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. 

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

[2] What Is Perihilar Scarring of the Lungs? (

[3] Personal correspondence.

A fuller version of this article appears in the Members’ Area. Join us as a member here.

Posted in category: ,
Posted in tags: ,

Jan Trewartha

Jan is the founder and director of the British Fascia Symposium and The Fascia Hub. She has been in healthcare since 1979, originally training as a State Registered Nurse in the Queen Alexandra Royal Army Nursing Corps (QARANC), working with patients on the wards and in the operating theatre; a superb if non-deliberate foundation for her future career as a specialist in scars and adhesions.

In 1988 she was taught by a blind massage therapist to really ‘feel’ the body, leading to a lifetime passion for body work. Jan was a massage volunteer at the Auckland Commonwealth Games where she learned from professionals from all modalities. Her work now is the culmination of many years of training and experience in different disciplines. Through her school, Body in Harmony Training, Jan runs a variety of light touch therapy courses, including Sharon Wheeler’s ScarWork, for which she was the first accredited tutor in the UK.

To learn more about Jan please visit her website:

Jan is also the co-editor and lead author of the book Scars, Adhesions and the Biotensegral Body, published by Handspring Publishing in May 2020.

Joining The Hub

There are many benefits to joining The Fascia Hub community. We will be continually revising and updating how we can better support our members.  Of course, if you have any ideas or thoughts as to what you would like to see, then we would love to hear from you.    Our membership proposition is continually evolving and changing to ensure that we bring you the best from the world of fascia.  If there is something you would like to learn more about, please do drop us a line and let us know.

Keep Up to Date with The Fascia Hub

Welcome to The Fascia Hub community!  Sign up below to join our monthly newsletter to receive up-to-date articles, details of our virtual and in-person events, plus news from the world of fascia..