A c-section is major abdominal surgery. There are protocols of rehabilitation for many major surgeries. Most orthopedic surgeries require physical therapy afterwards. No one would have an ACL reconstruction and wing it after surgery. Why aren’t women encouraged to seek out physical therapy post baby?
A look at C-sections from the outside in
Scar tissue healing is a process and to heal optimally, it is imperative to address it properly. When scar tissue forms it lays down in a haphazard fashion that is mechanically inefficient in distributing forces. Massage helps to organize the tissue to heal stronger. Post ACL surgery, patients are taught how to massage the scar tissue to promote healing and prevent the scar tissue from binding down to the tissue below. Often knee and ankle surgeries get the most attention for scar tissue management as they can bind to the bone below easily. But, what about abdominal scar tissue healing or binding to lower musccular levels and/or organs? For optimal healing the scar not only needs to heal externally, but also needs to organize properly internally to help transmit forces placed on the abdomen properly. All women post c-sections should be educated on scar tissue massage.
The breach of the abdominal wall can impact breathing, and disrupt the muscle patterns of activation that support and stabilize the body during movement. If a person post ACL surgery is not out running at 6 weeks, why can a woman post c section be lead to believe she can/should run and do sit ups at 6 weeks without a conversation and evaluation by a specialist? The abdominal musculature of all pregnant women becomes stretched and mechanically inefficient during pregnancy. Adding a c-section surgery can further the dysfunction of the abdominal wall. The inner core musculature is pain regulated, meaning the muscles can shut down with pain. While our body's are very resilient, not all abdominal muscles return to a totally optimal state of activation post pregnancy and c-section.
Women who have had a c-section often are glad for the lack of trauma to their pelvic floor. However, if you had bowel or bladder leaking during pregnancy, pelvic pain during pregnancy or you pushed for an extensive time during labor prior to your c section it can be assumed you are at increased risk of pelvic floor dysfunction post baby.
What Should Moms Post C Section do?
Minimally, moms should be shown how to massage the scar tissue to optimally heal the tissue superficially and reduce the risk of internal adhesions (which can continue to develop well past the scar healing externally).
Women should see a women's health PT to assess their inner core pressure management strategy post baby to ensure proper abdominal activation.
Core exercises should be started with your spine in a neutral position and be progressed according to your individual ability to activate your core muscles during exercise once medically cleared.
Moms should be taught proper lifting strategies for baby right away.
Is a mom of two, life long exercise & nutrition enthusiast, women's health specialist & physical therapist.