PT plays big role in breast cancer rehab

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It is most likely happenstance that Breast Cancer Awareness and National Physical Therapy Month both occur in October, but they do. And, because of (or in spite of) it there are several articles about the role that physical therapy plays in breast cancer surgery rehabilitation.

Breast cancer treatment options are surgeries (biopsy, lumpectomy, mastectomy, reconstruction) and either radiation, chemotherapy or both. These treatments can take a toll on you, both physically and psychologically.

Common effects include scar tissue adhesions; pain in the shoulder, chest, back, neck or arm; restricted range of motion or stiffness of the shoulder, neck and spine; lymphedema (painful swelling where lymph nodes were removed); weakness and fatigue; neuropathy; bowel and bladder changes; pain with intercourse; axillary web syndrome (cording) and post-mastectomy pain syndrome (PMPS).

Prehabilitation physical therapy is defined as treatment between the time of diagnosis and the actual cancer treatment. There’s strong evidence that physical therapy can improve physical and psychological outcomes by assessing baseline measurement such as range of motion of shoulders and spine, and circumference of both upper extremities.

The PT can identify any impairment that may affect recovery such as muscle weakness, posture issues and pain. The therapist can educate the patient about lymphedema and risk reduction and establish an exercise program for the patient to start before the surgery and immediately thereafter.

The American Physical Therapy Association reported on a study that was conducted in Italy and whose findings were reported in 2014. It found that women who received physical therapy as early as two days after surgery regained normal glenohumeral (shoulder) function one year after surgery “and reported less pain, while an untreated control group continued to report limitations.”

But wait, there’s more. Everyday Health explains that most women treated for breast cancer have lymph nodes between the breast and underarm examined or removed to check to see if the cancer has spread (metastasized).

“This procedure can cause fluid to build up in the tissues. The swelling, called lymphedema, can make it hard to move the arms and limits range of motion for months or longer. The condition is considered one of the most disabling and distressing complications of breast cancer treatment, affecting up to 56 percent of patients at two years following surgery,” Everyday Health said.

If you’ve ever known someone with lymphedema you know how debilitating it can be. It makes simple tasks such as brushing your hair or putting on a shirt difficult. I know a woman who had to leave her job at a grocery store because she no longer could reach the higher shelves.

Everyday Health reported that a study that was released in February of this year found that a “tailored physical therapy exercise program sped the return of range of motion after axillary (arm pit) node dissection, in which lymph nodes, many near or under the arm, have been removed.”

In this study, 568 women with breast cancer were randomly assigned to either a group that received educational materials on how to identify and prevent lymphedema, while the other got the same information but were also sent to a physical therapist for individualized arm stretches and breathing exercises.

“One year after surgery, more women in the exercise group reported full range of motion in both arms (91 percent left arm; 90 percent right arm) compared with women who just got educational brochures (84 percent and 83 percent). After 18 months the exercise-only group had caught up, with 93 percent of women in both groups regaining full range of motion.” Everyday Health said.

“At the one-year mark, the exercise group saw range of motion in the affected arm improve by 32 percent on average compared with just six percent in the education group. At 18 months the exercise group reported a 37 percent bump in scores compared with 13 percent in the education group.”

Bonner General Health has physical therapists trained in cancer rehabilitation, lymphedema treatments and exercise programs related to range of motion. Go to www.bonnergeneral.org/cancer-rehabilitation for more information.

“If we can send women to just one physical therapy appointment after they’ve had node dissection, they will recover their range of motion quicker,” Everyday Health concluded.

Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at kathyleehubbard@yahoo.com.

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