• Hypertrophic scars
 - Thick, raised, pink, hard. Excessive collagen production. Often form after prolonged healing or infection.

• Keloid scars - 
Overgrown connective tissue growths. May be more raised. Usually red or purple. Can continue growing over time. Aggressive work will make these worse, not better.

• Atrophic scars
 - Sunken scars from acne, chickenpox, stretch marks, or disrupted healing where collagen production was insufficient.

• Adhesions - 
Internal binding between tissues. Extremely common after surgery. Even minor or laparoscopic procedures. Studies suggest up to 95% of patients develop adhesions after certain surgeries.

Scars may be passive (not currently provoking symptoms within the system) or active (contributing to pain, movement restriction, altered tone, or sensory changes within the system).

From Skin to Bone: Everything Is Connected

A major theme of the lecture was understanding scars in the context of the skin’s layered anatomy.

From the skin to the bone, we move through:

• epidermis

• dermis

• superficial retinacula cutis

• adipose tissue

• superficial fascial membrane

• deep retinacula cutis

• deep fascia layer

• hyaluronic-acid-rich layer

• epimysium, perimysium

• muscle

• bone

These layers are connected, but not glued together. They’re designed to slide, glide, and transmit force efficiently. When scars restrict movement between layers, force distribution changes. Muscles stop contracting efficiently. Joint mobility degrades. The fascial system will then compensate.

This is why scars can influence posture, gait, coordination, and pain far from where they’re located. I have witnessed this with clients when i was working in the student clinic and also in my own practice.

Fascia, Movement, and Quality (Not Just Range)

One part of the lecture that stood out for me wasn’t about pain, it was about movement quality. It’s not just that we can extend an elbow. It’s how we extend our elbow.

Try this now. Hold your palms in front of you, facing each other, about 12” apart. Now press them together with intention. Notice the stages of movement. Can you move slowly, evenly, without shaking, stopping, speeding up, or bracing? Does the movement remain smooth from start to finish? Scars distort this fluid movement.

Our fascial system:

• transfers force between muscles (Huijing, 2007)

• acts as a mechanosensitive system for coordinated movement (Schleip, 2003)

• synchronizes motor activity so movement is efficient and fluid (Stecco & Stecco, 2009)

When scars interfere with sliding (especially in the superficial and adipose layers), movement loses fluidity before it loses range.

ScarWork Starts With Communication, Not Force

Manual therapy, as ScarWork instructors teach it, is communication between two intelligent systems. The medium is kinesthetic communication. Most anatomy books explain what scars are, meanwhile Sharon’s ScarWork protocol addresses how to communicate with them.

Scar tissue is dense, irregular, and difficult to navigate safely, which is why the instinct has been to attack it. But ScarWork techniques do the opposite. ScarWork uses light touch because force makes tissue defend. Light touch allows layers to reorganize. This is where Sharon’s concept of tissuephilia comes in.

Why ScarWork Changes Movement, Not Just Tissue

Scars influence more than local sensation. They distort movement quality. As Wojtek emphasized during his lecture, fascia coordinates force distribution, timing, and efficiency of movements. When scar tissue disrupts sliding between layers —especially in the superficial fascia rich in nerve endings— our movements may become hesitant, jerky, or over-controlled.

ScarWork often begins with scars because restoring sliding improves the body’s ability to move with constant speed, control, and fluidity. Because of the thixotropic nature of hardened fascial tissues, we can soften scars and reintegrate them into the fascial system. When we integrate scar tissue into the fascial web, balance returns because the layers can communicate.

Tissuephilia: A Quality of Touch.

Tissueophilia is defined by Sharon as a quality of touch when fingers want to be in contact with the tissue; they are attracted to the scar. Each part of the hand maintains contact and pressure with the skin. Remember that a scar is a creation made up of good connective tissue that has become crumpled, irregular, and blocked. You have to be calm, confident, and satisfied when working on scars. It’s a relationship.

Hands that want to be there.


Contact without urgency.


Pressure without force.

ScarWork should never be painful (2–5 out of 10 at most). Redness means you’re working too hard. Inflammation means the tissue needs a break. Clients often describe the result simply:

“My scar feels like it’s part of me again.”

The Four Directions of Scar Movement

A scar is not a line, it’s a three-dimensional structure.

We assess movement in four directions:

1. Longitudinal

2. Transverse

3. Rotational (clockwise/counterclockwise)

4. Vertical lifting

Watching how fluids move around a scar —pressing, releasing, observing— tells you how the layers are behaving.

The following are foundational techniques presented to us during the lecture by Wojtek. Notice that none of them are about “breaking up” scar tissue.

The Nine Foundational ScarWork Techniques

One thing Sharon Wheeler is very clear about, ScarWork is not aggressive. It is not corrective through force. And it is never about tearing tissue apart. Every foundational technique exists to restore relationship between layers so the scar can rejoin the larger fascial network of the body. These techniques are not recipes. They are ways of listening to the tissues with your hands. The techniques also reinforce something I deeply respect: this work requires humility, patience, and constant observation.

The Common Thread of Every ScarWork technique shares a few non-negotiables:

• work from surface to depth

• stay within a low pain range

• watch for redness or inflammation

• adapt constantly

• let tissue respond instead of forcing change

1. Feather Sweeping

(Introducing safety and sensation)

Feather sweeping is often the very first contact with a scar, especially a new or sensitive one. The touch is extremely light, almost like brushing dust off skin. The goal isn’t to move tissue deeply, but to introduce sensation without threat. This technique helps calm the nervous system, orient the client to touch near the scar, and begin encouraging fluid movement in the superficial layers.

It’s commonly used:

• shortly after stitches are removed

• on burn scars

• on areas with heightened sensitivity or fear

This is less about “doing” and more about saying, “Hey, this area is safe to feel again.”

2. The Eraser

(Softening rough or dense surfaces)

The eraser technique is used when scar tissue feels thick, stiff, or uneven. It is often used after burns, radiation, skin grafts, or road rash-type injuries. Using a very gentle, rubbery motion (like erasing pencil marks), the practitioner works on the surface layer of the scar while keeping both hands at the same depth. One hand stabilizes the tissue and the other creates small, controlled movement.

This technique helps:

• soften dense superficial layers

• create tone and organization

• prepare tissue for deeper work later

It’s subtle, slow, and easy to overdo, so restraint matters.

3. Scraping

(Guiding tissue back into the scar)

Scraping is often misunderstood. It is not scraping across the scar line aggressively. Instead, one hand gently holds tissue away from the scar, while the other hand uses a soft plier grip to guide tissue toward the scar from either side. The motion is directional and intentional, helping fill in areas where tissue has pulled away or become disorganized.

This technique is useful for:

• long surgical scars

• joint replacement scars

• areas where the scar feels hollow or disconnected

You don’t “go back” over the same path. You guide, release, and re-assess.

4. Filling In

(Restoring missing volume)

Filling in is used when a scar leaves a gap, indentation, or sense that tissue never fully came back together. One hand gently stretches or stabilizes the area. The other hand works around the edges of the gap, gradually “stuffing” tissue back toward the center using fingers in sequence. This encourages collagen to reorganize and layers to reconnect.

This technique is especially helpful for:

• atrophic scars

• acne scars

• surgical scars with visible hollows

5. Cat Technique

(Redistributing fluids in complex scars)

The cat technique is often used for deep, uneven, or highly distorted scars such as after burns, abdominal surgeries, or radiation.

The practitioner applies slow, whole-hand pressure that helps redistribute fluids across multiple layers. Over time, this allows the practitioner to distinguish deeper structures and observe how tissues respond under load. This technique is about organization, not force. It helps normalize pressure systems and reduce chaotic tissue behavior.

6. Matching Layers

(Correcting misalignment)

Sometimes scars heal but the layers don’t line up. One side may sit higher. Another may drift sideways. There may be a gap along the scar line that affects nerve sensation, tone, or movement. Matching layers involves gently guiding misaligned tissues back into relationship. This is especially important for:

• C-section scars

• abdominal surgeries

• scars with numbness or distorted sensation

Restoring alignment can dramatically improve sensory feedback and movement control.

7. Dropping

(Releasing over-expansion patterns)

Dropping can be done with a fingertip or the whole hand. On a small scale, the fingertip relaxes into piled-up scar tissue, repeatedly allowing the tissue to settle downward until it smooths out.

On a larger scale, whole-hand dropping helps release patterns of chronic over-expansion, like lingering abdominal distension after pregnancy, swelling after infection, or even diaphragm holding patterns after trauma.

This technique is not forceful. The hand relaxes, the tissue follows.

8. Combing

(Refining scar edges)

Long scars often develop rough, spread-out edges over time. Combing involves gently separating fiber by fiber away from the scar line, helping define and smooth the edges. This improves both the texture of the scar and its mechanical behavior.

It’s especially useful for:

• long surgical scars

• areas where the scar feels dry or rigid

9. Playing the Piano

(Creating tone in ropey scars)

This technique is commonly used on long, rope-like scars, especially C-section scars. Using alternating finger pressure along the scar (like playing piano keys), the practitioner creates tone and elasticity within the scar tissue. This helps reduce rigidity and improves how the scar transmits force.

Clients often report improved sensation, warmth, or a sense of “connection” afterward.

All are designed to re-bond tissue, guide cells, and restore continuity rather than destroy scar tissue.

Fresh Scars and Healing

ScarWork on fresh scars begins after the wound is fully healed, dry, no longer hot or reactive.

Early work happens around the scar, not on it. This encourages lymphatic and interstitial fluid flow, supporting fibroblasts and stem cell activity, and avoids introducing infection risk.

Direction matters, but control is limited. We influence pressure and pathways without trying to force outcomes (“Let’s break up this scar!”).

Why This Matters to My Work

ScarWork reinforces how I approach self-care, posture, and movement education: change doesn’t come from force. Pushing too hard and fast often delays healing. That’s just physics (equal and opposite forces and all that). Healing comes from awareness, quality, and listening. Gentle work allows us to have a greater impact and creates longer-lasting change.

When we help the body organize itself through thoughtful touch, better sleep habits, improved postural awareness, and smoother movement patterns, the nervous system responds. Healing happens.

ScarWork reminds us that scars don’t need to be erased to stop influencing us. They need to be reintroduced to the fascial system in a gentle, gliding, restorative manner.

ScarWork is about mending, not tearing.


About listening, not overpowering.

And when done well, scars don’t just soften.

They rejoin the body.

That’s not just healing.


That’s reintegration.

If you have scars that may be impeding movements, and you are in Las Vegas, massage may help! You may book time on my massage table by clicking this link.