Back, hip and knee problems due to a cesarean or other abdominal scars, it’s more common than you think. 33 percent of all women in the USA will have a c section. In some cases, the doctor determined that their birth is likely to have complications if they delivered naturally, while in other cases, there was pressure placed on the doctor due to concerns of liability as well. In countries like Brazil, C sections are very common and planned for convenience at many private clinics, with minimal concern for possible long-term effects. My Brazilian cousins admitted to me that having a c section was not worth the pain and other physical manifestations felt afterward. Years later, after c-section delivery, many women are reporting back, knee, and hip problems that developed after their pregnancy. The connection between their scar and their symptoms is rarely made, which can cause painful problems months and years later that may seem like they are not being caused by it. A scar that causes pain in the neck, back, and extremities is known as an active scar because it affects their body mechanics, usually months and then for years on end. Ironically, most of their healthcare providers do not make the connection either. Many visits to health care providers that do not result in their symptoms either improving or resolving over time are a common occurrence. Hernia repairs can also cause similar problems due to scarring around the mesh used to strengthen the weakness in the abdominal wall. Doctors’ offices are filled with patients with back and lower extremity complaints that are treated with chiropractic manipulation, massage, physical therapy, and other regimens, yet, as these patients age, their problems worsen, even with those interventions. There is growing scientific evidence that surgery on the abdominal wall can cause chronic back, hip, and leg pain in the future (1, 2, 3 ), and the relationship between the surgery and the future effects on how the person functions are closer than has been previously thought. While Cesarean section and hernia repairs is common, informing these patients about the effects of the scar tissue underlying the surgery and the way it can affect them for years to come is often never discussed. Most physicians do not consider the long-term side effects a serious health problem unless it causes problems in the intestines or other organ systems. On the other hand, physicians are working on less invasive ways of performing surgeries that do not puncture the abdomen, which is essential to the proper function of the core, and the way we walk, move and even perform when engaging in sports. If you search PubMed.gov, you will find numerous studies mentioning a large assortment of post-surgical pain in their backs, necks, shoulders, knees, and other areas which were reported and presented in major journals. In the past, most studies often failed to establish the link between abdominal post-surgical weakness, sub abdominal adhesion of the fascia and musculature, and its effect on gait. Now growing evidence supports the idea that an active scar can ultimately alter the gait system, resulting in painful compensations throughout the back and extremities. Even the most minor scar on the surface can cause many problems in the abdominal cavity, affecting the way you walk, feel and function for years to come. These studies are presented at the Fascia Research Congress which is attended by experts in fascial therapy from around the world every other year. When we read about why people hurt, most articles talk about the core and how essential it is to the way we function mechanically, yet, most doctors do not fully understand the effects of surgery on this region, and how it affects core function, stability, and the fascial system. If you already are built asymmetrically, as many of us are, an active scar can worsen the way you feel and function, since it aggravates already problematic body mechanics. If you have had abdominal surgery, you can improve the way your core functions by working on the scar itself, even though the procedure was done years previously. There are simple techniques to relieve the effect of the scar superficially such as using your thumbs and gently stretching it in opposite directions. Foam roller balls that are soft on the surface are also quite helpful. Often, this will break up surface adhesions, restore mobility superficially and improve the way it feels and even the way it looks, although you will need the help of a professional if the scarring is deep into the mesentery, which is the area underneath the scar where the ovaries, bladder, and kidneys are located. Mesentery scars may have deep adhesion to structures beneath the scar such as the internal fascial planes, psoas, iliacus and can affect the way you walk and move. A chiropractor or other therapist who performs myofascial release can be essential because they will be able to find, identify and treat those adhesions either by hand using myofascial release or with instrument-assisted soft tissue methods such as Graston which can be quite helpful on scars that are deep and inflexible. Considering a chiropractor could be your best option since the combination of manipulation of the joints affected by the adhesion, as well as soft tissue work at the scar and into the mesentery will likely yield the best result. After treatment, exercises to strengthen and retrain the region can improve overall function for the best long-term improvement of the condition. Abdominal scars being responsible for back, leg, and knee problems are often overlooked and are rarely discussed by healthcare professionals, resulting in many failed treatments to resolve pain in the abdomen, back, and legs. With today’s high deductibles and co-payments, choosing the wrong approach or provider can be quite costly, and frustrating as well. If you have had abdominal surgery or c section, it is important to tell your doctor for the best diagnosis and treatment approach for your problem. It is important to look at people as a whole, rather than just where they hurt. Often, scars in the abdomen affect people and the way they move. More evidence is suggesting that back and knee problems are a movement problem, rather than back problems. Since abdominal scars affect how you move, it is essential for your healthcare provider to consider the effects of a scar when being evaluated and treated for problems in the back or legs. Often, a simple movement screen that involves movement against the planes of the scar can offer an accurate assessment of whether the scar is active or not. For the best results, patients should be evaluated after the 6th week postoperatively since scars are just beginning to set. Signs of an active or symptomatic scar development can be addressed before the problem becomes chronic during this time. It is appropriate that surgeons learn some skills in evaluating fascia and scars and have their patients screened after six weeks to determine if they may require a specialist who can resolve the developing scar before it becomes a chronic problem. We specialize in problems related to active scars that can cause problems in your neck, back, and other joints in the body. Book online here to schedule your first appointment to find out if your problems are due to an active scar. 1. SAUD SULEIMAN, M.D. and DAVID E. JOHNSTON, M.D. University of New Mexico School of Medicine, Albuquerque, New Mexico Am Fam Physician. 2001 Aug 1;64(3):431-439. 2. Valouchová P, Lewit K. Surface electromyography of abdominal and back muscles in patients with active scars. J Bodyw Mov Ther. 2009 Jul;13(3):262-7. doi: 10.1016/j.jbmt.2008.04.033. Epub 2008 Jun 9. 3. Bordoni B, Zanier E Skin, fascias, and scars: symptoms and systemic connections J Multidiscip Healthc. 2013 Dec 28;7:11-24. doi: 10.2147/JMDH.S52870. eCollection 2013.