This post was written by Juna Advisor & Physical Therapist, Katie Hunter, DPT. 


If you’ve had a C-section you’re very familiar with the literal scar it left behind. This is typically a small incision at the lowest part of the abdomen just above the pubic bone. While the scar may appear small, it spans quite deeply into the abdomen all the way to the uterus. The doctor typically cuts through 5 layers of tissue (skin, muscle, and fascia) before they get to the uterus. That is a lot of layers! 

Most importantly, during a C-section the fascia involving the rectus abdominis, internal obliques, and transverse abdominis muscles are cut. These are three of the four muscles that make up the abdominal wall. These muscles are very important core muscles that protect our abdominal organs, lower back, and pelvis. 

Scar tissue and adhesions: what are they and why can they be a problem?

stay at home mom postpartum
Photo: @lifeforeverchanged on instagram

Scar tissue is part of the normal healing process. Any time we have an injury (including a C-section), our body learns from past experiences and replaces normal tissue with stiffer, fibrotic tissue to prevent re-injury. Scar tissue innately has less mobility and does not function in the same way as normal tissue.

Through the normal healing process, we can develop adhesions between layers of tissue that can also be problematic. Each layer of tissue has to glide over the layers above and below it in order for us to move and function.

Scar tissue and adhesions can prevent these layers from gliding over each other properly. This can prevent our muscles from contracting as expected and weaken our core function.  

Two problems can arise from C-section scar tissue and adhesions: pain and core muscle weakness. It is normal to feel pain and soreness in the first 6-8 (up to 12) weeks postpartum while your incision is still healing. Normal sensations can include sharp, tugging, aching, soreness to the touch, and soreness with tight clothing or seat belt straps.

After the initial 12 week period, your scar should no longer hurt. Up to 18% of women report pain at their C-section scar 3 months after delivery and 11% report persistent pain 6 months after delivery.

Concurrently, muscles take about 6 weeks to fully recover postpartum and you should not return to core strengthening exercises until after your 6 weeks appointment with your doctor. Pregnancy alone leads to de-conditioned abdominal and pelvic floor muscles and having a C-section can augment this weakness. It is very common for core exercises to feel nearly impossible after having a C-section.

Scar tissue mobilization: What is it?

While we cannot get rid of scar tissue conservatively, we can improve the mobility and eliminate adhesions between the tissue layers. One nonsurgical treatment for adhesions and pain is scar mobilization. This is a manual therapy technique to improve the skin stretch and sensitivity surrounding the scar. This technique has been shown to reduce pain and improve function in just four sessions of physical therapy. 

Scar tissue mobilization is a combination of soft tissue manipulation techniques used by physical therapists. This can include skin rolling, myofascial release, and deep fascia manipulation. Physical therapists typically start this treatment once a woman has been cleared at her 6-week appointment with her doctor for sex and exercise.

How to do it

Skin rolling and light massage is something that women can perform at home. You can start this treatment as soon as your scar appears fully healed on the surface. Apply light pressure over your scar and perform circles from end to end.

Skin rolling consists of pinching and lifting the tissue of the skin right over the scar. A lotion or oil can help make the treatment more comfortable. I recommend vitamin E oil, coconut oil, or massage lotion like Biotone.

These treatments can be uncomfortable but are effective. I typically recommend spending up to 5 minutes on the scar per day. Doing this right out of the shower can make it slightly more comfortable since the tissue is warm and flexible.

Photo by @mommy.labornurse on Instagram

I believe that all women should receive at least one appointment with a pelvic floor physical therapist after having a baby. This will help you to determine if any musculoskeletal problems exist that could prevent you from returning to life and exercise safely.

You can also develop a plan and home program individualized for you. If you continue to experience pain or have difficulty returning to exercise 12 weeks after delivery and have tried these techniques with no relief, I recommend seeking treatment from a pelvic floor physical therapist. 

This post was written by Juna Advisor & Physical Therapist, Katie Hunter, DPT. 


References 

  1. Sung, Sharon, and Heba Mahdy. (2020). “Cesarean Section.” StatPearls, www.ncbi.nlm.nih.gov/books/NBK546707/.
  2. Corr, D., Hart, D. (2013). Biomechanics of scar tissue and uninjured skin. Adv Wound Care. 2(2), 37-43.
  3. Jin, J. (2016). Prevalence and risk factors for chronic pain following cesarean section: a prospective study. BMC Anesthesiology. 16(99). 
  4. Wasserman, J. et al. (2018). Soft tissue mobilization techniques are effective in treating chronic pain following cesarean section: a multicenter randomized control trial. JWHPT. (42)3,1-9. 

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