How Physical Therapy Can Help Your C-Section Scar
In order to successfully perform a cesarean section, the physician must cut through 7 layers of tissue. As these layers heal, it is normal to produce scar tissue. Because scar tissue naturally has less elasticity than normal tissue, there tends to be more tightness and restriction. The body can also lay down scar tissue in an unorganized manner, contributing to adhesions with healing.
Ideally, the layers of tissue glide independently of each other. When the superficial layers are pulled, we want the deeper layers to be uninfluenced. However, scar tissue and adhesions make this difficult - these tissues are often stuck to each other.
This can:
increase pain and sensations of pulling
decrease tissue mobility
contribute to a shelf-like appearance of the scar (skin puckers and/or folds over)
Adhesions throughout the lower abdominals can contribute to other symptoms as well. Common reports after a c-section include:
Painful intercourse - increased abdominal tightness can also lead to pelvic floor tightness
Increased urinary frequency - scar tissue decreasing the bladder’s ability to expand and fill with urine contributing to higher frequency with peeing
Low back pain - can be multifaceted but often the increase in abdominal and pelvic floor tightness/tension can also contribute to tissues along the lumbar spine tightening as well.
What can physical therapy do?
It is highly recommended to mobilize the scar and abdominal tissue after the initial healing takes place (usually around 6 weeks post-op). The scar needs to be fully healed with no scabbing before intervention. Here are a few options for tissue mobilization:
Massage
Massaging the abdominals and scar are a great way to get the tissues moving. I have patients start along the abdominals (particularly the lower portion). You can start gently as tolerated and gradually increase pressure over the course of weeks-months. Work on massaging the tissues vertical, horizontal, clockwise and counterclockwise circles. Combine with skin rolling, pulling, pushing and gliding in all directions. Gradually progress to the scar when you feel ready and do the same thing. This shouldn’t be painful - if it is, lighten your intensity a bit.
Cupping
Cupping is a great technique for mobilizing and decompressing the tissues by lifting/suction. You can get a cheap set on Amazon (I usually recommend this one). Rub a little coconut oil or massage lotion on the scar and abdominals. The cups are pinched and placed on the skin, so once you let it go, it lifts the tissue into the cup. Slide the cup along the tissue to improve mobility of the tissue layers as well as increase localized blood flow.
Take a look at this post I did a while back on Instagram that demonstrates how cupping can be used at home:
You can also use cupping functionally. If you have tightness in certain positions or movements, you can use the cups in that position to help mobilize the tissue when you are symptomatic. For example, clients often report that they feel pulling in the incision while in a lunge. Mobilizing in this kneeling/lunge position can be a great way to treat that symptom.
Check out this Instagram reel:
3. Dry needling
Using dry needling to the scar can be a useful method in decreasing pain and increasing mobility. While there aren’t any randomized controlled trials yet, there have been several case reports that show benefit to needling. Using thin filiform needles, I’ll insert the needle under the surface of the scar, placing all along the areas that are symptomatic. Gently moving and/or rotating the needles is thought to alter the adhesion, stimulate fibroblast activity (promote healing), increase dermal elastin and collagen, and “encourage realignment of collagen bundles in the direction of stress” (PMID: 36660004).
Dry needling can be done gently and is a great option for those with a c-section shelf to improve the appearance of the scar!
Here is a quick video on my personal c-section scar mobilization routine that I performed most days for the first year postpartum. I recommend trying to perform at least 5 days per week for the first year.
We have a long way to go when it comes to C-section moms feeling educated and prepared for the postpartum phase. The bare minimum is learning how to care for and treat your scar. There are many people who report scar pain years after the surgery. This can be treated! Even if you are over a year postpartum, you can get so many benefits from learning how to mobilize your scar and abdominal tissue.
