The Relationship Between Scars and Mobility

The relationship between scars and mobility is one of the most common questions asked by patients with scoliosis. Scarring occurs due to various causes such as trauma, disease or congenital deformity. If it’s not treated properly, these injuries may cause permanent damage to your spine. In some cases, the problem is so severe that it prevents you from walking normally. The problem is often very difficult to diagnose because there are many different types of scars. Some are superficial (like those caused by surgery), while others have deep grooves.

There are two main types of scars: hypertrophic and nonhypertrophic. Hypertrophy refers to any growth that does not involve bone; it includes cartilage, ligaments, tendons and other connective tissues. Nonhypertrophy refers to any growth that involves bone.

Examples include vertebrae, ribs and sternum.

Hypertrophy scars are usually found on the back, but they can occur anywhere along the body. They’re generally larger than nonhypertrophy scars and tend to be darker in color. They can be raised or flat and are often painful to the touch.

Hypertrophy scars that occur on the back may bend (or curve) the spine.

Nonhypertrophy scars are less common than hypertrophic scars, but they’re more problematic and difficult to treat because they do not respond well to manual therapy techniques. These scars often cause a segment of bone to become fused, which can permanently damage the spinal column.

The primary cause of scarring is trauma, such as motor vehicle accidents, falls, sporting injuries or medical procedures. Other causes include inflammatory diseases, genetic disorders and cancer. Some people are born with certain types of spinal deformities and these are typically not treated until a child is older because the spine is still growing.

Many times, the cause of spinal deformities is unknown. In these cases, the condition may be diagnosed as idiopathic. The treatment will depend on the type of abnormality, but in most cases surgery and bracing are necessary for correction.

Fortunately, technology has improved greatly when it comes to corrective procedures. Many hospitals have dedicated scoliosis correction centers where patients can go for multi-disciplinary treatment. This includes exercises, manual therapies, surgery and more.

You’ve been wearing the brace for a year and it’s been making your back feel better, but you’re starting to feel like you’d rather be without it. Your friends make jokes about it behind your back, and sometimes to your face, but you don’t really mind because at least they’re still talking to you.

Your parents are concerned about your low spirits. They offer to take you out to dinner and a movie to give you a break from the monotony of your daily brace routine, but you decline. You’d rather just stay in and rest, because even lying down with the brace on is uncomfortable at this point.

After another year passes, the novelty of having friends has started to wear off and they’ve all moved on to other things.

None of them contacted you over the summer, so why bother trying to reconnect now?

You continue to wear the brace for another two years because your parents remind you that you still have a ways to go and you should never give up. As time passes, the pain gets worse and you feel more limited in what you can do. You become more withdrawn and begin to resent the brace.

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At age 17, you graduate from high school and your parents tell you that you’ll finally be getting surgery soon. You’re excited by this news because it means you’ll finally be free of the brace, but as the days pass you become nervous.

What if something goes wrong? What if you wind up with a hunchback? Who will want to be your friend then?

You’ve become so obsessed with the possibility of deformity that you often find yourself fixating on other peoples’ posture. The smallest deviation from what you believe is “normal” may catch your eye.

You feel as if you’re living in a prison of your own making. You have no control over anything. You’ve become a prisoner to this brace and to your own fear of what may happen if you have surgery.

The day finally arrives when you’re supposed to go in for surgery and you’re so anxious that you can’t eat breakfast. You drive to the hospital with your parents and wait in the pre-op area. A nurse comes in and begins asking you questions.

Do you have any last questions?”

she asks.

When will I be able to shower?”

“Well, it will be at least a couple days. Possibly a week.”

You nearly faint.

A whole week without being able to take a shower?

You’d go insane.

“It won’t be that long,” the nurse says as if reading your mind. “Actually, since you’re scheduled for surgery in the next hour, we’ll have you sit in a tub of disinfectant for a few minutes before we scrub you down and give you a quick rinse off. The sooner we get your incision protected with antiseptic, the better.”

“Okay,” you say.

“Now I need your full name.”

You tell her your full name and she types it into her phone.

“All right, everything seems to be in order. The doctor will be in to see you before your procedure and when you wake up, a nurse will help get you ready for a shower.”

“Thanks,” you say meekly.

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You’re so nervous that you can barely think straight. Your palms are sweaty, your heart is racing and you just wish the nurse would give you something to calm you down.

The doctor finally walks in and asks you how you’re feeling. You tell him that you’re a little nervous, so he gives you a mild tranquilizer to help take the edge off. A few minutes later, you begin to feel more calm.

You remember what the nurse said, that you’ll get a quick rinse before getting your incision protected with antiseptic. At least it isn’t a full shower, but even that seems too much to bear right now.

What if they slip up and get some of this disinfectant on your incision?

That would be awful.

You’re already anxious about being able to play the violin after the surgery and having your scar exposed to the world.

What if you can’t do either?

What is going to happen to your future?

After all that worrying, it is finally time for you to get wheeled into the operating room. You take a series of elevator rides until you are finally in the right place.

You get wheeled into a small room with a few people in surgical gear and a table with stirrups. You’ve never seen this on any TV show–maybe that’s why it seems so scary.

Everything seems to happen really quickly once you’re in the operating room. You lie on the table and they strap your knees down. The doctor tells you that he’s going to put you to sleep and begins putting a mask down over your face.

You try to think happy thoughts as you slowly begin to lose consciousness.

You wake up in a hospital bed with a bandage wrapped around your head. You move your hand to touch it and feel a large bulge under the bandage.

“Hey, you’re awake!” your mother says, looking up from her phone.

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You try to sit up, but a sudden spike of pain goes through your head so you lie back down.

How do you feel?”

“Like somebody hit me in the head with a baseball bat.”

Your mother smiles and nods her head. “Yeah, you got quite a few stitches. The doctor said you’ll be okay in a couple days.”

She pauses before continuing.

“The police want to talk to you about the break-in at your school. They say they need to know what happened so they can catch the person who did this. They said they’d be here in a few minutes.”

You nod and try to remember what happened last night. You can remember bits and pieces, but it’s all very fuzzy–like it happened to someone else.

You hear a knock on the door.

“Come in,” your mom says.

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Two men in suits enter. One is holding a notepad while the other is holding a tape recorder. The one with the tape recorder speaks first.

“I’m detective Anderson and this is my partner detective James. I understand that you were present when the burglar made his escape.”

You nod as Anderson shows you his tape recorder and then puts it on the table next to your bed.

“I’m going to record our conversation so that nothing is misquoted.

Understood?”

You nod and he presses start.

“Now, tell me what happened from the beginning.”

You tell the two detectives everything you remember. You start from being at band practice to waking up in the hospital.

How much did you drink at the party?”

James interrupts.

“I didn’t drink at all. My mother didn’t let me drink when I went to the party.”

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So, your mother went with you?”

“No, she dropped me off.”

The two detectives look at each other.

How old are you?”

Anderson asks.

“Thirteen. I’m in the eighth grade.”

Both detectives nod as if this explains everything.

“Okay,” Anderson says. “Now, tell me everything you know about the man who broke into your school.”

You explain as much as you can about the burglar. The two detectives interrupt you several times asking questions and clarifying details.

After you’re done, there is a moment of silence. The two detectives stare at each other not saying anything. It feels weird to you.

Well? Aren’t you going to ask me any more questions?”

you ask.

“No,” Anderson says. “You’ve given us everything we need to know.”

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He turns off the tape recorder and stands up. He takes a card out of his pocket and puts it on the table.

“That has my cell phone on it. If you think of anything else, call me directly. I’ll make sure we get this guy.”

The two detectives walk out of your room without saying another word. You lie in your bed and think about what you can do to help the police catch the burglar. After thinking for a bit, you realize there isn’t much you can do.

You’re not even sure if the guy will be able to get into another house.

The next few days are filled with the police questioning everyone at school to see if anyone knows who broke into the school. Nobody knows anything although rumors start to fly about what happened. You try to keep a low profile since you know that people at school will think you’re just making up the story since you got so drunk you don’t even remember what happened.

You just hope the police catch the guy soon so this all ends.

Two weeks later

You wake up in the morning and find your mom sitting on the edge of your bed. This scares you because you can’t remember if you did anything wrong.

“Hey, it’s okay,” she says. “I didn’t mean to scare you.”

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Are the police here? Did they catch the guy?”

Your mother shakes her head.

“The police have been trying to catch the guy but they haven’t found him yet. No, I’m not here about that. I’m here because I need to go back to work.”

You nod.

“Yeah, I know it sucks. I remember I had to go back really early too when I was in the fifth grade.”

“Well, we’re doing it a little earlier because we need the money. So I’ll be leaving in an hour to go get ready for work.”

Your mother leaves your room and you start thinking about what you’re going to do all day by yourself for the next fourteen hours. You get out of bed and look out your window. All you see is a sea of rooftons with no end in sight.

You think about how you’ve been staring out this window for the past two weeks since the break-in at your school and nothing has changed. The burglar hasn’t been caught or seen anywhere and you haven’t had another blackout. You’re starting to get worried that something might be seriously wrong with you.

You go down stairs and find your mom making breakfast. You haven’t eaten since yesterday so you devour the meal she gives you. You pack some food in a lunchbox for you to eat later since you don’t think you’ll be able to cook anything by yourself.

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After breakfast, your mom drives you to school and speeds away as soon as you get out.

You enter the school with purpose. You’re not going to let what happened to you two weeks ago happen again. You need to find somewhere safe to hide and you think you know just the place.

You walk into school and head towards the auditorium. The hallways are completely empty, which makes sense since classes have been canceled today. The school is holding some kind of fun fair for the students to try and help them forget about what happened two weeks ago. You grab the railing of the stairs that lead up to the auditorium and begin climbing to the upper floor. You’re about halfway up the stairs when you feel something hit you in the back.

You fall down the stairs and desperately try to grip anything you can to stop your fall, but there is nothing. You keep falling until you eventually hit the floor with a loud thud. You don’t move.

You try to get up, but your body doesn’t respond. You lie on the ground looking up at the ceiling wondering if you’ll ever get up again. You blink once… Then twice… Then your eyes close and you drift into darkness.

You don’t know how long you’re out for, but when you wake up you’re in a hospital bed. Your mother is asleep in a chair next to you. You try to get up, but the pain in your back is too much and you end up wincing.

You take deep breaths and wait for the pain to subside before trying again. You slowly lift your body up so you’re sitting and then stand up. You take small steps so you don’t put pressure on your wounded back. You manage to get out of the hospital room and into the hallway without waking your mother and once you think you’re far enough away, you break into a run.

You run down the hallway and turn a corner only to slam into another person. Your face bounces off their chest as you fall to the ground. You look up and see that it’s Nathan Miller, the schools “bad boy”.

He makes it no secret that he hates you, though you don’t know why. You’ve never said one word to the man.

He holds his arms out and helps you up to your feet. He gives you a wink and a smirk before walking away. You stare at his back confused since that didn’t feel at all like how it usually does when he bumps into you in the hallway.

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You shrug your shoulders and continue on your quest to escape the hospital.

You walk down the hall and take an elevator to the first floor. You manage to sneak out of the hospital without anyone seeing you and once you’re a fair distance away, you start running. You don’t stop until you reach your house.

You go up to your bedroom and fall face first onto your bed. You took three hours to get home, but you made it.

You lie in bed thinking about what happened at school.

What did Nathan mean by that wink?

You’ve never even spoken to the guy before. He’s the last person you’d want to associate yourself with.

You fall asleep and have the most horrible nightmares. You dream that you’re still in the hospital, but instead of a regular room, you’re in a mental ward. The doctors and nurses treat you like a mad man and they give you pills that make the pain go away, but also make you lose who you are.

Soon, you no longer feel any pain and you’re smiling all the time even when they do horrible things to you. You don’t care because the pills make you feel good.

You wake up in a cold sweat. That was too real to just be a dream. You push the thought out of your head and try to get back to sleep, but now you’re wide awake.

You turn over and stare at your phone. You could call Elise…

You: Hey, can we meet up?

Elise: Sure!

I should be free in about an hour, where do you want to meet up?

You: How about the coffee shop near my house?

Elise: Sounds good, see you then.

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You set your phone down and lay in bed, staring at the ceiling. It’s been an intense night for you. You’ve gotten hurt, met a new friend and had a nightmare all in the span of a few hours.

You look over at your alarm clock and see that it’s eleven. In three hours you’re supposed to meet Elise at the coffee shop near your house. You’ve never been inside before, but Kyle and some of his other friends sometimes go there.

You’re not sure if you’re really a coffee person, but it’s somewhere to go and you can always get something else if you don’t like it.

You turn over and close your eyes, willing sleep to come. Eventually, it does.

The next time you wake up, it’s because someone is shaking your shoulder. You open your eyes and see your mom standing above you.

“Get up!

What do you think you’re doing sleeping all day?”

She spits at you.

You sit up and rub your eyes. You notice it’s already evening and you skipped school today.

“I have a lot of homework to do.” You explain to her groggily.

“It can wait till tomorrow. Right now, you need to come with me to the store.”

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She walks out of your room and you follow her downstairs to the front door. Your dad is sitting in his chair, watching TV. He looks over at you when you walk in front of the screen.

Where are you two going?”

He asks, barely shifting his eyes from the show to look at you.

“I need her to come with me to the store. Our food is running low and I need someone to help carry things.” Your mom explains.

Why can’t she go by herself?”

“Because I said so, that’s why.”

Without another word, your mom opens the door and walks out. You follow her, not really understanding why she’s so mad. On the way to the car she turns around and snaps at you.

“Stop dragging your feet! Hurry up!,” she orders as she opens the passenger door for you.

You get in the car and sit down. Your mom goes around the other side and gets in. She waits a moment, staring at you, before driving off.

She doesn’t turn on the radio or attempt small talk of any kind. The whole time she’s driving, she just stares straight ahead. After about ten minutes, you reach the supermarket and she pulls into a parking space.

“Alright, we’re here. Get out.”

You unbuckle your seat belt and get out of the car. Your mom locks it with the automatic lock and looks up at the supermarket sign.

“I won’t be long,” she says, and then turns to look at you. “Don’t go anywhere.”

She turns and quickly walks into the supermarket. You watch her go inside before walking around the car to get in the back. You sit down and wait for your mom.

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You don’t know how long you wait, but it feels like forever. The waiting is interupted by a voice coming from above you.

“Hey kid. Your mom isn’t coming back.”

You look up and see an older man looking down at you from a second floor window. He has a heavy beard and shaggy hair and is wearing a dirty white tank top.

What do you mean?”

You ask, scared about what the man might say next.

“She left you. I saw her drive off with you in the backseat.”

Tears begin to fill your eyes as the man goes back into his apartment. He left you. Your own mother just got in the car and left you.

You’re all alone now. With no one to help you, no one to love you, nothing.

“Why…?” You begin to cry.

Just then, the supermarket door opens again. It’s not your mom. It’s the cashier from earlier.

He walks up to you and looks down at you for a moment, unsure of what to say. Finally, he speaks.

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Do you want me to call CPS?”

He asks.

What’s CPS?”

You ask through your tears.

“The child protection services. They help kids like you. They’ll find a nice family to live with until you’re 18 and then you can decide what you wanna do.” The cashier explains.

Really?”

“Sure. C’mon, let’s get you out of here.”

The cashier kneels down and offers you his hand. You sniffle and wipe your nose and take it. He helps you up and then grabs your backpack.

“Let’s go inside and I’ll call them.”

You follow him into the supermarket and he walks up to the manager’s office. He knocks on the door and then opens it a crack.

“I need to call child services. There’s a kid out here who needs help.”

He opens the door wider and you can see inside. The office is fairly large, with a huge desk on one side and a table with chairs on the other. There’s also a cabinet full of things like extra rolls of paper towels and cleaning supplies.

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A man sits behind the desk and he jumps up when he sees you. He runs around the desk and hugs you.

Sources & references used in this article:

The effect of massage to scars on active range of motion and skin mobility by CJ Donnelly, J Wilton – The British Journal of Hand Therapy, 2002 – journals.sagepub.com

High-mobility group box protein-1, matrix metalloproteinases, and vitamin D in keloids and hypertrophic scars by DE Lee, RM Trowbridge, NT Ayoub… – … Surgery Global Open, 2015 – ncbi.nlm.nih.gov

Mobility and stability adaptations in the shoulder of the overhead athlete by PA Borsa, KG Laudner, EL Sauers – Sports medicine, 2008 – Springer