How can physical therapy help in the breast cancer battle?

Dr. Linsey James, PT, CLT-UE

October 2, 2020


October is National Physical Therapy Month, as well as Breast Cancer Awareness month. You might not think these would have a correlation, but they do! We, as physical therapists, want the community to know that we are here to help in the breast cancer battle. We are able to provide skilled care regarding symptoms and/or impairments throughout the breast cancer treatment journey.

When a person is diagnosed with breast cancer and directed for interventions and treatments that include mastectomy with or without reconstruction, lumpectomy, axillary lymph node dissection, chemotherapy, or radiation it can affect that individual’s function in many ways during their survivorship, such as:

  • Impaired tissue integrity
    • Scar tissue
    • Radiation burns
  • Impaired joint range of motion
    • Cervical spine (neck region)
    • Thoracic spine (mid-back)
    • Scapulae (shoulder blade)
    • Upper extremity (most often shoulder to elbow)
      • Risk of adhesive capsulitis (frozen shoulder)
  • Altered sensation
    • Pain
    • Numbness
    • Tingling
  • Axillary Web Syndrome or “cording”
    • Fibrosis of lymphatic ducts (post axillary lymph node dissection)
    • Most common 3-4 weeks post-op
  • Lymphedema
    • Neck, Breast, Torso, Upper extremity

Statistics show that there are 2.8 million breast cancer survivors in the United States with a 5-year survival rate of 90%. The National Cancer Institute also reports 50-70% incidence rate of lymphedema after axillary (arm pit region) treatment. We as physical therapists can provide skilled care during early, late or even long-term effects post treatment interventions.

You mentioned lymphedema; What is that?

Lymphedema is defined as an abnormal accumulation of protein rich fluid located between skin and organs that usually causes chronic inflammation and reactive fibrosis of the affected tissues/regions if left untreated.

  • Primary lymphedema correlates to an imperfect development of the lymph vascular system.
  • Secondary lymphedema is relating to an external source of defect; in this context relating to it’s most common cause in the United States: Breast Cancer, and it’s directed treatment.
    • With breast cancer treatment the risk of lymphedema development varies based on cancer type/severity and if any lymph nodes were removed/damaged.
    • Lymph nodes are located in various regions of the body in clustered formations with ducts or pathways helping to distribute the flow of the protein-rich lymphatic fluid throughout the body.
      • When the nodes are removed or damaged this inhibits the pathway or the flow of fluid and causes congestion like a ‘traffic jam’ and promotes risk for lymphedema onset with fluid ‘back up'.

How can physical therapy help in the breast cancer battle?

Risk Factors

  • Axillary radiation therapy
    • Highest incidence when both combined
  • Obesity or elevated BMI
  • Advanced disease at time of diagnosis
  • Post surgical seroma (fluid accumulation)
  • Blood flow (venous or arterial) abnormalities

Common Signs and Symptoms

  • Slow or rapid onset of swelling
  • Progressive
  • Often begins distally (fingers/hands)
  • Loss of boney contours (generalized “puffiness”)
  • Upper extremity asymmetry
  • Symptoms of heaviness, achiness in the affected limb

Role of Physical Therapy

Complete Decongestive Therapy

  1. Manual Lymph Drainage (MLD): a directive massage technique to promoting a clearing effect of the protein rich fluid to locations of functioning and viable lymph nodes; directing the flow away from the swollen region/limb.
  2. Bandaging: Use of short stretch compression bandaging along with other layers of foam and/or cotton post MLD to prevent return of the protein rich fluid into the limb. Goal for bandaging post treatment sessions to provide comfortable limb volume constriction with goal to reduce the arm size and progress towards a compression garment (ready-to-wear or custom-made based on cost/need).
  3. Bandaging
  4. Exercise: Range of motion education with compression bandaging in place and/or with use of compression garment to promote pumping mechanism to mobilize fluid and prevent re-accumulation. Education to reduce over activity/stress to the limb and the importance of gentle progression of resistance for strengthening activities.
  5. Skin & Nail Care: Direction for meticulous skin and nail care to promote moisturization and prevention of open areas (damaged cuticles, blisters, ingrown nails etc.); preventing risk of infection. Using lotion free of parabens, reducing
    • No blood pressure or needle sticks per the affected arm
    • Limit risk for skin injury (cessation of shaving, use of protective garments for yard work)
    • Limit tight fitting clothing
    • Limit restrictive jewelry (watches, bracelets, etc).
    • Consider compression with air travel/arm exercise
      • Always best to confirm with your medical provider

Please consider Dunn Physical Therapy to address any concerns during your breast cancer battle and survivorship. We are here for you!


References:

Földi M. Textbook of Lymphology: for Physicians and Lymphedema Therapists. -: Klose Training & Consulting Llc; 2004.

Klose, G., Keith, L. Klose Training & Consulting. Lymphedema Therapy Certification Course. July 2014.

Sgk. Did You Know? Susan G Komen Kentucky. https://komenkentucky.org/about-breast-cancer/did-you-know/. Accessed October 1, 2020.

What is Lymphedema? National Lymphedema Network. https://lymphnet.org/what-is-lymphedema. Accessed October 2, 2020.

Winicour, J. Klose Training. Breast Cancer Rehabilitation. 3 March 2016.

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