Strengthening Your Core After a C-Section

Core StrengtheningC-Section DeliveryPhysical TherapyWomen's Health

Apr 28

The rate of c-section deliveries is steadily increasing, comprising over 30% of births in the United States in the last year. A c-section is a major surgery involving a horizontal incision just above the pubic bone that can negatively impact core muscle function and strength. Following a c-section, it’s critical to gradually retrain and strengthen the core under the guidance of a physical therapist. In the video below, Mangiarelli Rehabilitation physical therapy assistant Patti explain how to safely strengthen your core after a c-section delivery.

How a C-Section Affects a Woman’s Core

During pregnancy, the core muscles undergo significant changes as the abdominal and pelvic floor muscles lengthen to accommodate the growing baby. Abdominal muscles may also separate to a certain degree to accommodate the baby and are affected by pregnancy hormones that increase muscle and ligament laxity. This can contribute to a breakdown in the functioning of the core muscles, which is exacerbated by the trauma of a c-section on the abdominal muscles.

Since the 1990s, the rates of cesarean section (c-section) deliveries of babies have been steadily increasing, comprising over 30% of birth in the United States in 2021. A c-section is major surgery. During a c-section, the surgeon makes a horizontal incision just above the pubic bone through five layers of skin, tissue, and muscle to reach the uterus, amniotic sac, and the baby. The five layers include the outer layer of skin (the derma), fat, fascia, the rectus abdominal muscle, and the peritoneum (layer of tissue that supports the organs of the abdomen).

While the skin, fascia, and rectus abdominis are cut horizontally, the other abdominal muscles are separated from one another and moved to the side. Since doing the horizontal cut, it saves several of the other abdominal muscles that make up the core; those muscles are not cut allowing women to regain strength in the core post-c-section. A vertical cut along the midline (rectus abdominis muscle) is rarely used except in severe emergency c-sections and can be slower to heal with more scarring. Since

Once the child has been delivered, the surgeon sews the cut layers back together, which can create scarring through multiple levels of tissue of the abdominal wall. The scarring can also affect the abdominal muscles’ ability to glide over the top of each other during muscle contraction, contributing to weakness and a lack of core stability. The c-section procedure of moving the abdominal muscles aside during delivery can interrupt the function of the muscles and their ability to respond to movement.

C-Section Recovery with Physical Therapy

Following a c-section, it is essential that you allow your body to rest and heal for the first six to eight weeks, engaging in gentle walking as your form of exercise. At your six-week postpartum checkup, the doctor may give you clearance to begin activity and exercise again. However, this does not mean that the tissues are done healing or that you can jump straight into high-intensity running, weightlifting, or intense core workouts. In fact, at six weeks post-surgery, the abdominal fascia has only regained about 50% of its strength. It generally takes 6 months to regain up to 73-93% of abdominal strength. Instead, focus on gradually rebuilding your core and pelvic floor muscles.

After a c-section, you may experience gas in the abdominal cavity and constipation. To address gas, gently massage your abdomen and begin walking short distances. If dealing with constipation, engage in movement and start eating fiber-rich foods to encourage bowel motility; do not strain. If you need to sneeze or cough while healing after a c-section, use a pillow or place your hands over the c-section scar to brace yourself as you cough or sneeze. Be sure to avoid lifting heavy objects. When getting up from bed, roll onto your side and push up using your arms, not your core.

A physical therapist can help you address c-section incision site pain, return to exercise safely, and gradually retrain and strengthen the core and pelvic floor muscles. The physical therapist uses soft tissue mobilization techniques to soften and flatten the scar tissue around the incision site to minimize pain and promote elasticity and mobility in the fascia. A physical therapist can also provide pelvic floor rehabilitation to strengthen the pelvic floor muscles and reduce pain or pelvic floor-related incontinence and develop a progressive core strengthening program based on your specific condition and ability.

A 2021 study found that women who received physical therapy after a C-section had significantly improved outcomes compared to those that did not. Seventy-two women who had c-sections between 37-42 weeks’ gestation were studied. The control group received the standard of care at the hospital which involves a physical therapy consult, written information about scar management, and a general program of suggested abdomen exercises. The other 33 patients received six weeks of physical therapy that included scar therapy and mobilizations of the low back, hip joint, and soft tissue as well as stretching, core stabilization exercises, and a home exercise program.

Researchers found that those who received targeted physical therapy achieved substantially lower pain levels more quickly than those who received the standard of care and that the physical therapy group had higher patient satisfaction scores at 14 weeks and 6 months. There was also significantly improved self-reported ability to perform exercise in the physical therapy group at 14 weeks through 18 months compared to their baseline.