Chronic caesarian section scar pain treated with fascial scar release techniques: A case series.
OBJECTIVE
To describe outcomes of two subjects with chronically painful Caesarian section (C-section) scars following an intervention of specific myofascial scar release techniques.


METHODS
Case series.


BACKGROUND
Over 1.3 million C-sections are performed annually in the US. Anywhere from 7 to 18% of those will develop chronic scar pain. Although anecdotal evidence supporting the use of fascial release in reducing surgical scar pain exists, almost no research has been published.


METHODS
Two subjects who both underwent two C-sections resulting in chronic discomfort of 6-9 years duration participated in this study. Both reported premenstrual pain, pain upon pressure to the lower abdomen, and pain during bowel movements. Subject 1 also reported sharp pain with bed mobility. Four, 30-min treatment sessions over a period of two weeks consisted of stretching the scar until a release in tissue tension was felt by the treating therapist. Outcome measures included pain and pressure tolerance using a Pressure Algometer, measurements of scar flexibility using an Adheremeter, and the Numeric Pain Rating Scale (NPRS). These measures were collected at baseline, five days after the final treatment and at four weeks.


RESULTS
Both subjects demonstrated improvements in all outcome measures. At four weeks, pressure tolerance at all point improved as much as 79% (p < 0.0001) and scar mobility increased in all directions at all points as much as 200% (p < 0.0001). Following treatment, both subjects rated their premenstrual pain for all previously painful activities at 0/10 for the first time since their surgeries.


CONCLUSIONS
These results suggest that scar release techniques may help reduce chronic scar pain in women who have had C-section surgery.
Rocky Mountain University of Health Professions, Franklin Pierce University, 670 N. Commercial St, Suite 301, Manchester, NH 03101, USA. Electronic address: wassermanj@franklinpierce.edu.
Jennifer B
JB
Wasserman
Physical Therapist, Westside Physical Therapy, Beaverton, OR, USA.
Jessica L
JL
Steele-Thornborrow
Sports Physical Therapy Resident, Outpatient Physical Therapy, Auburn, WA, USA.
Jeremy S
JS
Yuen
Physical Therapist Advanced Medical, Marshfield, MA, USA.
Melissa
M
Halkiotis
Physical Therapist, Savannah, GE, USA.
Elizabeth M
EM
Riggins
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D059350:Chronic Pain / Q000628:therapy*; D002921:Cicatrix / Q000209:etiology* / Q000628:therapy*; D005205:Fascia / Q000503:physiopathology*; D005260:Female; D006801:Humans; D064746:Therapy, Soft Tissue / Q000379:methods*
Abdominal scar; Adhesions; C-section; Manual therapy; Myofascial scar release