Effects of Rehabilitation on Cesarean Scar Symptoms and Physical Recovery

Cesarean section is the most common inpatient surgical procedure worldwide, with rates continuing to rise; in Canada, approximately one in three births occur by cesarean. Despite its prevalence, there are no expectations for individuals who have undergone a cesarean section to seek out rehabilitation care. Physical recovery guidance and return to activity from a cesarean birth is poorly understood and inadequately supported, with most research focusing on immediate post-operative pain management within the hospital settings. Little attention has been given to long term physical recovery. Scar-related problems - such as tight or stuck scar tissue, sensitivity or discomfort around the scar, weakness in the abdominal muscles, and infertility or digestive complications - can severely affects the ability to complete daily activities and affect overall quality of life. Rehabilitation is a common and important part of recovery after most major orthopedic and abdominal surgeries. It can help reduce pain and complications, improve mobility, strength, and confidence in movement, and support a gradual return to physical activity. Just as importantly, rehabilitation helps individuals safely resume everyday responsibilities such as caring for their family, returning to work, and managing daily tasks. The purpose of this study is to examine whether one form of hands-on therapy results in greater improvements in scar comfort, mobility, and performance of daily activities compared with an alternative approach, when both are delivered alongside an identical exercise program. Participants will take part in an 8-week rehabilitation program following cesarean birth. Rehabilitation will be provided one-on-one by a qualified healthcare professional and will include a combination of in-person sessions and virtual (online) check-ins. In-person sessions will include education about recovery, hands-on therapy, and guided exercises. Virtual sessions will be used to answer questions, review progress, and ensure that exercises are being performed safely and correctly at home. To evaluate changes in recovery over time, participants will attend three assessment sessions: at baseline (week 0), mid-intervention (week 4), and post-intervention (week 8). During these sessions, researchers will collect information on: * How the scar looks and moves * The sensitivity or discomfort of the scar area * How easily participants can perform everyday movements, such as standing up from a chair * How participants feel about their scar, pain levels, and daily function There will be two forms off assessments. One that measures the objective changes: photographs of the scar, gentle pressure testing to measure sensitivity, simple movement tests, and ultrasound imaging, while the other form of assessment is patient reported questionnaires about how they feel they are improving. Ultrasound is a safe and painless technique that allows researchers to see how tissues under the skin are healing and moving. The anticipated benefit of this research is to improve understanding of physical recovery after cesarean birth. The results may help inform future rehabilitation recommendations and contribute to better support for individuals recovering from cesarean surgery.

Inclusion Criteria: * Have had 1 or more cesarean births. * Have had a cesarean birth, and within the past 6 months. * Minimum 5-weeks postpartum (to start the study), with a fully healed incision. * No history of wound complications during initial healing (e.g., wound opening, fluid collection, or surgical site infection). * Presence of pain or unpleasant sensations associated with the cesarean scar (e.g., hypersensitivity, pulling, tightness, or lower back pain) that were not present prior to surgery. The pain could be intermittent, at rest or with activity. o Numeric Pain Rating Scale (NPRS) will be used here. The potential participant will be instructed to rate their highest level of pain on a scale of 0-10 at some point in the month prior to this eligibility screening. This rating must be a minimum 3/10. If they are less than a 3/10 on the NPRS they will be excluded. * No previous or current scar therapy following the most current cesarean birth. Exclusion Criteria: * History of cancer. * Presence of an active infection. * Regular use of analgesic medication specifically for cesarean scar-related pain. * Currently pregnant, actively undergoing fertility treatment, or planning pregnancy during the study intervention period. * History of radiation therapy to the abdominal area. * Known connective tissue disorders affecting tissue healing (e.g., Ehlers-Danlos syndrome). * Uncontrolled diabetes or other endocrine disorders. * Neurological conditions affecting sensation (e.g., peripheral neuropathy or central nervous system disorders).