Issue link: https://www.massageandbodyworkdigital.com/i/68185
MASSAGE FOR CESAREAN SECTION CLIENTS ADHESION FORMATION AND OTHER POST-SURGERY ISSUES C-sections can save the lives of mothers and babies. During surgery, however, the body registers pain, loss, and outrage at being violated. It tries to protect itself from further injury by setting up involuntary muscle contractions and tension in the injured area. In my massage therapy practice, I have noticed that an area of ticklishness, for instance, in an otherwise non-ticklish person, almost always indicates an unconscious chronic muscle tension. Keeping this internal sentry standing guard can be the cause of a secondary pain, which may even outlast the original cause. Chronic pain may also indicate the formation of adhesions after surgery. Adhesions are bands of scar tissue that can distort anatomy and glue together organs and tissues that are normally separate. An important clue that adhesions have formed may be the appearance of an external scar. Tissues glued together cause an uneven look, as the top layer of skin is pulled down toward deeper tissue layers. Adhesion formation is extremely common for post-surgical patients. The Women's Surgery Group and other researchers estimate that adhesions can form in 55–100 percent of patients who have had gynecological surgery involving the uterus, fallopian tubes, or ovaries (including C-section).1 For the C-section client, other issues may arise in addition to chronic abdominal pain, including pain during intercourse (dyspareunia), bowel obstruction, and infertility (caused by the fallopian tubes being kinked, distorted, or blocked by adhesions). Subsequent surgeries, including repeat C-sections, are more complicated due to adhesions and can take longer and be more difficult to perform. When working with post- Cesarean clients, massage therapists and bodyworkers should remember to work only within their expertise. RELEASE ADHESIONS WITH MASSAGE While surgery for "lysis of adhesions" (adhesion removal) is commonly performed, resulting in 303,000 U.S. hospitalizations in one year alone at a cost of $1.3 billion,2 adhesions can re-form as much as 80 percent of the time, and additional adhesions can form as a direct result of the surgery meant to release them. Certain massage techniques, however, such as Bindegewebsmassage, neuromuscular therapy, Rolfing, specific postpartum massage therapies, and deep tissue sculpting, can limit the formation of adhesions and scar tissue in new injuries and can reduce scar tissue, or make it more pliable, at old injury sites. As soon after surgery as the client's surgeon approves it, delicate massage and thermal therapy using the body heat from your hands can increase circulation and therefore reduce ischemia to the injured tissues. This type of massage can also discourage the formation of thick hypertrophic scars and adhesions, drain injured tissues of the build-up of excess fluid caused by the surgery, and help reestablish lymphatic flow. With her doctor's permission, the client can begin the process even earlier by using her own (clean) hands to gently touch her incision and provide thermal stimulation. The client can apply circular massage strokes to the abdomen in a clockwise direction to help reestablish the flow of the intestines and stimulate organ function. After about two weeks, gentle vibration of the skin over the incision, progressing to deeper pressure as healing occurs, can stimulate nerves and help relieve any numbness. Tissue stretching can begin after about six weeks to encourage movement and to loosen existing adhesions. Abdominal trigger points, or irritable spots which make the muscles prone to spasm, should be located by a bodyworker and extinguished with appropriate techniques. THE MASSAGE PROTOCOL When working with post-Cesarean clients, massage therapists and bodyworkers should remember to work only within their expertise. Concern for the safety of your client should be foremost in your mind. When arranging an appointment with a new client, determine at the very first phone call if she is postpartum, and find out how many weeks. A note of caution—if her baby has died, she may not think of herself as postpartum, even if she is post-Cesarean, so be sure to ask about recent pregnancies and/or births. 64 massage & bodywork september/october 2010