I get asked a lot about C-section scars. And yes – I think that some women need to have their C-sections rehabilitated. See here for my thoughts on that. But this post is to demonstrate some of the basic myofascial, or massage-like techniques that I use to help get a C-section scar moving better. C-section rates are on the rise in North America. Around 30% of births are done via caesarean in the USA and Canada seems to follow suite on these things (Martin et al, 2017). It can be useful for professionals and women who have undergone the procedure to know how to massage the area to potentially help improve flexibility, movement and pain.
Always check with your physician to find out if your incision site is ready for massage and exercise before getting started. Wound closure and healing need to be progressed enough before applying pressure through the area, and your doctor is the best person to check with.
I always use these techniques after a full assessment. This is where I look for skin movement, underlying tissue flexibility, and hip/ pelvis/ spine movement, in combination with other treatment options. Sometimes I use heat, sometimes I use different positions, and almost always there are exercises.
- Circular Massage – Gently and firmly pressing finger pads into the area that needs work until some tension is felt. Here I do 5 circular motions in one direction and then change directions and do 5 more. I will do this along the scar and on the nearby surrounding tissue.
- Skin Rolling – I use my finger tips in a “pincer grip” to lift some skin and underlying tissue, if necessary. This skin is then “rolled” across the scar area, and often beyond. My fingers keep holding the pincer grip – my index and middle finger walk the little roll of skin forward, while my thumbs stabilize the skin and guide it forward. It looks like a wave of skin travelling across the belly. I do this is many directions over the scar. It can feel a little pinchy to begin with, but with time the tissue gives and relaxes and this is more easily tolerated.
- Cupping – The use of pliable silicone cups to help lift the skin off of the underlying surfaces. There are many ways to use silicone cups. The way that I seem to be using them lately is to apply them to the skin (with a bit of lotion or massage oil) and while holding the skin stable, drag the cups over the incision and surrounding abdomen.
- Extractor Tool – This is a tool that uses very small, firm plastic cups that attach to a syringe that creates a vacuum once applied to the skin. I use this for very restricted and stiff areas of a scar (often times the ends of incisions can be a little more resistant to movement). I apply with a lotion or massage oil so that I can glide the device a bit if needed.
For all of these techniques a little redness is common, though I try to avoid any bruising. I usually ask my patients to let me know if they experience pain above a 4/10. These techniques are often followed up with stretching exercises. I also ask my patients to learn some of the massage techniques to perform on themselves between appointments.
There are many different scar release techniques that can be used but these are some of my “go-to’s”. If you think that you might benefit from physiotherapy treatment for your C-section incision, talk to your doctor about finding a women’s health physiotherapist.
Katie Kelly, Physiotherapist
BSc., MSc. PT