Physiotherapy for surgical scars includes massage, soft tissue mobilization, and myofascial techniques, supported by systematic reviews and controlled studies showing improvements in pain, adhesions, thickness, and mobility [1, 2]. In particular, adhesions beneath scars can delay or prevent early manual intervention.

Cannabidiol and β‐caryophyllene, which have been investigated for their potential anti‐inflammatory properties [3], are included in a commercially available cosmetic cream gel together with capsaicin, arnica, devil's claw, escin, menthol, and camphor. We report three cases of post‐surgical scar adhesion management observed during routine physiotherapy practice using this product, VeroDol CBD cream gel (Tuscopharm, Italy).

Case 1

A 24‐year‐old man underwent Latarjet surgery for recurrent anterior shoulder dislocation. Physiotherapy started 7 days post‐surgery, coinciding with staple removal, twice weekly for 4 weeks. Sessions consisted of 60‐min skin rolling (pincé‐roulé), preceded by application of approximately 5 mL of the tested cream gel to the scar. Pain on pressure (VAS 0–10) improved from 8 at baseline to 0 at Day 28; tissue mobility (Likert scale: 1 = normal, 10 = worst) improved from 8 to 1. At Day 28, the surgeon confirmed complete recovery without limitation of range of motion (ROM).

Case 2

A 72‐year‐old woman began physiotherapy 45 days after reverse shoulder replacement. For 3 weeks, she received weekly sessions combining scar frictions, traction, joint mobilization, and application of the tested cream gel (~5 mL per session). VAS pain decreased from 7 to 1, while tissue mobility improved from 5 to 1. At Day 21, both the surgeon and physiotherapist confirmed complete clinical recovery (Figure 1).

Case 3

A 19‐year‐old man with a keloid scar following scaphoid osteosynthesis presented with raised tissue, redness, and pain on touch, making initial skin rolling impossible. Three sessions (baseline, Day 7, and Day 21) of Transferred Energy Capacitive and Resistive (TECAR) therapy were performed to reduce pain and improve scar tissue mobility and elasticity [4]. During TECAR, the conductive cream was mixed with 30% of the tested cream gel. The patient also self‐applied approximately 5 mL of the tested cream gel twice daily from baseline to Day 21. VAS pain decreased from 9 to 3, and mobility improved from 10 to 3. Progressive changes in scar pigmentation and perilesional skin appearance were observed, and by Day 21 the scar became treatable with skin rolling (Figure 2).

These small case observations suggest that integrating the topical application of the tested cream gel into physiotherapy protocols was associated with reduced pain and improved tissue mobility during treatment sessions. No comorbidities, smoking, concomitant medications able to affect wound healing, or adverse events were reported. In Case 1, early intervention was feasible immediately after staple removal. In Case 2, recovery was achieved despite delayed initiation of physiotherapy. In Case 3, the combination of the tested cream gel and TECAR therapy appeared to improve scar conditions sufficiently to allow manual treatment within three weeks.

Limitations include the small sample size, lack of statistical analysis, absence of blinded assessment, and restricted outcome measures [5]. The Likert scale used to assess tissue mobility has not been formally validated; therefore, findings should be interpreted as exploratory. Nevertheless, subjective scales, clinician agreement, and the practical “treatable/not treatable” threshold for skin rolling and accompanying aesthetic improvement supported the observed clinical changes.

This preliminary experience is based on uncontrolled case observations; therefore, larger controlled and randomized clinical trials [6] are required to better characterize the potential role of topical cosmetic formulations as adjuncts to physiotherapy in post‐surgical scar management. Integration with other modalities, such as laser therapy, ultrasound, and radiofrequency should also be evaluated.