c-section 101 for fitness professionals - burrell education...(c) burrell education 2013 3 an...

C-Section 101 For Fitness Professionals

Part 1:

The Procedure & Key Facts, Early Days Recovery, Scar Tissue and It’s Effects,

The Myofascial System and Great Resources/Information

© Burrell Education 2013

Introduction

• As Fitness Professionals, even if we’ve undertaken the highest level Pre/Post Natal education our profession offers, the C-Section client is still a bit of a

mystery to us. What happened to her, how does she recovers and what kind of exercise is right for her on her journey back to full strength/function.

• So I decided to put together this release to help answer some of the questions that you might have, even if you yourself had a C-Section and also

tie it all together with some of the more modern, future-facing considerations when creating effective programming for moms returning to

exercise with us. Hope this really helps and gives you a little more clarity and food for thought. 2 (C) Burrell Education 2013 www.burrelleducation.com

Reasons For Having a C-Section

• Currently in the United Kingdom, about 25 % of babies are delivered by caesarean – which means, all things being equal, you have a one in four chance of having to go the C-section route. Some women walk into their pregnancy already pegged for the procedure. For example, in expectant mothers with chronic conditions like heart disease, diabetes, high blood pressure and kidney disease, vaginal delivery can be dangerously stressful to the body, making a caesarean a safer option. Scheduled C-sections are also a necessity in HIV-positive women and those with an active genital herpes infection, because HIV and the herpes virus can be transmitted to the baby during delivery.

3 (C) Burrell Education 2013 www.burrelleducation.com

• An illness or a congenital condition in the baby that might make the already tricky journey through the birth canal even more treacherous.

• When the baby is too large to move safely (if at all) through the birth canal. When the baby is in a breech position and can’t be turned.

• You are having triplets or more.

• Placenta problems – if the placenta is partly or completely blocking the cervical opening (placenta praevia) or has separated from the uterine wall (abruptio placenta).

• If you develop pre-eclampsia (pregnancy-induced high blood pressure) or eclampsia (a very rare progression of pre-eclampsia that affects the central nervous system, causing seizures) and treatment isn’t working, your obstetrician might opt for a caesarean to protect both mother and baby.

• If you’ve had a previous C-section (although vaginal birth after delivery, or VBAC, is frequently successful and now more available).

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Reasons For Having a Scheduled C-Section

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• Far more frequently, the need for a caesarean isn’t obvious until a woman is well into labour. If your labour just can’t seem to get moving in the first place (your cervix isn’t dilating although you’re having contractions) after 24 or 25 hours in a first-time mother, or less if it is not your first delivery, your doctor might decide on surgery.

• Another possibility: you might sail right through the early stage of labour (dilation to 3 centimetres), only to have progress grind to a halt. While it’s possible that oxytocin or another labour stimulator could jump-start the contractions, if the problem is that the baby’s head is too big to fit through the pelvis (which is the case about half the time) a caesarean will be necessary – as it will be if you are becoming too exhausted, if the foetal monitor is picking up signs of foetal distress, if the umbilical cord slips into the birth canal in advance of the baby (it will be compressed as the baby comes through, cutting off his or her oxygen supply) or if your uterus ruptures.

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Reasons For Having a Unscheduled C-Section

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Types of C-Section Incision

The Transverse Incision is the most common and is also known as the Pfannensteil

Incision.


The C-Section Procedure (Transverse)

• A side-to-side incision in the abdomen known as the Pfannenstiel and less formally – the bikini cut is made. This is a four to six inch lateral abdominal incision.

• Once the skin is cut and subcutaneous fat moved out of the way, layer of connective tissue that covers the abdominal muscles is revealed (Aponeurosis -type of tendon). This tissue is cut laterally and then lifted off the muscle.

• The surgeon then uses their hands to separate the Rectus Abdominis – via the Linea Alba to reveal the Peritoneum which the physician pokes through with a scalpel or finger or scissors to reach the uterus.


The C-Section Procedure (Transverse) cont…

• The uterus is ready to be opened. In most C-Section births, a side-to-side cut called the Kerr Incision is made on the lower uterus using a scalpel. Fingers or a scissors are then used to stretch or further cut open the incision, making it just wide enough for the baby’s head to fit through.

• After the uterus is cut, if the woman’s water hasn’t already broken, it’s ruptured with a knife, clamp or scissor and it is now time for the baby to be born!

• The physician slips a hand inside the uterus and cups the baby around the top of his head. In the case of breech (feet first) or transverse lie (horizontal) the feet or tummy are grasped and the baby delivered.


A Few Key Facts!

• Abdominal muscles are NOT cut during the C-Section procedure!

• Cuts are to the skin, blood vessels, nerves, and a variety of types of connective tissue including layers of abdominal aponeuroses, peritoneum and fascia.

• The trauma affects the entire depth of the abdominal wall and requires much more than 6 weeks for mom to feel well and pain free again never mind have full function and strength.

• The midline tissues of the abdominal wall are not sutured (stitched) after they have been cut to allow access for birthing.

• Only the uterus (womb) and the outer layer skin/tissues are sutured(stitched) NOT THE MIDLINE. This is left to heal and re-integrate naturally.

• Having a C-Section birth does not mean that you are exempt from Pelvic Floor restore work post birth because a) you still carried the weight of the baby b) if you experienced an emergency C-Section, you probably still went through the ‘pushing’ phase of the birth process which traumatizes the Pelvic Floor.


Adhesions and Scar Tissue - How They Can Affect Recovery & Return to Full Function


Why Adhesions & Scar Tissue Form

• Adhesions usually form after surgery, infection, inflammation, trauma, or radiation therapy treatment. Adhesions are composed of strong, microscopic strands of collagen. Like a nylon rope made of a thousand tiny strands, these tiny collagen fibres (called crosslinks) bind together to create curtains, ropes, or blankets of tissue in areas of the body that have been injured by infection, inflammation, surgery, or trauma.

• We need this process to occur to heal after tissue trauma but unfortunately we don’t seem to have control over the extent to which this process continues over time, way after heading occurs to a point where it start to affect function and health.

• After the C-section surgery, these adhesions remain and can continue to develop in the pelvis for life, as a permanent by-product of the surgery.


Adhesions and Returning To Full Integrated Function

• Studies have shown a high correlation between birthing via C-Section and women experiencing bowel problems and ongoing sensitivity and/or pain at the site of their scar as restriction in form and function during hip and thoracic extension.

• When working with C-Section clients returning to exercise, check how she feels after your session in terms of an increase in scar tenderness/pain post workout.

• A painful scar after exertion is usually a sign that the session needs to be regressed a little. Regress and check whether the soreness continues.


Returning to Exercise Post C-Section - A Few ‘Off the beaten-track’ Considerations

• A few consideration……


The Myofascial Lines – Brief Overview

• Think of the Myofascial System as a skin-tight mesh spider suit from head to toe.

• The Myofascial System is the most pervasive muscle/connective tissue system in our bodies extending throughout our body in a non-specific direction.

• Fascia is composed of collagen and elastin fibres that provide elasticity and support for the entire musculoskeletal system. This multi-level matrix connects every cell to every other cell within our entire body, bones, muscles, organs, skin etc creating a UNIFIED, INTEGRATED WHOLE.

• Perhaps the most important quality of the fascia tissue is that it records all physical, mental, emotional, and cognitive activity.


The 7 Myofascial Lines

• Superficial Front Line • Superficial Back Line • The Lateral Lines (2)

• Arm Lines (4) • The Spiral Lines

• Functional Lines (2 – front and back) • Deep Front Line


The Myofascial Lines That Are Affected By C-Section

The Superficial Front Line (SFL)

The SFL runs on both the right and left sides of the body from the top of feet to the skull. Fast twitch muscle fibres predominate.

Provides balance to the SBL. A common human response to shock and trauma is the STARTLE RESPONSE –

a closing down and contraction of this front line. A chronic contraction of this line creates many postural/pain patterns.

Consider the trauma/dysfunction caused to this line by pregnancy and birthing especially via C-Section and also look at how extensive and far reaching the SFL is…toes to Occipitus. Issues in one area along this line can easily manifest either

near or far elsewhere along the line. 16 (C) Burrell Education 2013 www.burrelleducation.com


The Deep Front Line (DFL)

The DFL extends from the inner arch of the foot up the inseam of the leg into the pelvis and up the front of spine to

the bottom of the skull and jaw. Hugely important to posture, movement and optimal

function of the Pelvic Floor. Dysfunctions in this deep line has huge consequences for

global function and restoration of proper DFL functioning is by far the best preventative measure for structural and

movement therapies.



The Front Functional Line

Two girdles across the front and back of the body running

from one humerus to the opposite femur and vice-versa. Like the spiral and Functional lines, both are helical and help create

strong rotational movement.

In this line, think of the implications of a weakened anterior Pelvic Floor leading to increased tension in the adductors and

the dysfunction caused further up the chain in the pectorals by typical Post Natal posture….a hang-over from Pregnancy and

then feeding/general early-days mom posture.


Reconditioning the Core Post C-Section

• Integrated work is KEY! First LOCAL INTEGRATION – using the breath to connect the Diaphragm, Pelvic Floor, Abdominal Wall and Lumbar Muscles & Connective Tissue.


Reconditioning the Core Post C-Section

• Then, we take those principals into GLOBALLY INTEGRATED MOVEMENT - Work that focusses of stimulating stretching/strengthening the entire Myofascial line instead of small/spot movements such as crunches and we ALWAYS tie the breath to these movements too – think…squat into shoulder press taking the arms slightly behind the head (into extension) to really get the whole of the abdominal wall speaking to the arm lines, speaking to Pelvic Floor etc., as it was designed to do.


Interesting & Informative Resources

• http://www.clearpassage.com/what-we-treat/ A brilliant and indepth look at the ramifications of scar-tissue build up many years after all kinds of surgeries including childbirth. Great for all clients who undergo surgery anywhere on their body, not just Post Natal.

• http://theshapeofamother.com A great resource full of pictures and real life tales of pregnancy and birthing – some good, bad and in the middle.

• http://www.pregnancy.org/article/massage-your-C-Section-scar An easy to read resource for you and your clients about the value of C-Section scar massage.

• http://www.examiner.com/article/what-you-need-to-know-about- scar-tissue-management-after-a-C-Section

Another easy to digest source of info on C-Section scar massage.

• http://www.cesareanscar.com/ A fascinating resource full of pictures and stories about C-Section experiences.

• http://www.csectionrecovery.com/what_I_did_not_know.html A great and indepth resource for C-Section ‘everything’!

• http://www.worry-free-c-section.com/ Lots of great information and resources – nice holistic approach.

• http://www.cesareanrates.com/ A brilliant resource headed by a passionate campaigner who is against unnecessary C-Sections in the US, some states have rates over 50%!


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A Return To Integrated Core Strength – Some Key Starter Movements

• Next Part of March Release, filmed exercises showing…………….

• Key ‘Release’ Movements • Key ‘Integrated Functional’ Movements Post C-Section &

• Optimal Nutrition For Healing 22 (C) Burrell Education 2013 www.burrelleducation.com

c-section 101 for fitness professionals - burrell education...(c) burrell education 2013 3 an...

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