Have you ever had a C-section? No matter how old the c-section scar is it can contribute to decreased core stability, low back pain, pelvic floor issues, bilateral hip/knee, and lower leg pain. The scar can affect movement patterns and contribute to decreased core/leg strength.
You may be thinking- “I had my c-section over 30 years ago, how can that contribute to back or hip pain?“
In my 25 years of clinical experience of observing and treating women with back dysfunction, my patients have never associated their symptoms with their C-section scar, since their symptoms are not always close to the area of their scar.
Unfortunately, many therapists only treat the scar without looking at how it is affecting the rest of the body and addressing important movement patterns.
How can a small C-section scar affect my back, hips, or core strength?
Here’s what your doctor(surgeon) never told you:
- Most surgeons will tell you they aren’t cutting through muscle. They normally do the transverse cut as in the image above. However, with the transverse cut, they are slicing through important connections and fascia(connective tissue) which extends into the anterior thigh and throughout the hips and lower extremity.
- These areas that the surgeon cuts through affect important structures in the maintenance of pelvic stability, core stability, and optimizing intra-abdominal pressure(IAP). Sufficient intra-abdominal pressure is crucial for good core-stabilization. Core-stabilization from the inside out is driven by proper activation of the diaphragm which is significantly affected after a c-section.
What does all this mean?
In a nutshell, it means that the scar can inhibit the proper function of the core, hip, back, and leg muscles. If you lose intra-abdominal pressure, you lose core and back stability which over time can contribute to back and hip pain. In addition, it can contribute to pelvic floor issues such as incontinence.
It can even contribute to shoulder pain!Our bodies will try to make up for this loss by compensating with other muscles and poor movement patterns.
I recently had a patient who came to see me for complaints of back pain which increased with walking. She had a C-section 25 years ago. She was quite active with gym workouts, yoga, and pilates classes.
I discovered during the evaluation that she had poor core and back strength. She shared that she worked her core 5 days a week! Here is an example that you can work your core hard several times a week but if something is inhibiting your core muscles from functioning properly the core won’t get strong.
In this example, the C-section scar was inhibiting(shutting down) her core muscles and her back muscles were overcompensating causing pain.
To resolve the problem, I released the c-section scar with manual techniques, taught her breathing techniques to optimize her diaphragm function, and increase her intra-abdominal pressure.
I taught her corrective strategies to activate and strengthen the core muscles that were weak.
Her back pain completely resolved in a few sessions! She had no idea her scar was affecting her back pain and core.