Scar massage is probably the biggest thing you can do to help your recovery after a c-section. Lots of women report numbness, sensitivity, soreness, swelling or pain in the area, years after their c-section(s). Starting some massage early on can help prevent these sorts of issues.
What happens during a c-section?
A c-section birth is a major procedure. In a planned c-section an incision will be made in the skin of the lower abdominal wall about 3 centimeters above the pubic bone. The next layers to be cut are the subcutaneous fat and then fascia (which can also be called the rectus sheath). Next the surgeon has to get through the muscles, which are in- fact not cut, but pulled apart from the mid-line at the rectus abdominus (the six-pack muscles). After the surgeon is through the abdominals they come to the parietal peritoneum. This is a thin piece of tissue that covers the abdominal organs. Once through the peritoneum a cut is made into the uterus and then the baby is born. The surgeon will then start to suture layer by layer, starting with the uterus, and finishing with the skin.
The healing process
Post surgery the healing process begins. Scar tissue begins to form to heal each layer. Scar tissue is actually made of the same protein as regular tissue, however instead of being oriented in the same direction of the tissue it is replacing, it can orient itself in many different directions. All the layers of tissues, when healthy, are supposed to slide and glide over one another, but sometimes as they heal they can they form adhesions – or kind of stick together in places. Massage helps mitigate this.
For some Mum’s, the scar tissue formation may not really affect them that much. However, for others the scar tissue can have more lasting and negative impacts such as:
- Nerve irritation in the scar tissue or skin surrounding the scar.
- Pain or increased sensitivity in the skin around the scar.
- A feeling of tugging or pulling around the scar.
- Impact posture and alignment and lead to other muscular pain.
- Increased tension in the muscles (and fascia) around the scar.
- Increased urinary frequency or urgency
- Reduced skin mobility
Why does scar massage help?
Scar massage can prevent excessive scarring and make the scar appear less noticeable. It can be a great way to decrease pain by improving tissue mobility and improving function of the abdominal muscles.
And a lot of women won’t dare to touch their scar, even years after giving birth. An important part of the scar tissue massage is desensitization of the nerve fibers around the scar. Often times after a surgery, injury or trauma, nerves in the surrounding area become more sensitive than the nerves in the un-injured tissue.
Another great way to de sensitise the scar is to rub different textured surfaces over the scar ( a hair brush, soft cloth, or scrub brush). Allowing the nerves to feel that different surfaces or feelings are in fact not causing any harm can be very helpful.
When should you start?
You need to wait until the incision has healed completely. Usually 4-6 weeks after birth. If the scar does not look like it is healing properly, there is still significant redness in the scar or around it or the scar is unusually tender, check back with your doctor.
How often can you massage?
I advise carrying out scar massage for 5-10 minutes every day, in bed when lying down and relaxed is a nice time to do this.
Should it be sore?
Scars can be painful and often the skin sensation around a scar feels altered or numb. Initially scar massage may be a little uncomfortable but if painful that is often a sign that you are massaging too deeply.
How do you do it?
There are two strategies for massaging abdominal scars:
1: Skin stretching involves stretching the skin around the scar (Indirect)
2: Scar massage involves the skin directly on the scar (Direct)
Scar Massage: Skin Stretching (Indirect)
Begin about 4-6 weeks after surgery, as long as incision is well healed. This can be done on your own, at home, for 5 minutes/day.
- Place fingers 2-3 inches from scar.
- Stretch the skin by moving the fingers up.
- Repeat step 2 by stretching side to side and clockwise/counterclockwise.
- Massage completely around the scar, repeating each movement 5-10 times.
It is normal to experience a pulling or burning feeling when you initially are stretching the scar. If you feel an area that does not move as easily, spend a little extra time in this area stretching the scar.
Direct Scar Massage
Begin as soon as the incision is closed and well healed.
- Hold the pads of two or three fingers together. The fingers should be slightly arched.
- Place pads of fingers on the edge of the scar.
- Stretch the scar by pushing fingers ½ inch in one direction. Hold scar stretch for 10-15 seconds.
- Repeat by stretching the scar in the opposite direction
- Move along the scar every ½ inch-1 inch and repeat over the entire length of the scar, stretching in all directions (up/down, side to side, and diagonal).
Scar Lift and Roll
- Lift scar away using index finger and thumb.
- Roll the scar between fingers for 10-15 sceonds
- Move along entire length of scar repeating every ½ inch-1 inch.
These simple techniques do not take more than 5 minutes daily. You will be surprised at how quickly (within the first 2 weeks) the scar becomes less painful. The other fun part is that the appearance of the scar with be thinner and more favourable. If you begin using this massage and don’t find that it improves or you continue to have pain or weakness, you can see a pelvic physiotherapist who can help you.
What about older scars?
It is never too late to massage scar tissue and the benefits can be amazing. Scar tissue massage will desensitise the scar, improve the movement and therefore the tightness of the tissue and in doing so improve muscle recruitment around the area. Scar tissue can affect the organs below it and impact on their mobility. By moving the scar you are also nurturing the organs below. It should be considered a fundamental component of c section rehabilitation and is one that all pelvic health physiotherapist advocate for women as part of their postnatal journey.
Want to learn more about c-section recovery?
I have an entire online programme dedicated to c-section recovery. I’ll take you through a c-section massage tutorial, breathing and alignment tutorials, a full core assessment including a Diastasis Recti Assessment, before progressing to the exercise programme which includes Core, Mobility and Strength workouts. You can join the Complete Postpartum Programme today and get started here https://thebumproombeyondbirth.ie/courses/c-section-recovery/.