Should I do physical therapy if I have a c-section?
Miranda is a 32-year-old pregnant woman who was coming to pelvic floor therapy for low back pain and birth prep sessions. During a treatment session, Miranda mentioned that her friend is also pregnant and scheduled for a Cesarean section. Miranda asked her friend if she would be doing physical therapy either before or after delivery. Her friend said no since it would not be beneficial since she is not delivering vaginally. Luckily, Miranda’s physical therapist was able to share how physical therapy – before and after – can be helpful for those who have a C-section.
The most performed hospital-based surgery in the U.S. is a Cesarean section or C-section. This can either be a planned type of delivery or unplanned. Many women assume that a cesarean delivery eliminates the likelihood of pelvic floor involvement; however, there is a higher likelihood of low back and pelvic girdle pain as compared to spontaneous vaginal delivery. Another major assumption is physical therapy is only beneficial afterwards; however, this is not the case. A study looked at the impact of in-person physical therapy training and education before an elective c-section. Two groups were created with 54 women. One group received physical therapy education prior to their C-section and the other group was given standard nursing care. The physical therapy education included breathing techniques, leg and abdominal exercises, and education on body positioning with movement. The group who received physical therapy prior to surgery had a lower average pain score post-operatively, lower average pain medication use, reduced pain with return to functional activities (like sitting, standing and walking without support), and reduced length of hospital stay.
While it is not standard across every hospital in the U.S., some hospitals have physical therapy on the postpartum floors, which can be very beneficial. Fifty women who received Cesarean deliveries were followed during their hospitalization to determine the impact of physical therapy versus “routine nursing care”. The physical therapy group received treatment that included breathing exercises, leg exercises, transcutaneous electrical stimulation (TENS) to assist with pain, massage, pelvic floor exercises, and body position recommendations while caring for baby.
Women who received physical therapy began walking about 6 hours and 18 minutes after surgery while the non-physical therapy group didn’t walk until 8 hours. Those who received PT also had an earlier return of bowel activity than those who received routine care. The physical therapy group required less medication and had lower incision pain during the first- and second-days following surgery. Both groups saw a significant reduction in incision pain by the second day. The PT group had less difficulty with functional activities the first day after surgery like rolling in bed and sitting and standing transitions.3
Even if your hospital does not offer inpatient physical therapy, it is still helpful to attend physical therapy after discharge! Women who underwent a 6-week physical therapy plan of care with in-clinic treatment and home exercises reported significantly higher satisfaction 6 months after treatment. Those who participated in PT had significantly lower back disability and improved confidence to execute exercise up to 1 year after treatment.
Whether you are planning or have an unplanned Cesarean delivery, know that pelvic floor therapy before and after is extremely beneficial to your quality of life, reduction in pain, improved daily movements, and confidence with exercise. Reach out to your local pelvic floor therapist today to either get prepping or assist with recovery!
Written by Jordan Schmidt, PT, DPT
References
- Stone, J., Skibiski, K., Hwang, S., & Barnes, C. (2021). Physical Therapy in Addition to Standard of Care Improves Patient Satisfaction and Recovery Post-cesarean Section. "Journal of Women's Health Physical Therapy", 45(1), 10-19.
- Weerasinghe K, Rishard M, Brabaharan S, Mohamed A. Effectiveness of face-to-face physiotherapy training and education for women who are undergoing elective caesarean section: a randomized controlled trial. Arch Physiother. 2022 Feb 3;12(1):4. doi: 10.1186/s40945-021-00128-9. PMID: 35109917; PMCID: PMC8812015.
- Çıtak Karakaya, İlkim, İnci Yüksel, Türkan Akbayrak, Funda Demirtürk, Mehmet Karakaya, Özgür Özyüncü, and Sinan Beksaç. "Effects of physiotherapy on pain and functional activities after cesarean delivery." Archives of Gynecology and Obstetrics 285.3 (2011): 621-627.
