C-Sections are major abdominal surgery that unfortunately seems to have very little guidance on recovery, outside of walk a little bit to avoid clots and keep the incision clean. Very few women are referred to physical therapist post c-section, but if you had any other surgery, you would be sent to see a PT.
So, with the minimal guidance provided after you’re sent home with an adorable little baby post major surgery, how can we approach recovery post-c-section?
The things that we may want to focus on with post-c-section recovery include scar mobilization and reconnecting the anterior oblique sling.
First: The Incision Site / Scar
As our incision heals, there is initial inflammation that is bringing extra blood flow to the area to help initiate the healing process. The tissue is thin during the first few weeks, as it develops a new frame work for blood vessel growth.
Starting around three weeks, the tissue goes through a remodeling phase, where it is reconnecting to itself and pulling the wound closed. This tissue is stronger and tighter than the previous phase.
The risk of uterine rupture is highest if the interval between pregnancies is less than six months (Stamilio et al, 2007). This could mean that the c-section incision is generally healed by six months post-op, as the risk of uterine rupture does not increase with any interval beyond 6 months. Six months is a long period of time for the incision to be healing and for the tissue to be reconnecting!! This means there is six months that we can really work to help the incision heal to support overall function.
If the first six months are when our connective tissues are reestablishing its structure, we want to focus on scar mobilization during this time to help with the healing process. This is to not that say beyond six months scar mobilization is useless, it is still really helpful well beyond six months postpartum!
Mobilization provides movement that will help the tissues weave together in a patterned way that supports its integrity, range of motion, and structure. Mobilization also helps our connective tissues and surrounding structures from “sticking” to each other, decrease the movement capability and affects how the overall system interacts with itself.
Adhesions occur when different parts of tissue are sticking together that are not normally joined. When we have adhesions, it can affect overall function by limiting the range of motion of our tissues.
Then, consider the kinetic chain
Our body is a kinetic chain, where the action at one location affects movement at another location. The muscles, tissues, and fascia need to smoothly glide without restriction to accomplish movement. Think of our fascia as a sheet. If I place a sheet on the floor, and then pull one corner, the entire sheet glides across the floor. If I place a heavy object on the sheet, when I pull one corner, the sheet cannot glide as smoothly, or even gets stuck, and it takes much more effort for me to pull the sheet.
Let’s consider the c-section incision and the tissues that are healing afterwards. If the tissues around the incision site stick to the surrounding structures, such as your abdomen or your bladder, or the fascial layer that connects to your low back, then movement that occurs through that area can be choppy, feel stuck, or even feel tight.
Mobilizing our incision site can be incredibly helpful in our recovery. It helps to minimize the “sticking” and “pulling” sensations that may restrict the range of motion of the surrounding tissues. We recommend seeing a pelvic floor physical therapist so that you can receive an individualized assessment of your scar and have one-on-one guidance on scar mobilization techniques that best suit you.
Reconnecting the Anterior Oblique Sling
Our c-section recovery program focuses on reconnecting the anterior oblique sling. The anterior oblique sling connects our upper body to the lower body diagonally through the front of the pelvis.
If we consider where the incision is, it essentially severs the anterior oblique sling in the lower abdomen. If we focus on exercises that utilize the anterior oblique sling (oblique to opposite adductor), then it would help this sling reestablish its connection and improve function.
An observation that we have from working with prenatal and postpartum clients, is that our c-section mothers tend to have more pubic symphysis dysfunction and pain with subsequent pregnancies following their c-sections. The anterior oblique sling helps to stabilize the pubic symphysis (front pelvic joint), and if there wasn’t a deliberate rehabilitation to reconnect this sling post c-section, it may not be able to properly stabilize the joint during pregnancy. This is a theory of ours based on our observation, but when we incorporate more anterior oblique sling focused exercises, we find the SPD diminishes pretty significantly.
Finally, consider nutrition!
Our nutrition can support our healing after pregnancy and birth, particularly if we are recovering from a c-section. Focusing on enhancing our nutrition postpartum can enhance and support our healing. Read more on nutrition here.
There is some research that supports collagen supplementation may enhance wound healing postpartum. (Use code MAMASTEFIT for a 20% off discount on Needed collagen and nutritional products)
Read more here on the benefits of collagen.
Post C-section recovery can be fairly vague and unknown; you’re sent home with a baby and minimal guidance on how to return to function after a major abdominal surgery! We have found that focusing on scar mobilization and reconnecting the anterior oblique sling help with recovery post-c-section, in addition to overall postpartum rehab such as pelvic floor recovery and core stabilization.
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References:Stamilio DM, DeFranco E, Paré E, et al. Short interpregnancy interval: risk of uterine rupture and complications of vagin*l birth after cesarean delivery. Obstet Gynecol. 2007;110(5):1075-1082. doi:10.1097/01.AOG.0000286759.49895.46
