Medical systems can often create a vicious cycle and the Cesarean section is one such cycle. The creation of specialist departments often creates a vacuum where, what some might think as minor issues go ignored, yet affect those who have to undertake specialist procedures. In any other system say finance or banking it would be called negligence or incompetence for failing to notice where the system broke down (something not often noticed until after the debacle has occurred) but because it often involves individuals who suffer from one of the most common medical issues in the world the cause and effect often go unnoticed. It's a simple statement Cesarean sections could be one of the leading causes of back pain in females. A statement that can be validated fairly easily when you observe this phenomenon on a regular basis . I have never met a female client who had a C-section who didn't suffer from either lumbar, cervical or sacroiliac joint dysfunction. Governments who want to save hundreds of millions of unnecessary cash spent on treating back pain may want to scrutinise this point. It often serves the medical insurance system to keep this cycle system in full flow.
Females who have suffered from back pain, most likely due to failure to rehabilitate the key stabilising mechanisms of the the lumbo-pelvic complex may have avoided back pain all together. Implementing a basic program would not only help to avoid back pain but may aid women back into exercise much sooner assisting any psychological issues such as post-natal depression.
A general rule for low level exercise post C-section to begin is 6-8 weeks. The healing process starts immediately post op and the nutritional status and individuals immune system plays a significant role in healing time, decrease of infections and energetic processes.
During the surgery process. The skin, abdominal fascia, Rectus Abdominus and Transversus Abdominus (TrA) are easily severed with many nerves also being affected by the surgeons scalpel. This is where the chaos begins. Whilst the global implications of movement dysfunction are readily observed with restrictions to simple tasks such as standing, sitting and even turning over in bed. The local intrinsic nature of lumbo-pelvic stabilisation dysfunction is not observed until the women attends a specialist to deal with a particular pain syndrome. More often than not light cardiovascular exercise is recommended which serves to deepen the dysfunction not only due to the lack of appropriate muscle activation but also due to its effects on respiration.
The TrA whilst important with its synergistic role with the multifidi, diaphragm, pelvic floor muscles also has an essential function with respiration. During inspiration the primary muscle of inspiration the diaphragm contracts displacing the abdominal viscera outwards and downwards placing both the muscles of the pelvic floor and TrA in a stretched position. The natural recoil of the TrA assists in exhalation,helping to force air from the lungs. Post C-section this action can diminish placing additional stress on the excessory muscles of respiration. Additionally the flexors of the trunk, primarily the Rectus abdominis often become inhibited and other muscles can facilitate in response to altered movement dysfunction. In one case a patient with multiple C-sections presented with chronic recurrent cervical and lumbar disc issues. In particular the MRI showed a flattened cervical spine and it is worth-speculating that the anterior cervical flexors facilitated in response to a lack of trunk flexion. The patient was literally trying to flex her whole spine with her neck flexors. Use of Neuro Kinetic Therapy (TM) helped to re-establish synergistic neck and trunk flexion by restoring equilibrium.
In this and 100% of all clients who have had a C-section the TrA can either be facilitated or inhibited. strategies to stabilise compromised structures and dysfunctional movement can be local or global. How Muscular dysfunction occurs
Strategies can include:
Breath holding via facilitation and compromised diaphragmatic action Facilitation of the pelvic floor Clenching of the masticatory muscles of the TMJ/Jaw Local compensation such as Quadratus Lumborum facilitation Cervical muscle facilitation and inhibition Altered lower limb mechanics including plantar fascia and disruption of dorsi flexion and toe mechanics.
Scar tissue formation can be problematic due to adhesions of healing tissue in particular to fascial continuation, function and adhesion of tissue to internal organs. Addressing these adhesions and restoring optimal function of the TrA and its dual facilitory or inhibitory effect on both local and global structures can be achieved with therapies such as NKT and appropriate corrective exercises. Even without a Cesarean section, you can apply the same rationale to tears or episiotomy procedures and the same fuzziness that the nervous system experiences when trying to provide stability to the body.
References: Chek, P. Posture and Craniofacial Pain. A Chiropractic Approach to Head Pain. Williams and Wilkins 1994
Weinstock, D. Neuro Kinetic Therapy. North Atlantic Books. Berkeley, California.