How to deal with back pain after CS?

Back pain after childbirth is a condition that many new mothers complain about, but back pain after a cesarean section (CC for short) may have slightly different causes than back pain after a vaginal delivery. 

How to deal with back pain after CS, where to look for help? On the forum, future mothers often look for an answer to this question. In the article, we suggest what can affect the occurrence of back pain after CC and present simple exercises that can help.

Back pain after CS it may begin during pregnancy

To understand the cause of back pain after CC, it is worth looking at some changes that occur in the female body during pregnancy: 

• The fetus growing in the uterus affects the statics of the female body: the center of gravity shifts forward, the pelvis changes its position (greater anterior tilt), and lumbar lordosis deepens. The risk of overloading structures, e.g. increases in the spine, pelvis and sacroiliac joints. Studies show that lumbopelvic pain occurs in up to 45-56% of pregnant women[1].
• They also contribute to back pain during pregnancy pregnancy hormones. Increased level relaxation i estrogen causes, among others: a slight widening of the female pelvis, loosening of ligament and joint connections and changes in the tension of the pelvic floor muscles[1].
• Patients who suffer from back pain are more likely to complain about back pain during pregnancy back pain was present even before pregnancy[3]. In addition, back pain during pregnancy is more severe in women who were not physically active before and during pregnancy.

These are just some of the factors that can cause back pain during pregnancy, but often also back pain after CC or back pain after vaginal delivery (PSN).

What could be the additional reasons back pain after cesarean section (CC)?

Childbirth by cesarean section is a surgical procedure that involves incising the patient's skin, subcutaneous tissue, fascia and uterus in order to extract the baby. Back pain after CS may additionally be associated with:

• with the resulting tissue damage in the abdominal cavity, and with the postoperative scar itself: many women on the forum complain of back pain after CC, but few patients associate back pain with an incorrectly healed scar.

Adhesions, which may appear deep in the abdominal cavity, often contribute to the development of lumbar spine pain after CC [6]. That is why it is so important to work with the scar resulting from the so-called "cesarean section", ensuring its proper flexibility and mobility in relation to the subcutaneous tissue and fascia.

• Back pain after CC is one of the possible complications of spinal anesthesia. Among the available options for central conduction anesthesia, spinal anesthesia is the technique most frequently chosen during cesarean section deliveries [4].

Taking into account the etiology of spine pain after CS, the therapeutic treatment in the postpartum period and in the longer period after childbirth will also differ from the rehabilitation used in patients after vaginal delivery.

Back pain after CS: what to do when you can massage the CC scar?

In the case of lumbar spine pain immediately after the so-called "Cesarean section", a woman should report her symptoms to her doctor. The staff will also instruct the patient on how to care for the CC scar. Many women on the forum ask when they can start massaging the CC scar and how to do it correctly?

The skin above and below the scar can be gently touched already in the first days after CC, using circular stroking movements on the skin surface. To prevent the formation of internal adhesions in the abdominal cavity, which may result in back pain after CC, it is also worth performing the so-called "breathes into the scar". Breathing through the so-called diaphragmatic path lower ribs, may help relieve lumbar spine pain after cesarean section.

In the case of back pain after CC, the therapist may also suggest: massage, manual and visceral therapy, trigger point therapy, kinesiotaping, or physical therapy. After giving birth, it is also worth visiting a urogynecological physiotherapist who will help restore proper tension in the pelvic floor muscles. If a woman does not know which therapist to consult, on an online forum for parents you can ask other mothers in your area for contact details of proven specialists.

Simple exercises and habits that can help relieve it pain in the lumbar spine after caesarean section

In the first days after giving birth, it is worth focusing on doing breathing exercises and adopting the correct body posture. When walking, standing or sitting, straighten your back and gently extend the top of your head towards the ceiling (chin retracted).

From 4-6 days after CS, you can also lie on your stomach for about 15-20 minutes, placing a pillow under your hips. This position perfectly affects the contraction of the uterus after childbirth and helps to relieve pain in the lumbar spine after a caesarean section.

Here exemplary exercises, which can help relieve back pain after childbirth (we perform them from the 4th-5th week after CC):

• While lying on your back, bend your legs and feet on the floor. Then we tuck the pelvis, slightly tighten the buttocks and stomach and lift the hips up. You can put a small ball or pillow between your knees and make sure it doesn't fall out when you lift your hips.
• When lying on your back, bend your legs; feet and hips on the floor. We make circular movements of the pelvis, 8 repetitions in each direction.
• Item as above: we pull one knee, then the other, towards the stomach; finally, both knees at the same time. The lumbar section is glued to the ground.
• Lying on your back, put your arms to the sides, bend your knees and place your feet on the ground. We gently move the joined knees once to the right side and once to the left side.

What Else Can Help Relieve Back Pain After a CC? On the forum, many doctors, midwives and physiotherapists draw attention to the need for women to take comfortable position while breastfeeding or rocking the baby in your arms.

It is also important to lift the child: by slightly bending the legs or crouching, keeping the back straight and the abdomen slightly tense.

Źródła:

Majchrzycki M., Mrozikiewicz P., Kocur P., Bartkowiak P., Wieczorek J., Hoffmann M., Stryła W., Seremiak-Mrozikiewicz A., Grześkowiak E., Lower spine pain in pregnant women, Polish Gynecology 2010; 81(11):851–855;
Karowicz-Bilińska A., Sikora A., Estemberg D., Brzozowska M., Berner-Trąbska M., Kuś E., Kowalska-Koprek U., Physiotherapy in obstetrics, Ginekologia Polska 2010; 81(6): 441–445
Miksza A., Smolarek N., Chmaj-Wierzchowska K, Zgrzeba L., Pain in the lumbar-sacral area in pregnant women, Polski Przegląd Nauk o Zdrowiu 1 (50) 2017: 115–123;
Białowolska K., Spinal anesthesia for cesarean section - searching for the ideal dose of local anesthetic, Anestezjologia i Ratownictwo 2021; 15: 257-264;
https://www.forumginekologii.pl/artykul/znieczulenie-zewnatrzoponowe-i-inne-metody-lagodzenia-bolu-porodowego [dostęp 15.06.2023];
https://www.praktycznafizjoterapia.pl/artykul/rehabilitacja-blizny-po-cesarskim-cieciu [dostęp: 15.06.2023];
https://www.opiekaokoloporodowa.pl/artykul/dolegliwosci-bolowe-kregoslupa-po-porodzie [dostęp: 15.06.2023].