Nerve Pain Post Cesarean Delivery
We have a current patient with abdominal pain immediately following her cesarean delivery - one WEEK post delivery to be exact! We typically do not see women this soon postpartum unless they are having symptoms, and this woman definitely was.
She presented three days after her Cesarean delivery. This was her third C section, and recovery from her previous two had been no problem at all. Since her delivery she was having sharp, stabbing, 10/10 pain in the left lower portion of her abdomen. She went to see her O.B. who cleared her scar and ensured there was no infection, and sent her to us. (The perfect course of action, might I add. The answer here is NOT to "wait and see if the pain goes away.")
The patient admitted she was nervous to go to PT because she could barely walk. She couldn't pick up her new baby girl, could barely go to the bathroom without pain. She was nervous we were going to put her through the ringer in the gym! But luckily she came, and after one visit has cut her pain in half.
The first visit consisted of gentle massage and manual therapy to her abdominal muscles. Because she was only three days post delivery at the time of this visit, she had steri strips on her scar. We typically recommend gentle touch around the scar up to 6 weeks PP. Then once the scar is fully healed and cleared, we can begin touch and gentle massage on the scar. Our PT also encouraged the use of a TENS unit ( Linked here ).
The nerves that supply the abdomen and groin start in the mid/lower spine, wrap around to the front of the body and continue down towards the vulva/groin. This group of nerves are typically the ones to be irritated post cesarean. We can use a TENS unit for pain relief along the pathway of these nerves. In this particular patient, we used TENS electrodes placed as pictured below in white squares: to the midback at the level of your bottom rib, and directly on the area of pain on the abdomen.
The patient was encouraged to use the TENS unit daily, along with ice to her abdomen. You should not use a TENS unit if you have any of the following:
Cardiac pacemaker or difibrillator
Spinal stimulator for pain or otherwise
Numbness or decreased sensation to area where you will place the TENS
Diabetic neuropathy
The patient did this consistently over the weekend and returned the following Monday with signifciantly less pain. Amazing! Her next session we continued massage along her painful areas, and began doing very gentle deep core activation and deep breathing. This will help her low back feel more supported during the day, and will keep that irritated nerve happy with gentle movement and good blood supply. As her pain continues to decrease, we will do less manual therapies and progress her towards core exercise.
The thing we cannot stress enough about this patient is - get here sooner rather than later! Sharp, intense pain is not normal following a Cesarean. If you have any of these symptoms, be sure to call your OB and your physical therapist as soon as it starts. If this patient, or her OB, had let the pain drag on without intervention, it would be a much longer fix.