C-section Scar Pain Recovery

“I had an emergency cesarean three weeks ago and the scar still hurts.”

“I had a cesarean 16 months ago and it hurts to be touched.”

“I had a c-section 3 years ago and it still hurts when I exercise.”

“I had a c-section 13 months ago and it is constantly itching.”

Each year 1.27 million mamas will have a c-section in the US and up to 228,000 mamas will develop chronic pain afterwards. I wish the stats were different, but I want you to know that you are not alone in worrying about c-section scar pain. When you have a c-section, your doctor cuts through sever layers to reach your sweet baby and bring them into this world. Your doctor had to cut through skin, fat, fascia and the rectus abdominis muscles, the peritoneum which helps support the organs as well as the uterus and amniotic sac. SEVEN LAYERS. That is no laughing matter, in fact it is major abdominal surgery. If you had an ACL surgery you would give yourself time to heal and recover and you would also expect therapy to strengthen the area as well. Fascia, which is the third layer, regains 51-59% of its strength at 42 days postpartum (~6 weeks) and 73-93% at 4.5 months postpartum. If you are newly postpartum (less than 6 weeks), please know it is not only OK but beneficial to slow down and allow your body the time and space to heal. 

A few key things to remember are that if you are newly postpartum or the pain increases in severity, it is important to see your provider for further evaluation. If you are concerned that the scar you can visibly see looks gnarly, please remember that the outward appearance of your scar does not represent how the inner layers look, feel or move!

Steps to relieving cesarean scar pain:

1. Breathe
   Whether you are newly postpartum or your youngest baby is in college, start your healing by working on the breath. This may sound easy, but holy moly can it be hard after having a baby. During pregnancy our bellies grow and our ability to breath in 360º becomes increasingly more difficult each month. After birth our bodies naturally hold onto this newfound breathing pattern, even if it isn’t ideal. Add the c-section scar into the mix and it is even harder to breathe optimally because it’s almost like there is a speed bump in the way when we inhale and it requires more work for the breath to gently descend into the pelvic floor. The key is to keep practicing and get some 1:1 work to ensure you are breathing in a way that makes the abs, back and pelvic floor all work together!
   

2. Mobilize
   A recent study showed that 4 sessions of manual therapy can decrease chronic pain associated with c-section scars. If you are at home, you can gently massage the scar yourself. In an ideal world we want to work on all layers of the scar, including the fascia which is the connective tissue between muscles and the skin. As the fascial layer and muscle layer are deep, it is helpful to see someone trained in scar tissue release and mobilization to ensure the entire body is moving properly.
   

3. Align
   It’s not uncommon to have the “mom stance” after having a baby. You know the one, where you jut out your left hip so you can support your baby hippo on your hip it rather than using your arms. Or the one where you lean so far back you pretend you are a crib to prevent the sleeping kiddo from waking up from their nap. Either way, moms often find themselves in awkward positions and it’s for that reason that it’s also important to look at alignment. There’s no need to be afraid of any position, but it is important to try and keep a neutral spine (diaphragm and pelvic floor aligned, hips centered, weight over the whole foot and not just the heel) to help keep the pressures of motherhood over the center.
   

4. Nourish
   Nourishing our body through food following a cesarean is similar to how we prepare for birth - nutrient dense foods, fiber, and making sure we are well hydrated. We want to make sure we are getting enough macronutrients such as carbs, proteins and fats as well as micronutrients. It’s also important to have regular bowel movements - that means so straining or pushing and going daily.
   
   When it comes to healing, proteins are important because they are the building blocks of the entire body including repairing tissue! I love grass-fed meat, eggs, bone broth, beans and lentils, wild-caught fish as well as nuts and seeds as sources for postpartum protein.
   
   When it comes to tissue repair, collagen and vitamin C are both important in helping the body optimally heal. For collagen you can consume hydrolyzed collagen or you can eat fibers high in threonine (most foods listed above plus carrots, bananas, dairy products and spirulina) as well as green leafy vegetables (spinach, kale, arugula), strawberries, citrus, pumpkin seeds and garlic. When it comes to vitamin C it isn’t just organist—try to eat kiwi, bell peppers, strawberries, broccoli, kale, pineapple, cauliflower, peas or even tomatoes to boost your Vitamin C levels without supplementing.
   
   Fiber and water should go hand-in-hand to help with bowel movements and regular poops are a great way to decrease pressure on the scar! When it comes to fiber, getting it through foods is a great. A few high-fiber foods include berries, pears, avocados, figs, peas, Brussels sprouts, beans (black, lentil, kidney, chick, lima, split) and seeds (flax and chia). I don’t love over-the-counter fiber supplements because consuming fiber supplements and not enough water can basically make you have concrete poops…and nobody enjoys that.
   
   If you want individualized help with nutrition postpartum, I love Mama & Sweet Pea Nutrition and Lactation. The owner, Meghan, is a a Registered Dietitian and Certified Lactation Counselor who understands the nutritional needs of pregnant and postpartum mamas.
   

5. Strengthen
   Remember that ACL? Yeah, I’ve never met a surgeon who doesn’t recommend therapy following major surgery…except when it comes to women’s health. Your provider literally cut through your muscle, so now that your scar is moving better thanks to eating well, regular bowel movements, and manual therapy, it is time to strengthen. A few of my favorite core strengthening exercises are deadbugs, birddogs, side planks and rolls as well as simply carrying objects! I also love mixing them up and adding more or less resistance based on your personal needs!

Cesarean scar pain can be worrisome, but it isn’t something you have to deal with for the rest of your life! If you are tired of your scar keeping you from exercising or playing with your kids or you are done worrying whether or not this pain will last forever, schedule a visit with Dr. Lauren today. 

References:

1. Guttormson R, Tschirhart J, Boysen D, Martinson K., 2008

2. DOI: 10.1097/JWH.0000000000000103

The information by Dr. Lauren Keller of Elemental Chiropractic, Inc. is provided for general information only and should in no way be considered as a substitute for medical advice or information about any particular condition. While every effort has been made to ensure that the information is accurate, Dr. Lauren Keller nor Elemental Chiropractic, Inc. make no warranties or representations as to its accuracy and accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. If you have any specific questions about any medical matter or think you may be suffering from any medical conditions, you should consult your doctor or other professional healthcare provider. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

Pubis Pain aka “Lightning Crotch” or Pelvic Pain During Pregnancy: Part 2

Part 2 - Managing pubic symphysis dysfunction through exercise

Not sure what pubic symphysis dysfunction is or the causes? Check out Part 1 for more information!

The most important thing to know is that each mama is unique in her needs. For that reason, it is important to see a chiropractor or physical therapist with additional training in pregnancy and postpartum to find out what your specific needs are. With that being said, there are some general guidelines. Y’all know by now that I love mamas to stay active during pregnancy but there are some exercises that are best modified or temporarily taken out when you have SPD.

The ‘Don’ts’ of exercising with pubic symphysis pain (exercises to avoid with lightning crotch):

• Don’t over-stretch

  • Yes, it is possible to over-stretch, especially during pregnancy when relaxin and progesterone are helping muscles and ligaments relax in order to prepare for birth. If you are doing yoga or pilates, it’s a great idea to not push mobility at the end of any pose as this can increase your risk fo stretching too much and destabilizing the pelvis

• Limit single leg movements for a few weeks (2-3 weeks) and slowly add them back in your routine to see if you can manage the load. If not, that’s OK…you can take them back out. If they do not increase or cause pain, it’s a great idea to add them back!

  • This includes taking out lunges, bulgarian split squats, pistol squats, warrior pose, assault bike, and step ups as all of these exercises are one-leg dominant and can increase shearing on the pelvis.

  • Here’s the catch…some mamas actually benefit from single leg movements with a little modification. If you notice that deep lunges cause pain, you can modify it! First, try to change the position of your feet by bringing them closer together. You may notice that by bringing your feet closer together decreases your pain but still lets you use those muscles. This is great! You can strengthen this area and then try to increase the distance between your feet as you get more comfortable. The next thing you can change is the depth or how far down you go into the lunge. If a full lunge causes pain, try to lunge at half depth or a quarter of the depth. If you are able to do these without pain, that’s great - you should continue to do them! Our goal is never to exclude the movements you love but to work with them to see what can work with your body at this time.

• Use caution with traditional “core” exercises 

• Traditional core exercises like sit-ups and crunches focus on activating one or two muscles independently of the core system (diaphragm, pelvic floor and all abdominal and back musculature). Working these muscles can actually pull on the pubic rami and increase pain. Core exercises like the plank are advanced and require full pelvic/core stability and joint centration (the pelvic floor and diaphragm should be aligned). It is common for mamas to compensate during this movement as their natural gravity shifts and this compensation can lead to increased pelvic and low back instability.

• Watch deep squats or sumo squats

  • I love deep squats because the bottom of a squat is when the pelvic floor is most relaxed (hello benefits in labor) BUT that stretch can be too much with pelvic pain. If you notice pain with deep squats OR after deep squats, it’s okay to take them out.

• Adductor stretch or adductor machines 

  • The adductors are connected to both the inner thigh and the pelvis and can definitely play a role in pelvic pain. Like most everything, it is best to figure out if the adductors need relaxed or strengthened. If you are constantly stretching and they don’t feel better, they may actually need strengthened! Vice versa, if you’ve been working hard to strengthen the adductors but they continue to be sore, you may need to calm the signal from the brain to down regulate this pain. The best way to know this is to see a professional who can guide you in what your body currently needs.

• Fast/explosive movements 

  • We want to continue moving during pregnancy but fast and explosive movements require the musculature around the pelvis to respond quickly and when there is pain this reaction is often slower. It is easier to compensate and not utilize the appropriate muscles to create the force to stabilize.

Exercises that may improve pubic symphysis pain

• Focus on posture and pelvic alignment

  • As you stand and walk your diaphragm should be aligned with your pelvic floor — this is a neutral spine. If you drop into too much anterior or posterior pelvic tilt this can increase pain/pressure on the pubic region. So one easy exercise to stand in front of a mirror and focus on finding that neutral spine.

• BREATHE

  • As we inhale, our pelvic floor gently descends and relaxes and as we exhale it gently lifts and contracts. This is a normal progression with diaphragmatic breathing that naturally helps to activate the deep abdominal muscles and stabilize the pelvic region with the breath

• Balance strength and mobility

  • All movements should be slow and intentional to start to focus on maintaining task-specific pressure (that’s the amount of support/brace/natural tension you need to create to stabilize the body). This intention trickles down to balancing strength and mobility so we aren’t over-stretching or strengthening a muscle that does not have its full range of motion.

• Work the glutes and adductors in synergy through movement

  • Banded monster walks

  • Glute bridges with band around knees and yoga ball or block in-between knees

  • High Bear or low bear: with bands around knees and yoga ball or block in-between knees —> if you are able to do this and looking to advance the movement without doing a bear crawl, you can simply lift and hold one arm or one leg at a time

  • Hip Hinge or banded good mornings

  • 90/90 or Shin box flow: this is a movement where slow and intentional movements are best

• Work all of the core together

  • Box squats: i mentioned earlier that deep squats may not be beneficial but shortening the range of motion to the point before there is pain can be extremely helpful in pelvic pain and keeping pelvic mobility with core stability

  • Side bridge

  • Bird dog with pelvic floor focus and focus on breathing and elongating spine

  • Dead bug with focus on crossover

Part 3: Labor and Delivery considerations for pubic pain

Mama, if you are struggling with pubic symphysis pain or any pelvic pain, I understand the frustration, anger and fear that comes along with it. I believe that no woman should have to suffer through pregnancy or postpartum in pain. Call 331-307-7110 to schedule an appointment today or book online. Not ready yet? That’s OK, schedule a free 15-Minute Healthy Mama strategy session today to discuss your options.