Do not forget the hidden scars

by Jan Trewartha

When we think of scarring, we tend to visualise a linear or other scar, caused by surgery or injury; normally visible, something we can focus on and work with in order to minimise its impact on local and even body-wide tissues, organs and systems.

However, scars may be the result of other less tangible causes; internal inflammation, the spread of infection, or the ‘rabbit warren’ under the skin, created by multiple laparoscopies, biopsies, drains and/or epidurals, where tracking adhesions can and usually will be residual. Even less obviously, endometriosis, vaginal hysterectomy, invasive dental work etc. all leave their hidden mark.

This month, with The Fascial Breath event imminent, I thought I would bring to your attention the scarring caused by respiratory issues. When lung tissues are damaged and/or scarred, this is generally known as ‘Interstitial Lung Disease’ or ILD. There are various types of ILD including the most common one, Pulmonary Fibrosis.[1] The lungs can become stiffened and work less efficiently, with oxygen transfer affected, and the damage can, it is considered, be irreversible.

Lung scarring may be caused by harmful pollutants such as cigarette smoke, asbestos, and coal, cotton and silica dust, or by chronic lung conditions, e.g. pulmonary fibrosis, tuberculosis, pneumonia, sarcoidosis, and more. Researching this topic online, there is a thought that minor lung scars can be considered to cause no real effects, however knowing what we do about the ramifications of scarring with the inevitable thickening of tissue and effect on functionality, this seems to me to be unlikely even if these ongoing issues are not always recognised as being due to the scarring.

There is an interesting point I read about perihilar scarring:

“’Perihilar’ designates the area of the lung around the hilum, a triangular depression where the major arteries and airways enter and leave the rest of the lung. These include the bronchus…..and the main pulmonary veins and arteries. The perihilar area is the most likely to scar, due to being the main area receiving air and thus receiving the most particulate and other matter.

“’Perihilar’ scarring’ can be caused by prior infections, such as pneumonia, inhaling particulates such as asbestos or silicates, inflammatory diseases such as sarcoidosis or hereditary diseases such as cystic fibrosis. It can be aggravated by environmental and health factors, most prominently smoking or working in a fume-heavy environment. The lung, however, is fairly resilient and small scars will not cause any long-term damage. Most scars will calcify and remain after the injury is inflicted.”[2]

Thinking about fascial continuity, however, if the perihilar area is affected, then one would imagine the mobility and functionality of these “major arteries and airways” may well also be damaged simply by the contracting, restricting effect that scarring will almost inevitably exert, especially to proximal structures. I discussed this with John Sharkey, who replied in agreement: “From a simplistic embryological viewpoint the paraxial mesoderm forms the tissues of the back, the thorax and a significant portion of the neck. And so, from a mechanotransduction viewpoint, scars and adhesions can have wider implications.” [3]

Never underestimate the results of scarring, especially of the hidden scars. Out of sight, out of mind, perhaps, but an on-the-ball therapist will be thinking of what lies beneath as well as what is visible and tangible. 

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[1] What Is Interstitial Lung Disease? – Lung Institute

[2] What Is Perihilar Scarring of the Lungs? (azcentral.com)

[3] Personal correspondence.

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