27/07/2025
✅️ Physiotherapy After Caesarean Section: Evidence-Based Information
As a Women’s Health Physiotherapist, I often work with women recovering from Caesarean sections to support their physical rehabilitation, reduce pain, and restore function.
While a C-section is a common and often necessary surgical procedure, it is still major abdominal surgery with significant implications for the pelvic floor, abdominal wall, posture, and overall wellbeing.
Physiotherapy plays an essential role in optimising recovery, preventing long-term complications, and improving quality of life.
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🟣 Who Can Provide Post-Caesarean Physiotherapy?
Postnatal physiotherapy should be provided by a specialist Women’s Health Physiotherapist, registered with the Health and Care Professions Council (HCPC) and ideally affiliated with the Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) professional network in the UK. These specialists are trained to assess and treat postnatal musculoskeletal and pelvic health conditions, including those following C-section delivery.
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🟣 What Does Post-Caesarean Physiotherapy Involve?
Individualised physiotherapy following a C-section may include:
Scar mobilisation and desensitisation techniques
Pelvic floor muscle assessment and rehabilitation
Abdominal muscle retraining, including management of diastasis recti
Postural and ergonomic advice
Pain management strategies (including for back or pelvic pain)
Guidance on safe return to activity and exercise
Therapy usually begins from 6–8 weeks postpartum, following medical clearance, though advice and education can be provided earlier.
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🟣 Why Is Scar Mobilisation So Important?
Scar mobilisation is one of the most crucial and often overlooked aspects of post-Caesarean recovery. Performed by a trained Women’s Health Physiotherapist, it involves gentle hands-on techniques to:
Reduce adhesions that may develop between the scar and underlying tissues (such as fascia, bladder, or uterus)
Improve tissue mobility and flexibility
Enhance sensation and reduce scar hypersensitivity or numbness
Prevent long-term pain, restriction, or postural dysfunction
❗️Evidence Base
Adhesions can restrict fascial glide, reduce mobility, and contribute to chronic pelvic pain or dysfunction (Stuparich & Schaffer, J Women’s Health Phys Ther, 2021).
Scar tissue has been associated with lower abdominal pain, altered core function, and restricted trunk movement.
NICE guidance (NG121) supports physiotherapy for women with pelvic or perineal trauma, including those with post-surgical complications.
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❎️Impact of Caesarean Section on the Body
1. Pelvic Floor Muscles
Although a C-section avoids direct trauma to the perineum, pregnancy itself places considerable strain on the pelvic floor. In addition, surgery may alter abdominal-pelvic muscle coordination.
Potential issues include:
Stress urinary incontinence
Pelvic floor weakness
Pelvic organ prolapse symptoms
Pain or discomfort during in*******se
Evidence shows that postpartum pelvic floor dysfunction occurs in both vaginal and Caesarean births. Therefore, pelvic floor muscle training is recommended for all women after childbirth (NICE CG171).
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2. Lower Back Pain and Core Weakness
C-sections can impact spinal and core stability due to:
Disruption of the transverse abdominis and re**us abdominis
Postural changes in pregnancy and the early postnatal period
Altered load through the lumbar spine
Research (Musculoskeletal Science and Practice, 2018) highlights that women post-C-section show delayed core muscle activation and are more prone to lumbopelvic instability, contributing to lower back or pelvic girdle pain.
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3. Sexual In*******se
Dyspareunia (pain during in*******se) may persist for months after birth, even without vaginal trauma. In women who have had a C-section, causes may include:
Scar sensitivity or internal adhesions
Pelvic floor tension or guarding
Hormonal influences, such as oestrogen deficiency during breastfeeding
A UK-based cohort study (BMJ Open, 2017) reported that up to 20% of women experience painful in*******se at 6 months postpartum, underscoring the need for comprehensive pelvic health assessment regardless of delivery mode.
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Conclusion
Physiotherapy following a Caesarean section is not simply optional—it is a vital part of postnatal recovery. Early intervention by a Women’s Health Physiotherapist can address scar health, pelvic floor function, core recovery, and musculoskeletal alignment. By recognising and treating post-C-section issues early, we can help women return to daily activities, intimacy, and exercise with confidence and comfort.
