by Karen McDonald, PT, MDT
Not counting some types of skin cancer, breast cancer is the most common cancer in women in the U.S., regardless of race or ethnicity. According to the Center of Disease Control, 210,203 women were diagnosed with breast cancer in 2008. The good news is that improvements in detection are helping doctors find the disease earlier, thus improving survival rates. For those affected by breast cancer, exercise has been shown to be beneficial in improving overall health and the quality of life when undergoing treatment. Exercise can reduce nausea, pain, and stress and help maintain a healthy weight.
Physical therapy has become a big component in the treatment of women who have undergone mastectomies, lumpectomies, chemotherapy, radiation, breast reconstruction or a combination of these. Physical therapists are trained in the evaluation and treatment of musculoskeletal dysfunctions. We can identify imbalances throughout the body, apply hands-on treatment, and recommend appropriate exercises. Here are some specific ways a physical therapist may be helpful during the treatment of breast cancer.
Fatigue
Cancer-related fatigue is the most common side effect of cancer treatment. Unlike tiredness, fatigue cannot be relieved by rest or sleep and can impact the entire body — physically, mentally, and emotionally. This fatigue can greatly affect a person’s quality of life as they are unable to perform their normal activities. Aerobic exercise and strength-building programs can lead to improved body function, general well-being, and sleep patterns. Because it is difficult (and maybe dangerous) to start a well fitness program at this time, you may need to see a physical therapist to build stamina and learn the best and safest exercise routines to follow.
Post-mastectomy, post-lumpectomy
After mastectomies, women may experience post-surgical pain in their chest wall, shoulder, arm, or torso. The pain may feel like a burning, tightness, or stiffness. This may be due to formation of scar tissue, a shortening of muscles, tendons, ligaments, and joint capsules, or fluid build-up. Physical therapists are specially trained to address these problems. We use soft tissue massage to loosen tight tissue. We may also use tools, such as The Graston Technique, to help to break down scar tissue. Stretching techniques can elongate tissues that have shortened with surgery. All of these interventions can improve range of motion, decrease pain, and lead to full functioning with activities of daily living.
Post Radiation
Pain after radiation is usually due to radiation fibrosis. Radiation fibrosis is the scarring of healthy tissue. Symptoms may include pain, weakness, stiffness, loss of motion, and lymphedema. These effects of radiation can be immediate or take months to develop. Exercise can be helpful in preventing some of the pain and stiffness that radiation can cause. If a woman does experience fibrosis of the soft tissue, a course of physical therapy may be helpful to soften and elongate the tissue in order to restore full range of motion and function.
Post breast reconstruction
Today, women have many options for breast reconstruction after mastectomies. Breast reconstruction after a mastectomy can improve a woman’s quality of life. Breast reconstruction may involve using breast expanders and implants, using your body’s own tissue, or a combination of implants and tissue reconstruction. Body type, health status, and cancer treatment all factor into which type of reconstruction will provide the best result. Research has proven that collaboration between physical therapists and nurses im-proves patient expectations for recovery after reconstructive surgery. Tissue flap procedures have become popular as an option for breast reconstruction following a mastectomy. These procedures use tissue from the abdomen, back, buttocks, or thighs to rebuild the breast. The two most common types of tissue flap procedures are the Transverse Rectus Abdominus Myocutaneous (TRAM) flap, which uses tissue from the lower abdomen, and the Lattisimus Dorsi flap, which uses tissue from the upper back. Although these procedures can produce excellent results, the recovery process has unique considerations. Physical therapists can play a vital role in optimizing outcomes with these flap procedures. We provide education in posture and body mechanics to ensure a safe recovery. We instruct patients in an individualized therapeutic exercise program to ensure full recovery in the range of motion and strength of their affected shoulder. These patients need to manage two incision areas: the donor site and the incision around the newly constructed breast. Often, manual therapy is required to soften areas of scarring and tightened tissue similar to post-mastectomy and post-radiation patients. In addition, these patients need help with muscle imbalance due to the transfer of muscle away from the abdomen or buttocks. Physical therapists can teach these patients safe exercise techniques to regain lost strength, regain motion, and return to all of the activities they did prior to surgery.
Are you or your loved one struggling with the consequences of breast cancer?
It is important to talk to your oncologist and plastic surgeon about how you can best return to your normal activities. They may recommend a referral to a physical therapist who understands the special needs of someone who has undergone treatment for breast cancer. At Dresher Physical Therapy, we offer treatment for women in all stages of breast cancer treatment. Contact us today and we can help get you back to all that life has to offer.
