Guest Blog Post: Physical Therapy Post C-Section
For National C-Section Awareness Month, we reached back out to one of our local #Herstory moms, Michelle Little, who is also a physical therapist, to highlight how physical therapy can play an important role in post-c-section recovery. Michelle, who is the founder of Women in Motion Physical Therapy and Wellness, is also a Board-certified orthopedic clinical specialist with post-doctorate specialties in obstetrics and pelvic health.
1. How can physical therapy help post c-section and what are the benefits?
Pregnancy comes with weight and hormonal changes that greatly impact our joints and muscles. Regardless of how babies enter the world, all women benefit from pelvic physical therapy to restore strength in the core, hip and pelvic floor muscles, as well as a return to exercise program.
A cesarean is a major abdominal surgery that comes with weight restrictions for lifting and carrying, yet most women receive no information on how to respect these restrictions and healing while caring for a newborn, or other children and still performing tasks around the home.
Early rehab can include:
Teaching patients how to roll out of bed without straining the incision or using their abdominal muscles
Education on alternative feeding positions to reduce strain on the abdomen
Baby carrying, lifting and baby wearing modifications to reduce abdominal strain and low back pain
Intentional diaphragmatic breathing to engage the core and pelvic floor to reduce swelling and muscle atrophy/loss
After clearance from an OB-GYN, Pelvic PT can incorporate:
Treatment for any orthopedic aches and pains that are common postpartum such as: low back pain, SIJ pain, tailbone pain, pubic symphysis pain, and hip pain.
Treatment for pelvic floor dysfunction such as: urinary or fecal incontinence, pain with penetration, bladder or bowel urgency, rehab after perineal lacerations, pelvic organ prolapse, hemorrhoids and fissures.
Scar massage and mobility to improve the appearance and proper activation of core muscles
Treatment for Diastasis Recti, and other muscle imbalances. Common areas include: hip, core, pelvic floor, low back and shoulders
Return to an exercise program. This is very important as 6 weeks of “rest” in addition to the weight and hormonal changes predisposes women to tendon pathology and bone injuries (stress fractures), so having a tailored program for your exercise routine is important to reduce the risk for injury. We also know the importance of exercise on women’s health, thus, supporting appropriate return to physical activity should be a major focus of the postpartum period to support women’s health.
You shared a great cesarean scar massage post on Instagram, could you elaborate on this method?
Some people are predisposed to more scarring than others. Scar tissue is less mobile and pliable, impacting how our tissues move and glide. Some women also experience increased sensitivity (nerve pain). There are two basic steps that can help reduce scar pain and improve tissue mobility.
Desensitization: This is used when women experience increased pain at the scar; sensations are commonly described as: numbness, tingling, and/or burning. This technique is used to normalize the body’s response to a particular sensation. I always advise touching the scar with different textures to improve the tolerance in the area.
Scar Mobility: This is used when the scar tissue is creating a shelf-like appearance. Clinically I also find that scar tissue in the abdomen can play a role in how our hips and low back move. There are various techniques to do based on what the patient tolerates. These techniques can be manual (hands-on), use of cupping, or dry needling.
How can a mom who has had a C-section best strengthen her core post surgery?
We have lots of evidence in orthopedic studies showing that after surgeries, the muscles in the surrounding areas atrophy (get thin and weak). Which is why prior to many orthopedic surgery’s patients get referred to physical therapy for prehab to help optimize post-surgical outcomes. The same happens to the core and pelvic floor after a C-section. Weakness in these muscles can greatly impact proper bowel, bladder, and sexual function, as well as contribute to low back, hip and pelvic girdle pain.
Generally, I recommend avoiding crunches or forward planks during the early rehab phase, especially if the patient has Diastasis Recti (abdominal separation). Core exercises will vary greatly based on the patient's presentation and any other aches and pains they have, but in general, starting in more supported upright positions can be great.
View this video for 3 exercises for early postpartum.
How can a mom prep her body with physical therapy for a VBAC birth (after a c-section)?
A physical therapist with a specialization in obstetrics and pelvic health can help support parents planning a TOLAC. There are a few key components here.
Exercise: We know that 30 minutes of moderate-intensity exercise most days of the week helps to reduce comorbidities and thus reduce the risk of a cesarean. Addressing any orthopedic aches or pelvic floor dysfunction acting as a barrier preventing women from exercising can help support physical exercise during pregnancy and thus improve birth outcomes.
Pelvic Floor Support: If your bicep muscle was “tight,” it would prevent you from fully straightening out your elbow. If the pelvic floor muscles are “tight” or have a lot of tension, they can impact the ability of the pelvis to move, and expand, impacting babies’ passage through the birth canal as well as pushing. We also have a great study showing that during pushing contraction of the levator ani muscle (deep pelvic floor muscle) can result in a longer second stage of labor (pushing stage). So, making sure our pelvic floor muscles aren’t “too tight” can be very helpful to shorten labor and improve the birth experience.
Support: Studies have shown that in addition to regular nursing care, one on one continuous birth support can help improve birth outcomes and reduce the risk of a cesarean. Doulas can play a major role in supporting families, however, not everyone can afford a doula or wants an additional person in the room. Most women have their partner or friend/family member in the room with them. Teaching the birth partners hands-on techniques to help the laboring person can be so beneficial in improving the birth experience and outcomes. Our clinic offers an in-person pregnancy prep class that has a strong focus on learning to relax your pelvic floor and training the birth partner with hands-on techniques to help manage contractions and support the laboring mother.
Note from the office: Along with Women in Motion, we also recommend Passages Physical Therapy and Physical Therapy at ACAC Charlottesville to our patients. We advise checking with your insurance to see who is in-network for your plan. (Some of these practices may not take insurance, or they may provide a superbill for you to submit yourself. Please confirm these details with your insurance before booking an appointment!)
