PT on the Net Research

Post C-Section Training


I have a client that not only has had a cesarean section but also had her left fallopian tube removed. She has had operations across and down her stomach. My question is: How well do the abdominal and underlying muscles heal after such operations, and do they have the capability to obtain a well defined six pack? Or is a flat stomach (i.e., no fat) as good as it gets? Thanks for your time. and keep up the good work!


Typically, surgical intervention of the abdominal wall results in cutting through all three layers of the abdominal wall. Depending on the nature of the surgical procedure, surgeons will follow the classic lines of fascia so as to minimize structural damage, such as cutting along the linea alba so as not to damage muscle function directly. Unfortunately, there are a number of surgical procedures and variances in the execution of those procedures, many of which result in cutting through the layers of abdominal wall muscle. The result of any surgical procedure that invades the abdominal wall is pain driven inhibition; the muscles stop firing because to do so causes pain. For example, after a C-section, if a woman sneezes or coughs, there can be tremendous pain. Straining with a bowel movement can also cause a lot of pain. By the same token, bending over to pick something up, which requires stabilization from the abdominal wall, is also typically inhibited; faulty recruitment patterns are immediately generated to compensate, and therefore, people often find themselves having strange muscle cramps or muscle injuries later on when under the stress of increased activity, the previously effective compensatory recruitment patterns no longer serve them.

When a surgical incision of the abdominal wall heals, scar tissue forms. Scar tissue presents a number of problems that often manifest as problems for clients and their therapists and trainers down the road.

Some of the challenges presented by scar tissue formation include:

  1. Scar tissue shrinks as it matures, which creates an effect called pursing. You will recognize this if you view anyone’s scar that has a bunched up look, like a zipper in a sweater looks after a number of trips through the washing machine. This pursing effect creates fields of tension in the facial system and can disrupt joint mechanics throughout the body.
  2. Scar tissue often develops very nasty trigger points. Scar trigger points can send very sharp, acute pain into any surrounding organ, muscle, literally any body tissue, disruption both physiology and function. Someone with scar tissue trigger points in the abdominal wall is likely to have an adverse reaction to exercise, particularly in the long run. The problem is, people often don't make the connection because the pain referral may be shutting down your gall bladder, causing low back pain, groin pain, etc.; yet all the time, the client and therapist/trainer thinks these additional problems are entities in their own right and therefore, typically run around treating all the little fires without getting to the root cause: the scar tissue triggers and related faulty mechanics.
  3. Scar tissue typically adheres multiple functional muscles and muscle/fascia layers together, completely disrupting synergy in the neuromuscular system.

Suggestions for your client are:

  1. Find a good, well experienced visceral manipulator. A good one typically only does visceral manipulation. Look for someone trained in the methods of JP Barrel, a French Osteopath with several books on the topic. A skilled cranio-sacral therapist may be very effective a restoring mobility as well.
  2. A skilled Rolfer or Heller worker can mobilize the fascia and may be able to restore natural movement between the functional muscle/fascia planes.
  3. Ice massage is an assessment technique that massages the scar until it goes numb and then test her abdominal well function. You can do before and after testing using the Prone TVA test and the Forward Bend test demonstrated in both my Scientific Core Conditioning course and my book, "How To Eat, Move and Be Healthy!"
  4. Find a skilled massage therapist who can take a wooden Q-tip (cotton bud for Europeans) and pull off the cotton and use the blunt end of the wooden stick to carefully probe for trigger points along any scar that you suspect may be a problem. Be warned that scar tissue trigger points can produce very acute pain, and the client may well jump when you make contact with a trigger point of this nature. Once found, repeatedly holding direct pressure on the point of concern for periods not exceeding 20 seconds will be beneficial. I usually mark active points with a skin pencil and then once I treat one, I come back to it later on, working along the scar three times in one session. Make sure the client drinks lots of water after such treatment because the release of such trigger points can also cause the release of a lot of toxins out of the body. The patient often describes feeling like they are getting the flu in the few hours after treatment. The worse the reaction, the more they needed it!

As for any removed organs or parts, they are gone now and all that can be done is to get a good visceral manipulator to free any unwanted adhesions so the natural peristalsis and motility of the organs is not disrupted. This can go a long way to improving abdominal wall function and appearance since the abdominal wall will always relax to decrease pain generating tension between organs if need be. In addition, any inflammatory process in an organ can reflexively inhibit the section of the abdominal wall that shares the same sympathetic innervation; everything above the umbilicus shares the same sympathetic innervation, and everything below the umbilicus shares the same innervation.

I hope you find this information helpful.