Untreated scar tissue is problematic. Anyone with a pain-in-the-ass scar knows exactly what I’m talking about – stiff, restricts movement and oftentimes hurts. Even if you don’t actively notice or feel an untreated scar you have, it is still sending negative afferent signals to the brain, disrupting autonomic nervous system (ANS) homeostasis. Remember, the ANS is the primary control center regulating our neurophysiology. ANS homeostasis is necessary to attain maximal health and cannot be achieved if scars are left untreated, whether they are painful or not.

Scar tissue has an unusually strong connection to the ANS. The ANS is a poorly understood system in our bodies, and ironically, it is the primary component of our nervous systems that keeps us alive. Exactly why scar tissue forms instead of just regrowing whatever was damaged is poorly understood. This is a fascinating area of study and some amazing breakthroughs are being made as we speak. This is a super exciting time for medical advancements. The optic nerve and the spinal cord in mice have both been able to regenerate and function with the help of a few simple injections, enhancing our natural, innate ability to heal. Crazy!

Reference: Check out Dr. David Sinclair’s work for more on this.

Why needling scars works so awesome is largely unknown. There is more acupuncture research on scar treatment than DN research, but overall, very little is scientifically understood.

I can tell you from personal experience, having had numerous, large surgical scars treated, and from having treated thousands of other scars, needling is the best scar tissue treatment I know of.

Remember, most Physical Therapy patients present with hyperactivity of the sympathetic autonomic nervous system (SANS). Anything that damages the body enough to induce fibroblastic proliferation, collagen deposition and scar tissue formation, is going to crank up our SANS. The SANS controls our fight-or-flight response, is typically stimulating, and is most active during the day. Norepinephrine is the primary neurotransmitter. Untreated scars are constant, nagging irritants and stimulants to the SANS. Thus, it behooves us to target the parasympathetic portion of the ANS (PANS), at the same time we treat the scar tissue itself. Targeting the PANS depresses the SANS, elevates the PANS, and brings the ANS toward homeostasis. The PANS is the calming part of the ANS and is most active at night. Acetylcholine is the primary neurotransmitter.

Reference: check out this article for more info on the ANS

There are numerous theories and hypotheses concerning how, precisely, needling improves scar tissue. The precise pathways are unknown. However, we do know some things, and the positive results are not surprising. We know tissue damage and scar tissue attract and trap pro-inflammatory cytokines, such as TNF-a and Interlukin-6. These are detrimental to healing in abnormal concentrations and stimulate excessive collagen deposition (scar tissue). We also know that thoughtful needling has a regulatory and homeostatic effect on pro-inflammatory substances throughout the body.

Needling the scar itself and the surrounding tissue, especially with the addition of low frequency microcurrent, significantly increases blood flow to and through the area. This brings healing nutrients, like oxygen and minerals, and flushes out the old chemicals stuck in the hypoxic scar tissue.

All of these effects seem pretty obvious they would help normalize scar tissue. Other substances thought to play a role in scar tissue healing are transforming growth factor (TGF-beta-1) and endothelin-1. These stimulate fibroblast survival through various pathways and may help improve scar tissue. Regardless of the mechanism action, needling scar tissue is beneficial for numerous reasons, ANS homeostasis being the most important.

What I would really like to know is, does needling scar tissue, or near unclosed wounds, along with targeting the PANS, increase intracellular expression of the Sirtuin genes (silent information regulators), especially Sirtuin-6 and Sirtuin-1 (the most powerful healers of the 7 Sirtuins)? I can almost promise they do. If anyone capable of testing this is reading, let me know! Sirtuins are relatively newly discovered genes, present in every cell in our body, that help clean up the cell and make sure our DNA is expressed properly. They are part of our epigenome, which controls DNA expression. Properly expressed DNA leads to properly functioning proteins and other stuff. Improperly expressed DNA leads to misfolded proteins and other issues that lead to impairments like cancer, Parkinson’s and Alzheimer’s.

Sirtuins, especially #1 and #6, reverse cellular aging, degeneration, and make you biologically younger, by a significant degree. If needling acutely following tissue damage does improve intracellular expression of Sirtuins, before hyperactive fibroblastic proliferation and excessive collagen deposition (scarring) occurs, this would certainly be a logical pathway through which needling improves scar mobility and functionality. In other words, I think acutely needling around scars, and once closed, needling the scar itself, limits collagen (scar) formation and maximizes sarcomere (muscle) regeneration, leading to reduced pain, maximal functionality and improved patient outcomes.

Needling Scar Tissue to flatten, mobilize & Awesomize (good word, huh?)
I am constantly amazed at how, on the surface, scars treated without needling may feel relatively OK. Mobile, supple, smooth, etc. Then you stick a needle into them and you find thick, fibrotic, immobile nastiness. It feels like trying to put a thin sowing needle through a thick piece of leather. Then you get those scars that are obviously horrid. They have not been treated, are stiff, either raised off the skin or indented, like they are glued to the bone, and have weird, contrasting colors compared to normal skin tone. They can also really freaking hurt and refer pain to anywhere in the body.

Needling is by far the fastest, most effective and comfortable tool to loosen up scars, flatten them out, and change them to as close to normal skin tone as possible. Again, little is understood about the neurophysiologic processes that accomplish this awesomeness. The mechanical effect of puncturing thick, fibrotic tissue is a little easier to understand. However, we still don’t even understand exactly how a muscle contracts, sooo… What we do know is this: Untreated scar tissue has collagen fibers like tangled fishing line or cooked spaghetti noodles. I like fishing line more than spaghetti, so I’m going with that. Tendons get the same tangled fishing line orientation when they heal without normal stress placed through them. Both tendons and scar tissue are over 99% collagen, although the collagen type is slightly different. Tangled fishing line collagen is not strong, mobile, or functional. Collagen fibers in parallel are stronger, more mobile, less painful, and increase function.

Needling scars takes tangled fishing line collagen fibers and straightens them out. This occurs on a mechanical level and a neurophysiologic level. We know, thanks in large part to Dr. Helen Langevin, that rotating the needle one direction, or the other, wraps collagen fibers around the needle. This is why the needle stops rotating and why it stings for a sec when it does. This creates a mechanotransducive effect, stimulating a neurophysiologic response in the ANS. The real magic lies in enticing the ANS and our body to reorient the collagen fibers to parallel all on their own! The underlying goal of all medical treatment should be aimed at enhancing our bodies breathtakingly wonderful, powerful, innate ability to heal.

Does tension on healing scars matter?
Now, the question is, why do scars heal with this chaotic fiber orientation? There are all sorts of theories and speculation out there, but when it boils down to it, it is some type of ANS dysfunction. Our body’s self-preserving responses can get carried away, both over and underproducing certain proteins and neurotransmitters, causing unwanted scar formation and pathophysiology. The way plastic surgeons are trained, they try to minimize perpendicular stresses on healing scars. This can be accomplished with repeated application of steri-strips, placed to decrease horizontal tension on the scar during healing. Needling around newly sutured, stapled or glued skin significantly reduces stress on the scar in all directions, way better than steri-strips do, secondary to exponentially increased microvascular vasodilation, increased muscle length, decreased sarcomere tonicity, increased endogenous opioid perfusion, SANS depression, PANS elevation and ANS homeostasis.

NOTE: All surgeons should require needling to be performed around the scar, immediately after closure. This overwhelmingly improves healing time, reduces the risk of infection, and stimulates healing with less scarring. Overactive fibroblastic proliferation, secondary to ANS dysfunction following injury, creates those horrid scars we discussed earlier and increases risk of infection. If any surgeons read this and have questions, please let me know.

Summary
We know for a fact that thoughtful needling has a formidable ability to improve ANS homeostasis. ANS homeostasis allows the body to use its mind-bogglingly awe-inspiring, innate ability to heal itself to the maximal extent possible. What if, with enough induced ANS homeostasis immediately after wound formation, our bodies would regenerate without scarring? We know this to be theoretically possible. Remember, bodily trauma, which is typically necessary to stimulate scar tissue production, severely elevates our SANS and depresses the PANS. Unbalanced ANS activity is like a swift kick in the junk, detrimental to general well-being. Far beyond normal cellular healing is being accomplished as we speak, in both mice and humans, using natural substances already present in our body to upregulate our healing ability. Thoughtful needling is the cheapest, most accessible and effective treatment that exists to normalize scar tissue, reduce pain, improve function and patient outcomes.

Let me know if anyone has any questions about anything. My contact info is on the website. Thanks.

Jason

References

Scars & Wound Healing

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Neural Plasticity

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B-endorphin

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• Vagus Nerve Stimulation
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Autonomic Nervous System

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• Castro-Sánchez, A.M., Garcia-López, H., Fernández-Sánchez, M., Perez-Marmol, J.M., Leonard, G., Gaudreault, N., Aguilar-Ferrándiz, M.E. and Matarán-Peñarrocha, G.A., 2020. Benefits of dry needling of myofascial trigger points on autonomic function and photoelectric plethysmography in patients with fibromyalgia syndrome. Acupuncture in Medicine, 38(3), pp.140-149.
• Skorupska, E., Rychlik, M. and Samborski, W., 2015. Intensive vasodilatation in the sciatic pain area after dry needling. BMC complementary and alternative medicine, 15(1), pp.1-9.
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• Sánchez-Infante, J., Navarro-Santana, M.J., Bravo-Sánchez, A., Jiménez-Diaz, F. and Abián-Vicén, J., 2021. Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis. Physical Therapy, 101(3), p.pzab070.
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