Scar Management For Mothers Who Delivered By Cesarean

Following surgery, the incision heals by a process called scar formation.  Scar tissue does not stretch easily and may cause adhesions deep in the tissue.  Adhesions can restrict movement and cause pain.  By massaging the tissue, adhesions and discomfort may be avoided. 
 Desensitization:  (2 weeks after surgery and no scab or seepage from scar) Use a rough wet towel to rub across the scar in all directions.  Repeat with dry towel if tolerated.  This helps decrease sensitivity of the scar and helps you feel more at ease touching it. 
The following is a list of scar massage techniques with the approximate time to start them. 
Push and Pull:  (after incision is completely healed four weeks) Place two fingers directly on the scar and move it slowly straight up toward ribs.  When the skin stops “moving”, continue to hold firm pressure on the scar for one to two minutes.  This should be a strong pulling sensation, but should not cause sharp pain.  Then push down towards the pubic bone and hold again.  Repeat to the left and to the right in similar manner 
Skin rolling: (Four weeks after surgery)  Pinch the skin on either side of the scar line.  Start at either end and move forward rolling and raising the skin as you move.  A free scar bulges upwards (try and pinch skin on your arm/ hand and notice the upward bulge).  A “stuck” scar dimples inward.  
Plucking: (6-8 weeks after surgery).  Put your index finger on one side and thumb on the other side of the scar. Try to pick up the scar, separating the underlying tissues.  If you can get under the scar, move your fingers slightly from side to side for one to two minutes.  Start at either end and work toward the center.  If the skin slips out of your fingers, you may not be ready for this stage, but keep trying. 
Points of emphasis about scar massage 
The more often you effectively massage the scar, the more complete your recovery will be.  You can make a difference by helping your scar move more freely.  All massage of your scar should be a gentle smooth movement. 
Try making the massage a part of your daily routine (while watching television, listening to music, reading). 
The benefit is greatest when the skin is worked firmly and just below pain threshold. 
You should never feel sharp stabbing pain. 
The sensation is one of strong pulling or light burning. 
Duration – 5-15 minutes/day. 
You may find massage more comfortable immediately after a shower.  You may use warm compresses before and after treatment. 
The pads of your fingers should “stick” to the skin NOT slide across the skin. 
When you massage your scar you may notice one or two directions that feel especially “stuck”.  “Stuck” areas of the scar do not remove as freely as other areas.  You may feel some resistance when massaging these areas.  Spend a little more time holding in those directions if possible to free “stuck” tissue.  This should be a gentle “hold” motion, not a forceful movement.

*This section on scar massage has been reproduced with permission from Elizabeth Shelly, PT, Cambridge Physical Therapy, Cambrideg, Massachusetts. 

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