Wound and scar care alongside physical therapy

After a burn, a surgery or a deep cut, the wound closes within weeks, yet the skin can feel tight, itchy or stiff for much longer. Many people are surprised to hear that a physical or occupational therapist may be part of recovery, not only a dermatologist or surgeon. This page walks through how wounds heal, what slows healing, the main types of scar, and the supporting role therapists play in moving a scarred area. It describes what sources say in general terms and does not recommend products or treatments.

How skin wounds heal in stages

A review in the Journal of Dental Research, available through PubMed Central, describes wound healing as four highly integrated and overlapping phases: hemostasis, inflammation, proliferation and tissue remodelling (Guo and DiPietro, Factors Affecting Wound Healing). Hemostasis starts immediately, with narrowing of blood vessels and the formation of a fibrin clot to control bleeding. Inflammatory cells then arrive, including neutrophils, macrophages and lymphocytes.

The proliferative phase follows and overlaps. It is marked by new skin cells growing and migrating across the wound, a process called re-epithelialisation. Finally comes remodelling, in which the repair tissue is reshaped toward the structure of normal tissue. The review says this last phase can last for years. That helps explain why a scar can keep changing long after the surface has closed. Even the small hole left by a skin biopsy goes through the same sequence, just on a tiny scale.

Factors that affect healing

The same review groups factors into local and systemic categories and notes that they are not mutually exclusive. Local factors include oxygenation, infection, foreign bodies and venous sufficiency, meaning how well blood returns from the legs. Systemic factors include age and gender, sex hormones, stress, reduced blood supply (ischaemia), obesity, alcohol use and smoking, and nutrition. Diseases such as diabetes are listed too, as are conditions that weaken the immune system, such as cancer, radiation therapy and AIDS. Medicines on the list include glucocorticoid steroids, nonsteroidal anti-inflammatory drugs and chemotherapy.

This is a list from a scientific review, not a checklist for self-diagnosis. Healing problems have many causes, and anyone with a wound that is not progressing, or that shows signs of infection, needs a clinician to look at it. Do not stop or change any medicine because of a list like this; that decision belongs to your own doctor.

Scar types at a general level

The NHS defines a scar as a mark on the skin after a wound or injury has healed, and says you cannot get rid of a scar, though most fade without treatment. It describes several common types (NHS: Scars). A hypertrophic scar is usually raised and firm but stays within the boundaries of the original wound, and it usually fades and flattens over time. A keloid scar is usually raised, hard and smooth, grows larger than the original wound and does not usually flatten or fade without treatment. A contracture scar feels tight, and the area may be difficult or painful to move; the NHS says it usually follows a burn. Fine-line scars and atrophic scars, which are sunken, are also described.

Contracture scars matter most for movement. Skin is not a passive covering, and when scar tissue tightens across a joint it can limit how far that joint moves.

What a doctor, dermatologist or surgeon may do

The NHS lists several treatments for scars: silicone dressings or gels, steroid injections or cream, cryotherapy (freezing the scar), laser therapy and skin camouflage. It says a GP can recommend treatments or refer to a specialist. These choices are medical decisions that depend on the scar type, location and the person, and a dermatologist may be the specialist who assesses and treats the skin itself. After a significant burn, a surgeon may also be involved. A New South Wales clinical guide for burn therapists mentions skin grafts, in which healthy skin is moved to cover a wound, and notes that splinting after grafting can help the graft take, which normally requires five to seven days of complete immobilisation (NSW Agency for Clinical Innovation, Burn physiotherapy and occupational therapy guide).

Our overview of how dermatologists diagnose skin conditions describes how the skin is assessed before any such decisions are made. The NHS also advises seeing a GP if a scar is painful or bothering you, and seeking urgent help if it is swollen, painful, warm to the touch or has pus coming out of it.

Where physical and occupational therapists fit

A physical therapist (physiotherapist in many countries) focuses on movement, strength and function. An occupational therapist focuses on helping people return to everyday activities and tasks. The NSW guide is written jointly for both professions, which reflects how closely they work in burn recovery.

According to that guide, exercise in burn care aims to maintain and regain range of motion, strength, exercise tolerance and function. Early movement of the affected area is described as key to optimal recovery, and burns over or near a joint need extra vigilance. The guide names the ankles and feet, hands and wrists, the flexor surface of the knees, the neck and the armpits as areas to watch. Because burned skin and scars keep contracting, it says that regular stretching through the day works better than a single long session. Where needed, splints and positioning are used so a joint rests in a position that keeps the skin lengthened rather than shortened.

Scar massage is another tool. The guide says massage is used to soften and desensitise the skin, prevent adhesions and reduce itching, and that it does not change the look of the scar immediately though it may relieve itch quickly. It also warns that fragile skin can break down if massaged too early, which is why the timing and technique are set by a therapist or surgical team, not by guesswork. Burn therapy, the guide says, continues until the scar matures, which usually takes 12 to 18 months and varies between individuals. Therapists may also help with compression garments, which the guide describes as a way of keeping emerging scars flat.

What the evidence shows, and its limits

A 2025 scoping review in the Journal of Clinical Medicine mapped the research on physical therapy for skin scars. From 13,419 records it included 92 studies. Pressure therapy was the most studied (41 studies), followed by physical modalities such as lasers (37), silicone products (29), massage (20), splinting (17), therapeutic education (11) and range of motion and stretching exercises (10). Burn scars were the most studied type (47 studies), followed by hypertrophic scars (32), keloids (20) and contractures (7) (Di Serio and colleagues, Current Physical Therapy for Skin Scar Management).

The authors are candid about weaknesses. They say there is significant variability in how treatments are applied, most studies had small samples and no control groups, almost half were based on expert opinion, and research has focused mostly on adults with burns. They conclude that high-quality research is still needed to identify evidence-based interventions. In plain terms, therapists use well-established practices in burn care, but the research behind many specific techniques is still thin, and results for one person do not predict another's.

Putting it together

Recovery from a serious wound usually involves several people at different moments. A surgeon or doctor closes and treats the wound, a dermatologist or other specialist may address the scar, and therapists help the area keep moving as the scar matures. Before an appointment with any of them, our note on preparing for a dermatology visit offers general ideas for organising your questions. No site that shares general information, ours included, can say which approach suits a particular wound.

The short version

Skin wounds heal through overlapping stages that can continue for years, many local and systemic factors influence the outcome, and scars range from flat and fading to raised, spreading or tight. Doctors, dermatologists and surgeons treat the wound and the scar itself, while physical and occupational therapists focus on keeping the area moving and functional, especially after burns and surgery. Evidence for specific therapy techniques is still limited. Individual care varies, and your own doctor or specialist has the final word.