Scars form over a period of time following injury (including surgery). Our brain’s proprioception (awareness) of the area changes with that injury and subsequent healing. It is very common to have altered or no sensation after Cesarean delivery in the lower abdomen and into the pelvis, but this can be improved in most cases with improved proprioception. After a scar heals, it needs to move, which helps to improve proprioception. Addressing scar mobility after a Cesarean requires a slow approach in order to facilitate healing in a way that is not overwhelming to the tissues or the human who inhabits them.
Begin with breath.
The function of the diaphragm is to lower on inspiration, thereby expanding the lungs for maximal air intake. After birth (both vaginal and Cesarean), this can be a challenge because of the biomechanical changes that have occurred during pregnancy and because of the rapid change in pressure and stabilization following birth.
One of the best ways to introduce motion (and therefore awareness) to the lower abdomen is simply breathing. I do not mean protruding the abdomen or pressing it out, but simply allowing the lower rib cage and abdomen to expand with inhalation in conjunction with the lowering of the diaphragm. Since breath is required for life, you can begin this at any point after surgery (and you’ll likely find it very difficult to achieve lower abdomen expansion in the first two weeks post-Cesarean).
Add your hands.
Placing your clean hands on your lower abdomen can offer an additional layer of proprioceptive input regarding the area. So whether you are breathing into your lower abdomen or not, if your hands are placed there, your brain is getting that information. You may find it difficult to touch the area of your scar – this is often an emotionally challenging activity. The emotional healing of this new scar is part of healing it as well.
It is often helpful to begin at the belly button and work your hands slowly down with each inhale and exhale. If you have steri-strips or bandaging at the wound, it is okay to place your hands over those, but be sure not to introduce bacteria to the wound. You do not need to apply any pressure with your hands: simply let them rest over your abdomen. Many patients have aberrant sensation into the pelvis and even upper thighs after a Cesarean, so extending the practice of light and slow touch to these areas is also beneficial.
When your wound is no longer dressed and has no scabs present, you can begin to mobilize the scar and its surrounding areas gently. Each of these steps may take you a few days or weeks to feel comfortable. These practices are meant to enhance your awareness and mobility while stimulating healing, and healing is a process that does better when not rushed.
While continuing to practice diaphragmatic breathing, place your hands directly over your scar. Using light pressure, move your scar by dragging your hands lightly and slowly up and down, perpendicular to your scar. You can move your hands in opposite directions (right hand glides up while left glides down) or together. Do this for the entire length of your scar. If you notice a pinching sensation or referral of pain to another area (such as into the hips or pelvis), I recommend moving slower and breathing more deeply through that portion of your scar.
Next (which may mean weeks later), roll your scar by pinching lightly above and below the scar and rolling the tissues between your fingers. Often, the scar itself will indent when you pinch above and below it; ideally this indentation lessens the more that you mobilize it. Again, repeat this across the length of your scar.
Using a jade roller (especially one that’s been in the fridge or freezer) can also be a great way to mobilize a scar in a very gentle way. One of my favorite ways to increase movement and awareness within a scar is to utilize cupping. A variety of practitioners – chiropractors, PTs, acupuncturists, massage therapists – all utilize cupping therapies, but you can do self-cupping as well. (I prefer glass cups with the top that looks like a bike horn, like this.) The intention is to decompress tissues with a light suction in order to facilitate blood flow, increase tissue mobility, and normalize proprioception. I answered quite a few questions in this post if you’d like more information on cupping.
The thing about breathing and tissue mobilization is that it’s easily accessible. Outside of buying your own set of cups or a jade roller, you can accomplish these things on your own. I always recommend chiropractic and pelvic PT in the postpartum period, but recognize that not everyone can make that happen. So if you’re working through healing a Cesarean scar on your own, these tips will hopefully help you honor that part of your body in a way that brings healing and awareness.
To Your Health,
Lindsay Mumma, DC
Triangle Chiropractic and Rehabilitation Center
Dr. Mumma received her BA from Kent State University in Kent, OH, and her Doctor of Chiropractic (DC) from Palmer College of Chiropractic in Davenport, IA, where she was named the Clinical Excellence Award winner for her graduating class. In addition to the academic requirements of the DC program, Dr. Mumma has also completed over 600 continuing education credit hours in areas such as rehabilitation, developmental kinesiology, pediatrics, pregnancy, nutrition, pain management, sports injuries, TMJ disorder treatment, disc pain, and neurology. She owns and manages Triangle Chiropractic and Rehabilitation in Raleigh, NC.
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