Cesarean Scar Massage
By Elaine Stillerman
Cesarean Scar Massage
By Elaine Stillerman
Scar massage, regardless of the scar's location or how long it has been there, is a technique to reduce scar tissue and improve skin elasticity. It is a progressive treatment and if too much force is applied too quickly, the colloid gel within the connective tissue responds with increased resistance. On the other hand, if not enough pressure is used the treatment will have little effect on the scar tissue.
Scars are formed from connective tissue, particularly collagenous fibers, that provide support but limited elasticity. When the repair reaction is excessive, a keloid scar results. These unsightly scars are dimensional, raised, often irregularly shaped, and contain more water and soluble collagen than normal scars. All massage directly on keloid formations must be avoided, but work can be done all around it.
The goals of any scar massage are to render the scar stable, manage the development of scar tissue, keep the connective tissue as pliable and flexible as possible by reducing adhesions between soft tissue layers, reduce discoloration and itching, reduce the scar to normal skin levels, eliminate fibrosis and myofascial stress patterns, and encourage an emotional connection with the site of the trauma.
During the first few weeks of recovery after a Cesarean (or any surgery), a gentle vibration over the bandage is adequate enough to reduce some of the lymph congestion within the surrounding tissue and ease some of the discomfort the new mother is feeling. (If the new mom notices any change to the scar, however, such as bleeding or oozing, she should contact her care provider and avoid touching the area.)
Any incision causes trauma and edema to the surrounding tissue with accompanying emotional issues. A cesarean incision (or hysterectomy) can harbor a wide range of emotions because of its location on the vulnerable front of the body, its reproductive relationship, and its link to a woman's image of herself as a woman and a mother. With that in mind, practitioners must proceed respectfully and at the client's pace when massaging the scar.
I had a student in one of my classes who fainted and had a seizure after massaging a small scar on her hand. The scar was a result of a ganglion cyst surgery she had when she was a young child and this was the first time she ever worked the area. She later recalled thinking that the doctor was going to remove her hand, and the memory of that childhood fear caused her to faint.
Since the goal is to restore elasticity, use very little lubrication to allow the tissue to stretch. If you glide over the skin's surface, wipe off the excess lubrication. When the incision has healed and the client signals that she is ready for the work, scar massage can begin. Instruct her on the steps she can take to massage the scar herself.
- In early postpartum recovery, gently vibrate over the bandage to stimulate lymphatic absorption.
- Lymphatic drainage starts at the neck, so gently stretch the skin in a "J" hook direction from the mastoid processes along the sides of her neck towards the clavicle using 5-7 grams of pressure. Remember to direct the pressure towards her clavicle and stretch at the end of each stroke.
- Lymphatic drainage at the site of the scar directs the flow of lymph towards the closest lymph nodes (the internal iliac and deep inguinal nodes). Use 5-7 grams of pressure.
- Myofascial stretching comes next. Get as close to the scar as possible and stretch the tissue in a horizontal direction above and below the scar. Next, stretch the tissue horizontally with the scar between your fingers.
- Stretch vertically above and below the scar. For the non-keloid scar, stretch directly across the incision. If there are any keloid formations, do not massage directly on top of them.
- Grab the scar between your fingers and lift, stretch, and vibrate.
- Gently end the scar massage with a light effleurage toward the scar.
If your client feels uncomfortable at any time, stop what you are doing until she is ready to continue. A wonderful healing lubrication after the treatment is done is made of equal parts of tinctures of calendula, St. John's wort, comfrey, and arnica mixed in Shea butter.
- Fritz S, Grosenbach JM: Mosby's essential sciences for therapeutic massage, ed 2, St. Louis, 2004, Mosby.
- Stillerman E: Prenatal massage: a textbook of pregnancy, labor, and postpartum bodywork, St. Louis, 2008, Mosby.
- Wittlinger H, Wittlinger G: Textbook of Dr. Vodder's manual lymph drainage, ed 6, Heidelberg, 1998, Karl F. Haug Verlag