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Physical Therapy Key to More Successful C-Section Recovery

young woman doing exercises at home using chair

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Key Takeaways

  • A Cesarean section is major abdominal surgery, and your body needs time to heal afterward.
  • C-section patients may receive a physical therapy consultation and a suggested abdominal exercise before discharge, but several weeks of physical therapy is not standard.
  • However, a new study found that women who received physical therapy after undergoing a Cesarean section had significantly improved outcomes compared to those who did not.

Based on the most recent data from the Centers for Disease Control and Prevention (CDC), about 30% of all babies in the U.S. are born via Cesarean section. This makes a C-section one of the country’s most common inpatient surgical procedures. But it’s still major surgery, and it’s important to follow medical advice to promote healing during the recovery period. 

The role of physical therapy in post-op recovery has been studied before, but the examined time period tends to be only the first few days or weeks postpartum. New research from University of Missouri Health Care, published in Journal of Women’s Health Physical Therapy, found that physical therapy may be the key to more successful, long-term C-section recovery.

“Myself and my colleagues had noticed that individuals with a history of Cesarean section have a higher incidence of low back pain and are at least as likely to have incontinence or pelvic organ prolapse as those who vaginally deliver," says study author Jennifer Stone, PT, DPT, a board-certified clinical specialist, orthopedic physical therapy, and pelvic health physical therapist.

The researchers wondered why postoperative physical therapy isn't standard of care following abdominal surgery, as it is after knee surgery, hip surgery, shoulder surgery, etc. "The only reason we could find was that it hadn't been studied," says Stone. "We know that many physical pain problems would not exist if people had stronger core muscles, and those get disrupted during cesarean sections, so we wanted to see if rehabilitating them would result in improved outcomes."

Samantha Spencer, PT, DPT

Once you have returned home and incision healing is underway, a physical therapist can guide your return to fitness, help with scar tissue recovery for softness and mobility, address bowel and bladder concerns, and help you resolve other aches and pains that might arise during the postpartum recovery period.

— Samantha Spencer, PT, DPT

The Study in Detail

The study involved 72 women who gave birth by Cesarean section between 37 and 42 weeks gestation.

A control group of 39 patients received the standard of care for the hospital, which included a physical therapy consultation, written information about scar management, and a general program of suggested abdominal exercises.

The remaining 33 patients received six weeks of physical therapy, which included scar therapy and mobilization for the lower back, hip joint, and soft tissue. They also received stretching, core stabilization exercises, and exercises to do at home.

Researchers used a visual pain rating scale, a disability index scale, a patient satisfaction questionnaire, and a self-rated exercise confidence scale to measure outcomes at eight and 14 weeks, and then at six, 12, and 18 months.

Participants who received physical therapy once or twice per week achieved substantially lower pain levels more quickly than participants in the standard-of-care group. Plus, those in the physical therapy group also had higher patient satisfaction scores at both 14 weeks and six months.

Jennifer Stone, PT, DPT

This study hopefully lays the foundation for larger studies that can investigate postoperative physical therapy for patients who have undergone Cesarean section. It is our hope that this can enhance lifetime wellness for individuals who undergo this and other abdominal surgeries.

— Jennifer Stone, PT, DPT

The researchers also learned that there was significantly improved self-reported ability to perform exercise in the physical therapy group at 14 weeks through 18 months compared to their baseline. Meanwhile, the control group reported lower levels of exercise ability compared to their baseline.

Although Stone wasn't surprised to find that physical therapy can speed up recovery post C-section, it was still exciting to reach this conclusion, as it hasn't been shown in the literature to date.

However, further research with a larger sample size is required—the results don't support statistically significant differences between groups in pain after six months, or in patient satisfaction after one year or 18 months.

"This study hopefully lays the foundation for larger studies that can investigate postoperative physical therapy for patients who have undergone Cesarean section," Stone says. "It is our hope that this can enhance lifetime wellness for individuals who undergo this and other abdominal surgeries."

Physical Therapy After Childbirth

Postpartum physical therapy is a valuable tool for anyone after birth, but particularly women who have had a Cesarean birth. "Abdominal surgery is a big deal no matter what, but when you’re also caring for a newborn during your recovery, it’s impossible to rest and recover as we otherwise would," says Samantha Spencer, PT, DPT, postpartum rehabilitation specialist and medical advisor at Aeroflow Breastpumps.

Even if you have no specific concerns during your postpartum recovery, Spencer recommends an evaluation with a physical therapist to serve as a "tune up" to check in with strength, alignment, and function and make sure you’re moving optimally.

A postpartum physical therapist can provide support from the hospital all the way through to helping you achieve your fitness goals postpartum.

"Early on, a physical therapist can help you move safely and efficiently as you begin the recovery process, even while you’re still in the hospital or when you first return home," Spencer explains. "Getting up out of bed the first few times, lifting your newborn, and using the bathroom can all be daunting tasks immediately after abdominal surgery. A physical therapist can go through movement modifications, positioning in sitting and baby care tasks, and how to get started reconnecting to your core muscles."

Samantha Spencer, PT, DPT

Abdominal surgery is a big deal no matter what, but when you’re also caring for a newborn during your recovery, it’s impossible to rest and recover as we otherwise would.

— Samantha Spencer, PT, DPT

A PT can also make suggestions specific to your needs and concerns during early recovery and get you started with basic exercises and movement patterns to help you heal and recover optimally.

"Once you have returned home and incision healing is underway, a physical therapist can guide your return to fitness, help with scar tissue recovery for softness and mobility, address bowel and bladder concerns, and help you resolve other aches and pains that might arise during the postpartum recovery period," says Spencer.

When Can You Exercise After a C-Section?

It is important to begin moving and walking as soon as you feel able after delivery—as soon as a few hours after the birth, if you get the green light from your doctor. "Diaphragmatic breathing and gentle activation of your core muscles while sitting, lying down, or moving around with your baby can be a simple way to begin reconnecting without straining as the incision heals over the first few weeks postpartum," Spencer says.

Samantha Spencer, PT, DPT

Diaphragmatic breathing and gentle activation of your core muscles while sitting, lying down, or moving around with your baby can be a simple way to begin reconnecting without straining as the incision heals over the first few weeks postpartum.

— Samantha Spencer, PT, DPT

But it's important to go slowly. Although your incision may appear healed after 2-3 weeks, it hasn't yet regained its strength and could be injured or become painful with too much exertion.

"You still want to emphasize reconnection and coordination with your core muscles for the first 6-8 weeks at least," Spencer says. "This might look like focused abdominal activation, as well as emphasis on coordinating your core with functional movements like standing up from sitting, lifting your baby, and rolling over in bed." She also recommends daily walking during this time as an essential tool for efficient healing and pain management.

A more traditional exercise program can begin following discussion with your care provider, usually around 6-8 weeks postpartum. "Consider that abdominal fascia has only regained about 50% of its strength at 6 weeks post Cesarean," Spencer says. "It typically takes 6 months to regain up to 73-93% of its original strength, so 6-8 weeks is just the beginning of your retraining program, and it may take 3-6 months to return to higher levels of intensity."

What This Means For You

Physical therapy may help with recovery after a C-section, but it's important to check with your OB/GYN before you start exercising. At around 6 weeks postpartum, provided there are no post-op complications, you'll probably be good to start gentle exercise, but every patient is different.

There are many ways to find a physical therapist, from getting a referral from your doctor or local hospital to searching online. The American Physical Therapy Association, the governing body of physical therapists in the United States, has a PT directory on its website—consider filtering for specialties such as "post-surgical rehabilitation" or "women's health."

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2 Sources
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  1. Centers for Disease Control and Prevention (CDC). Births—method of delivery. Updated April 20, 2020. 

  2. Stone J, Skibiski K, Hwang S, Barnes C. Physical therapy in addition to standard of care improves patient satisfaction and recovery post-Cesarean section. J Womens Health Phys Ther. 2021;45(1):10-19. doi:10.1097/JWH.0000000000000187