The goals of caesarean section scar therapy are to mobilise the scar, eliminate adhesions and fusions, restore tissue elasticity and mobility, reduce pain and sensory disturbances and improve the appearance of the scar. The therapy is consequently supposed to restore the structural and functional balance of the body. This raises the question of which methods and techniques are most advisable in scar therapy and what their effectiveness is.

Chamorro Comesaña et al. studied the effect of Myofascial Induction Therapy (MIT), a myofascial therapy used in physiotherapy and aimed at restoring altered fascial tissue. The researchers assessed the effect of MIT therapy on scars that had completed the repair process in healthy subjects, without accompanying pathology that could affect the healing process. In all 10 cases studied, changes in scar fold structure were observed after MIT application. Eight weekly MIT sessions were applied. Functional improvement was determined using the Schober test and patients’ quality of life was measured using a special questionnaire.

Wasserman et al. described the results of two patients with chronically painful caesarean section scars after intervention with specific musculo-fascial release techniques. Both patients reported premenstrual pain, pain on pressure on the lower abdomen and pain during bowel movements. One patient also reported acute pain with movement in bed. Four 30-minute treatment sessions over a two-week period consisted of stretching the scar until the therapist felt the release of tissue tension. Pain and pressure tolerance, scar elasticity and pain intensity were measured. After therapy, both patients showed improvement in all outcome measures.

Wasserman et al. studied the effect of soft tissue mobilisation on pain after caesarean section. After 4 weeks of therapy, there was a reduction in pain, improvement in scar mobility and functional status of the subjects.

Çıtak Karakaya et al. investigated the effect of a physiotherapy programme on pain and functional activities in the early period after caesarean section. Fifty women after caesarean section were assessed for the duration of movement and return of bowel function, pain intensity after incision, difficulty in functional activities and the number of analgesics required in addition to routine pain management. The results revealed the effectiveness of the physiotherapy programme used.

Other authors performed a systematic review on the effect of soft tissue mobilisation on symptoms associated with abdominal adhesions. Five articles with pain as an objective measure were eligible for the review and all reported a reduction in pain after treatment. Two studies assessed quality and functioning of life and both observed objective improvement after treatment of abdominal adhesions. Overall, improvements were also observed in scar mobility, infertility, posture, medication reduction, increased pressure tolerance and reduced postoperative bowel obstruction.

Antonina Kaczorowska

References:

1. Chamorro Comesaña A, Suárez Vicente MD, Docampo Ferreira T, Pérez-La Fuente Varela MD, Porto Quintáns MM, Pilat A. 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. 2017;21(1):197-204
2. Çıtak Karakaya İ, Yüksel İ, Akbayrak T, et al. Effects of physiotherapy on pain and functional activities after cesarean delivery. Archives of Gynecology and Obstetrics 2012;285(3):621-627.
3. Drozd A, Nowacka-Kłos M, Szamotulska J, Hansdorfer-Korzon R. Możliwości zastosowania terapii manualnej w obszarze blizny. Rehabilitacja w praktyce 2021; 4: 34-42.
4. Wasserman JB, Abraham K, Massery M, Chu J, Farrow A, Marcoux BC. 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 2018;42(3):111-119.
5. Wasserman JB, Copeland M, Upp M, Abraham K. Effect of soft tissue mobilization techniques on adhesion-related pain and function in the abdomen: A systematic review. Journal of Bodywork and Movement Therapies. 2019;23(2):262-269.
6. Wasserman JB, Steele-Thornborrow JL, Yuen JS, Halkiotis M, Riggins EM. Chronic caesarian section scar pain treated with fascial scar release techniques: A case series. Journal of Bodywork and Movement Therapies. 2016;20(4):906-913.