Does your Caesarean scar move how it should?
Try this: pick up the skin on the back of your hand, lift it up and drop it. Notice how stretchy it is? Good, healthy tissue, like a healthy body in general, MOVES. That’s right, mobility is as important for skin is it is for the rest of the body.
Scars, on the other hand, don’t have good natural mobility. This includes your Caesarean scar. Scarring, or the formation of tissue adhesions after injury or surgery, is a healing process. The priority for healing tissue is to become strong quickly to protect the injured area and prevent re-injury. Unfortunately, as part of this process, tissue becomes tight, stiff and inflexible. Scars become stuck to the tissue below, whether this be muscles, tendons, ligaments or even organs. How stuck they get depends on a lot of things: the part of the body; how deep the cut was; how well your healing process occurred (including how good your nutrition for healing was); how early you start movement rehab; how well you stick to your program; how much stretching you do, and more.
I can give a personal example here. In 2014 I broke my ankle on both sides and had surgery. There is a scar of several inches on the outside of my lower leg where they inserted a plate. I dutifully followed the surgeon’s instructions and kept my ankle completely immobilised for two weeks, then introduced controlled movement in one plane only. Despite following the correct protocol, by the time I was allowed to walk on the leg again (at six weeks) the ankle was incredibly stiff and horribly painful to take weight or to move or twist in any way. At twelve weeks, I needed to do painful stretches every day for around 2 minutes at a time in order to get the movement back. As in any orthopaedic rehabilitation, this is a slow and painful process.
Now take abdominal surgery. If you have had a Caesarean section, this is exactly the same process. The obstetrician cuts through many layers to get to your uterus: the skin, the fat, the fascia (tight connective tissue wrapping) of the muscle, the muscle itself, more fascial layers and finally the organ itself. So the scar you see in your lower tummy, neat as it is, is only the tip of the iceberg.
Try an experiment. Grasp your lower tummy in your hands – thumb above the scar, fingers below. Now pick up the skin and move it around. Stretch it, wiggle it, lift it, move it every which way. Does it move easily and painlessly? Can you even lift it?
When scarring is adhered to the underlying tissues, it’s hard or even impossible to lift. The edges of skin you try to lift collapse inwards into the crevasse that is the scar, tightly bound to the what’s underneath. It’s all gummed up under there, restricting circulation and compromising your range of motion; it can be responsible for underlying muscle tension and spasm and even pain. This is a common source I see of “unexplained” pain, where all medical investigations have come up with nothing. If your pain is new since your surgery, and other causes have been ruled out, you need to get your physiotherapist trained in connective tissue manipulation to check this.
It doesn’t feel nice to stretch a scar. In fact, it can feel quite horrible: it can sting, give you strange hypersensitive sensation and feel sore after you stretch it. But it is essential to get it as mobile as you can – and as much of this as possible needs to occur between the six-week and the twelve-week mark post surgery, because after this, scar tissue gets tighter (or stronger).
From the two-to-six-week mark, I massaged my strange-looking, bruised, hypersensitive leg with caution, trying to both remove swelling and get my nerves used to the sensation. From six weeks, when I tried “picking up” the scar, I realised how tight it had become – it was so “gummed up” I had almost no inward movement of my ankle. While this restriction is often less obvious in a Caesarean scar, it is absolutely an issue. I have seen many patients whose tight scar tissue is restricting their movement and promoting pain; in some, it’s even promoting dysfunction of the underlying organs.
Movement is essential for good health! And this goes for scars as well. If you are before the six-week point post-surgery, ask your physiotherapist for specific, safe mobilisation exercises for your scar. If you are past the six-week point post-surgery, get your scar moving vigorously. Pull it and stretch it every which way. Just play with it! For help with getting your tissue healthy and moving again, contact me at Equilibria.