Lila Abbate, PT, DPT, MS, OCS, WCS
Physical Therapy for C-Section Scars
Whether a birth occurs naturally or through caesarian section, seeing a physical therapist after delivery is always a good idea to promote proper healing. C-section births come with their own recovery path in terms of the abdominal scarring that occurs after the surgical delivery takes place. There are more than 1.27 million c-sections each year in the US and up to 18% of these will result in chronic abdominal pain.  Physical therapy is an affordable, non-invasive treatment for helping relieve this chronic pain & increase mobility in the scar tissue for all c-section mothers. 
Abdominal scars from c-section surgeries cause sensitivity to pressure, low pain thresholds, and can affect posture leading to low back pain. [2, 3, 4] These surgical scars cause pain in part due to their effect on the body’s fascia system. Fascia is a thin connective tissue found underneath the skin all throughout the body.  There are a variety of manual techniques your physical therapist can perform to promote elasticity and improved mobility of the body’s fascia, thus lessening the pain of your abdominal scarring. Skin rolling is a popular and effective technique, as is myofascial release. [2, 5] Your practitioner can direct you towards self-massage techniques to do between sessions so your healing is as smooth and expedited as possible.
In addition to seeing a physical therapist and performing self-massage at home, some studies show that there are topical approaches to treating scar tissue. These localized treatments include aloe vera extracts, vitamins E & D, and even onion extract.  These topical treatments moisturize the skin as it heals and have anti-inflammatory, antimicrobial, and protective properties. A 100-woman study evaluated the efficacy of topical patches containing allium cepa extract and allantoin, both derivatives of onions. The women who used the patches as directed experienced an increase in pliability of their scar tissue after four weeks. 
The chronic pain of c-section scars can be draining on new mothers who are focusing their time and energy caring for their newborns. The evidence and experience of our practice shows that physical therapy is an effective way to treat this debilitating scar pain. The studies referenced here were performed over only four treatment sessions meaning progress happens quickly in most cases studied. Together with topical treatments, the hope is that new mothers can avoid further invasive procedures, although if necessary laparoscopic adhesiolysis is an option.
Comesaña, A. C., PT, Vicente, M. S., PT, Firreira, T. D., PT, Varela, M. P., MD, Quintáns, M. P., MD, & Pilat, A., PT. (2017). Effect of myofascial induction therapy on post-c-section scars, more than one and a half years old. Pilot study. Journal of Bodywork and Movement Therapies, 21(1), 197-204. doi:https://doi.org/10.1016/j.jbmt.2016.07.003
Wasserman, Jennifer B. DPT, PhD1; Abraham, Karen PT, PhD2; Massery, Mary DPT, DSC3; Chu, Jennifer PT, MS, WCS4; Farrow, Alicia DPT5; Marcoux, Beth C. DPT, PhD6 Soft Tissue Mobilization Techniques Are Effective in Treating Chronic Pain Following Cesarean Section: A Multicenter Randomized Clinical Trial, Journal of Women's Health Physical Therapy: September/December 2018 - Volume 42 - Issue 3 - p 111-119 doi: 10.1097/JWH.0000000000000103
Kelly, R. C., Armstrong, M., Bensky, A., Foti, A., & Wasserman, J. B. (2019). Soft tissue mobilization techniques in treating chronic abdominal scar tissue: A quasi-experimental single subject design. Journal of Bodywork and Movement Therapies, 23(4), 805-814. doi:https://doi.org/10.1016/j.jbmt.2019.04.010
Wasserman, J. B., Copeland, M., Upp, M., & Abraham, K. (2019). Effect of soft tissue mobilization techniques on adhesion-related pain and function in the abdomen: A systematic review. Journal of Bodywork and Movement Therapies, 23(2), 262-269. doi:https://doi.org/10.1016/j.jbmt.2018.06.004
Agnooti, L., Msc of OT. (n.d.). Therapeutic Massage Techniques. Retrieved 2021, from http://research.umsha.ac.ir/uploads/massage_basic_hamedan.pdf
Conti, V., Corbi, G., Corrado, B., Giugliano, L., Lembo, S., Filippelli, A., & Guida, M. (2020). Effectiveness and tolerability of a patch containing onion extract and allantoin for caesarean section scars. Frontiers in Pharmacology. doi:https://doi.org/10.3389/fphar.2020.569514