Tip of the Week: Desensitizing Your Scar Is Just As Important As Mobilizing It
I love working with patients who have had abdominal surgeries. And, while I wish that seeing a pelvic health PT would be recommended after ANY abdominal surgery (seriously-- laparascopy? hysterectomy? gall bladder removal? I'd love to see them all!), this doesn't always happen! In the recent years, however, we have had many more patients seeking care after surgeries, especially after C-sections-- which makes us so THRILLED!
A few years ago, I evaluated a patient who was experiencing pelvic and abdominal pain after a Cesarean birth. Her baby was around 8 months old, and the pain was just persisting, making it difficult for her to wear jeans and exercise the way she wanted to. When I examined her, I noticed that even light tough around her scar and across her abdomen was sensitive and painful. Her scar was of course sensitive, tender, and not moving well also.
So, where do we start?
It's really easy to jump right in to mobilizing the scar-- and patients often want us to go there! However, in cases like these, when sensitivity is so significant-- we really will get the best results by desensitizing the tissues first-- and then mobilizing around the scar! There are so many small cutaneous nerves that are cut within surgeries like this, and this can lead to substantial sensitivity for many people while their nerves are regenerating. In my patient's case (and many like her!), this desensitization was key!
How do we desensitize scar tissue and attached structures (ie, the abdomen!)?
Create a sensory progression
I often start with something like a piece of silk or bamboo cotton- gently rubbed across and around the scar as well as around the sensitive tissue (which could include the whole abdomen!). You can also start with a make-up brush, or a cotton ball.Build a progression to gradually increase pressure/sensory input
This can mean moving from a soft fabric to a more stiff one-- ie. silk --> cotton --> linen --> burlap. Then, you can progress to using hands gently over tissue, increasing in pressure and speed of movement. ** The key here is gradual progression-- spending just 2-3 minutes each time, using an input that is mildly uncomfortable-- not painful!Input can be increased by adding something like cupping
Using a silicone cup to increase pressure gradually, gliding in all directions across the abdomen (with nice oil/lotion).
Progressing through desensitization like this often leads to better and faster progressions with manual therapy and fascial mobilization around the scar. This is exactly what happened in my patient's case! We created a progressive program for sensory desensitization, and she responded very quickly. Within a few weeks, she no longer had discomfort wearing pants, and was feeling much better in her day-to-day activities-- and then we could progress from there!
If you have a scar or an area around the scar that is bugging you-- let us know! Feel free to connect with your PT if you're a current patient with us, or respond to me, and I'm happy to guide you in your plan to get started!
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Weekly Tips Pelvic Health Tips By Dr. Jessica Reale PT, DPT, WCS