Can Old Scars Cause Pain? What Changes After Surgery

Healed on the Outside, Different on the Inside: What Changes After Your Body Is Cut

Healed on the Outside, Different on the Inside: How Surgery Scars Affect Your Body

Key Takeaways

1. Any surgery cuts through skin, nerve endings, and fascia, and the body repairs them with scar tissue that is stiffer and weaker than the original.
2. Scar tissue and adhesions can interrupt the signals between an area and your brain, so other muscles take over the work and that workaround becomes your normal.
3. An old abdominal scar, including a C-section scar, can shift load onto the low back, even decades after surgery.
4. Lasting pain after surgery is common. It follows 10 to 50% of common operations, and about 15% of women still have pain three months after a C-section.
5. Focused shockwave therapy, scar mobilization, and progressive strengthening may help an old scar reconnect and ease the pain around it. Results vary between individuals.

The surgery went well. The stitches came out, the scar faded, and life moved on. Years later, your low back aches, your core feels switched off, and nothing you try seems to hold. Most people never connect the two. But surgery cuts more than skin. It cuts the fascia underneath, and an old scar can quietly change how your body moves long after it has healed.

This article draws on three episodes of The Unpain Podcast: How to Relieve Back Pain When Nothing Else Works, C-Section Recovery: Shockwave Therapy for Pain Relief, and our conversation with physiotherapist Shauna Mann about treating the whole body.

What actually happens in your body when it’s cut?

A surgical cut goes through several layers at once: skin, the nerve endings inside it, the fascia underneath, and often muscle. Your body closes the gap quickly with scar tissue. It holds things together well, but it repairs the area rather than rebuilding it. The new tissue is stiffer, less organized, and never quite as strong as before.

The body lays down new collagen fast, with fibres going in many directions, then slowly reorganizes that patch over a year or more. Even then, a mature scar only reaches about 80% of the strength of the original tissue [1].

Fascia is the thin, continuous web of connective tissue that wraps every muscle and organ in your body. It’s packed with sensory nerve endings. Uran Berisha, founder of Unpain Clinic, compares it to fibre optic cable. It carries a constant stream of information to your brain about position, pressure, and movement.

When fascia is cut, those fibres are physically interrupted. That’s why many people still have a patch of numbness, tingling, or odd sensitivity around a scar years later. The surface closed, but the wiring underneath changed.

“When you have a surgery, the skin is cut and the fascia is cut. Those fibres are physically damaged. The moment you have the surgery, your brain loses connection with that site.” Uran Berisha, Founder of Unpain Clinic

Why can a scar that healed years ago still affect how you move?

As you heal, the body forms adhesions, bands of scar tissue that bind together layers that normally slide past each other. They hold things in place, but they can also block communication through that area. When your brain can’t get a clear signal from the muscles near a scar, it recruits other muscles to get the job done.

After surgery you still need to get out of bed, lift, and carry on, so your low back, neck, hip flexors, and even your jaw step in. That workaround gets you through recovery. The problem is that it often stays, and because it feels normal, you don’t notice.

Adhesions are common. A review of 25 studies found they formed in about half of people after abdominal surgery, and in 51% after obstetric and gynecological surgery like C-sections [2].

Fascia also links muscles into longer chains across the body, which anatomy research has confirmed [3]. Think of it like a fitted bedsheet. Pinch one corner and twist it, and the wrinkles spread across the whole bed. A tight scar at the front of your body can tug your posture forward, so your back and neck work harder to hold you upright.

How can an old scar lead to low back pain?

Most abdominal scars sit right over the core, and the core is what protects your low back. When the deep core muscles don’t respond well, the work they should be doing travels to the smaller muscles of the low back. Those muscles tighten to keep you stable, and over time they start to hurt.

In our episode How to Relieve Back Pain When Nothing Else Works, Uran describes a pattern he sees often. Someone has an appendectomy at age five and starts having low back pain at fifty with no clear reason. When you’re young, the body compensates easily. As small injuries and years of sitting add up, the compensation runs out of room, and the low back starts to complain.

The low back has its own reasons to be sensitive, too. Research shows the fascia of the low back is densely packed with sensory nerve endings, including ones that can signal pain [4].

If you’ve tried core strengthening and felt it mostly in your back, this may be why. The exercise lands on the muscles doing the backup work, not the ones that switched off.

Why do C-section scars cause so many lasting problems?

A C-section is major abdominal surgery and one of the most common operations in Canada, with about one in three births delivered this way. The surgeon goes through skin, fat, the fascia over the abdominal muscles, and the wall of the uterus, and all of it heals while you’re recovering from pregnancy with a newborn to lift.

Lasting pain after a C-section is real and often brushed off. A 2025 review of 48 studies found about 15% of women still had pain three months after their C-section, about 10% at six months, and about 5% at one year [5]. That fits a wider pattern: lasting pain follows 10 to 50% of common operations [6]. Nerves play a part. In a study of 690 women with a low horizontal incision from a C-section or hysterectomy, one in three still had pain at the scar two years later, and more than half of those with moderate to severe pain had a trapped nerve [7].

In our episode C-Section Recovery: Shockwave Therapy for Pain Relief, a guest described years of back and shoulder pain after two C-sections. She had accepted it as part of being a mom. Once the scar was treated, her balance and strength changed quickly. Results vary between individuals, but her story is one we hear often.

For more on the early weeks, read our guide to C-section benefits, risks, and recovery tips. For pain that has hung on for years, read how shockwave therapy is helping women with chronic C-section pain.

Which surgeries and injuries can change how your body moves?

Any cut through skin and fascia can change how you move, including small ones. Size isn’t the only factor. Where the scar sits, how it healed, and how your body adapted all matter. Here are some common patterns.

C-section

Area: lower abdomen, core, and pelvic floor. You might notice low back pain, numbness around the scar, a weak or disconnected core, or trouble standing fully upright.

Appendectomy

Area: lower right abdomen and core. You might notice low back or right hip tension, or a core that feels weaker on one side.

Hernia repair

Area: groin and lower abdomen. You might notice tight hip flexors, or groin or low back discomfort.

Laparoscopic (keyhole) surgery

Area: several small entry points across the abdomen. You might notice a core that doesn’t feel connected, even though each scar is small.

Tummy tuck or other abdominal surgery

Area: the abdominal wall. You might notice a hard or stuck feeling in the belly and changes in posture or breathing.

Joint replacement or breast surgery

Area: hip, knee, shoulder, or chest. You might notice changes in walking or arm use that load the back, neck, or the opposite side.

What are the signs an old scar is part of your pain?

A few patterns suggest an old scar may be playing a role. None of them prove it on their own, but they’re worth mentioning at your assessment.

• The skin around the scar is still numb, tingly, or oddly sensitive.
• The scar feels tight, puckered, or stuck when you stretch or twist.
• You feel core exercises in your low back instead of your stomach.
• You hold your breath or clench your jaw when you brace or lift.
• Your pain started months or years after a surgery, with no new injury.
• Treatment for your back helps for a while, then the pain comes back.

“It’s rarely one thing that’s the culprit.” Shauna Mann, Physiotherapist, Unpain Clinic

How can shockwave therapy help an old scar?

Focused shockwave therapy sends acoustic waves deep into scar tissue and the fascia around it. It may help loosen adhesions, boost blood flow, and encourage the body to remodel the scar into softer tissue. The goal is to restore the signal between the scarred area and your brain, so the muscles that were being bypassed can switch back on.

The research is promising but still growing. A 2020 review of physical scar treatments, including shockwave and manual therapy, found moderate to strong improvements in scar pain, stiffness, and thickness [8]. A 2024 review found similar benefits for raised scars [9], though not every trial agrees. A 2022 trial on burn scars found no clear difference when shockwave was added to standard care [10].

Most of this research is on burn and raised scars, not surgical scars like C-sections. For C-section scars, hands-on scar work has shown benefits. In a 2022 Canadian study, two weekly sessions of scar mobilization made C-section scars less stiff and less sensitive to pressure [11].

At Unpain Clinic, focused shockwave is one part of the plan, not the whole thing. It’s paired with scar mobilization, radial shockwave for tight surrounding muscles, EMTT magnetic therapy when needed, and exercise that rebuilds strength.

What does scar treatment at Unpain Clinic look like?

Scar treatment starts with finding out what your scar is actually doing to your body, not just how it looks. The plan then works to reconnect the area and rebuild the strength that was bypassed around it. Here’s what that usually involves.

1. A full history. We ask about every surgery, injury, and pregnancy you’ve had, from childhood on, even the ones that seem unrelated.
2. Testing how your body responds. We check how your core and balance hold up under a simple challenge before any treatment.
3. Treating the scar and the tissue around it. Focused shockwave therapy and hands-on scar mobilization work on the scar, with radial shockwave for tight muscles nearby. We often treat old ankle sprains and other injury sites in the same visit.
4. Retesting in the same session. We repeat the same test so you can feel whether your body responds differently.
5. Building strength that holds. Once the area is responding, breathing work, deep core retraining, and progressive strength exercises can finally reach the right muscles. If internal pelvic floor work is needed, we refer you to a trusted pelvic floor physiotherapist.

Some people feel emotional after scar treatment, especially after a difficult or emergency surgery. That’s normal, and it usually passes within a few days.

When should a scar be checked by a doctor first?

Scar treatment is for scars that have fully healed. See your doctor or surgeon first if you notice any of these:

• Redness, warmth, swelling, or discharge from the scar.
• Fever after a recent surgery.
• A new bulge near the scar, which can be a sign of a hernia.
• A wound that hasn’t fully closed.

Frequently asked questions

Can a scar from decades ago still cause pain?

Yes. A scar can affect how your body moves long after it has healed, because the scar tissue and adhesions underneath can interrupt the signals passing through that area. Many people find their pain started years after a surgery they never connected to it.

Do small keyhole surgery scars matter?

They can. Laparoscopic surgery leaves several small scars, and each one still passes through skin and fascia. Size is only one factor. Location and how the area healed matter just as much.

Why is the skin around my scar still numb?

Numbness around a scar usually means small nerve endings in the skin and fascia were cut during surgery and did not fully reconnect. It’s very common. It can also be a sign that the area isn’t sending clear information to the brain.

When can I start scar treatment after a C-section or other surgery?

Scar treatment starts only once the wound has fully closed and your surgeon or doctor has cleared you. For a C-section, that’s usually six to eight weeks after delivery at the earliest. If the scar is still pink and sensitive, starting a little later is often better.

Does shockwave therapy on a scar hurt?

Most people describe it as strong but tolerable, like a firm tapping. Tighter or more restricted areas tend to feel more intense, and that usually eases as the session goes on. Your practitioner adjusts the intensity to your comfort.

Do I need a referral to have a scar assessed at Unpain Clinic?

No. In Alberta you can book directly with a physiotherapist or chiropractor without a referral. Some extended health plans ask for one before they reimburse treatment, so it’s worth checking your plan.

About the author

Written by Uran Berisha, Founder of Unpain Clinic and the Medical Shockwave Institute. Medically reviewed by Uran Berisha. Last reviewed October 16, 2026. Uran has spent more than 20 years in rehabilitation, with over 13 years focused on shockwave therapy. Unpain Clinic is located in Edmonton, Alberta. unpainclinic.com

Wondering if an old scar is part of your pain?

If you’ve tried everything for your back or core and the pain keeps coming back, an old scar may be part of the story. At Unpain Clinic in Edmonton, we look at your full history, including every surgery and old injury, test how your body responds, and build you a clear plan. It doesn’t matter if your surgery was last year or 30 years ago. No referral needed. If this approach isn’t a good fit for you, we’ll tell you honestly.

Book your assessment.

References

1. Gurtner GC, Werner S, Barrandon Y, Longaker MT. Wound repair and regeneration. Nature. 2008.
2. Okabayashi K, Ashrafian H, Zacharakis E, et al. Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity. Surgery Today. 2014.
3. Wilke J, Krause F, Vogt L, Banzer W. What is evidence-based about myofascial chains: a systematic review. Archives of Physical Medicine and Rehabilitation. 2016.
4. Tesarz J, Hoheisel U, Wiedenhöfer B, Mense S. Sensory innervation of the thoracolumbar fascia in rats and humans. Neuroscience. 2011.
5. Wang LZ, Huang JY, Hu HJ, Xia F. Incidence of chronic postsurgical pain after caesarean delivery: a systematic review and meta-analysis. Anaesthesia. 2025.
6. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. The Lancet. 2006.
7. Loos MJ, Scheltinga MR, Mulders LG, Roumen RM. The Pfannenstiel incision as a source of chronic pain. Obstetrics and Gynecology. 2008.
8. Deflorin C, Hohenauer E, Stoop R, et al. Physical management of scar tissue: a systematic review and meta-analysis. Journal of Alternative and Complementary Medicine. 2020.
9. Gili N, Micallef Stafrace K, Laybats F, Mifsud T. The role of extracorporeal shock wave therapy in keloids and hypertrophic scars: a systematic review. Cureus. 2024.
10. Aguilera-Sáez J, Dos Santos BP, Serracanta J, et al. The effect of extracorporeal shock wave therapy in the treatment of burn scars: a prospective, randomized, controlled trial. Burns. 2022.
11. Gilbert I, Gaudreault N, Gaboury I. Exploring the effects of standardized soft tissue mobilization on the viscoelastic properties, pressure pain thresholds, and tactile pressure thresholds of the cesarean section scar. Journal of Integrative and Complementary Medicine. 2022.
12. The Unpain Podcast. How to Relieve Back Pain When Nothing Else Works. Unpain Clinic. https://www.unpainclinic.com/en/podcast/lower-back-pain-causes-treatment
13. The Unpain Podcast. C-Section Recovery: Shockwave Therapy for Pain Relief. Unpain Clinic. https://www.unpainclinic.com/en/podcast/c-section-recovery-shockwave-therapy