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Soft Tissue Mobilization Techniques Are Effective in Treating Chronic Pain Following Cesarean Section: A Multicenter Randomized Clinical Trial

Wasserman, Jennifer B., DPT, PhD1; Abraham, Karen, PT, PhD2; Massery, Mary, DPT, DSC3; Chu, Jennifer, PT, MS, WCS4; Farrow, Alicia, DPT5; Marcoux, Beth C., DPT, PhD6

Journal of Women’s Health Physical Therapy: September/December 2018 - Volume 42 - Issue 3 - p 111–119
doi: 10.1097/JWH.0000000000000103
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Objective: To determine whether soft tissue mobilization (STM) will reduce chronic pain and improve impaired function and mobility resulting from cesarean section (C-section) surgery.

Study Design: Multicenter randomized clinical trial.

Background: More than 1.27 million C-sections are performed annually in the United States. Of these, 6% to 18% will result in significant chronic pain.

Methods and Measures: In total, 28 subjects reporting chronic pain following C-section underwent 4 treatment sessions. Subjects were randomly assigned to one of 2 groups. Group 1 received superficial abdomen and lumbothoracic massage and superficial skin rolling of the painful scar. Group 2 received the same treatment plus abdominal myofascial release and direct deep scar mobilizations. Outcomes included pressure pain threshold (PPT), scar mobility, Oswestry Disability Index (ODI), Global Rating of Change (GROC), and Numeric Pain Rating Scale. Two baseline measures were collected 4 weeks apart to demonstrate stability of symptoms, then at 2 weeks postintervention, and again at 10 weeks.

Results: Pain, PPT, ODI, and scar mobility all showed statistically significant improvements (P < .002) in both groups. There were no significant differences between treatment groups on any outcome, with both showing improvement. There was no change in any outcome during the baseline period. GROC was 5.06/7 (“quite a bit better”).

Conclusions: This study demonstrates that 4 sessions of STM techniques are effective in reducing stable chronic pain following C-section. These findings support the use of STM interventions as a valuable and cost-effective treatment option for the many patients with chronic C-section–related pain.

1Doctor of Physical Therapy Program, Franklin Pierce University, Manchester, New Hampshire; Rocky Mountain University of Health Professions, Provo, Utah.

2School of Health Professions, Shenandoah University, Winchester, Virginia.

3Massery Physical Therapy, Glenview, Illinois.

4ITR Physical Therapy, Mclean, Virginia.

5Refined Physio, Seattle, Washington.

6Professor Emeritus, University of Rhode Island, Kingston.

The authors declare no conflicts of interest.

Copyright © 2018 by the Section on Women's Health, American Physical Therapy Association.
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