A couple of months ago, a beautiful woman came into my office, wondering why she had been referred to physical therapy after she started radiation therapy. She had a partial mastectomy with axillary lymph nodes removed three months before, and had already had chemotherapy. She felt pressure in her arm with a little bit of stiffness when she did her hair each morning, but that was it. She thought she had no pain, and wondered why physical therapy was necessary and what the purpose of it was.
According to Dr. Susan Love in her book ” Dr. Susan Love’s Breast Book,” she reports “that all mastectomy and axillary lymph node dissection patients get an automatic referral to physical therapy where at a minimum, they are taught basic exercises and also receive additional lymphedema education.” Side effects of surgery and radiation can occur three to six months after treatment; it is best to start early with physical therapy so prevention techniques can be started with the patients. Research has indicated that physical therapy should begin after drains are removed or on the 12th to 14th day after surgery.
Side effects following mastectomies and lumpectomies are numerous. This is the reason skilled intervention by a breast cancer physical therapist is needed. Some of the problems come from the surgical intervention due to removal of the axillary lymph nodes. This resection in the armpit is the reason for most of the shoulder stiffness and axillary web syndromes.
Loss of mobility in the tissue under your armpit is painful; shortening of the muscles and tendons occurs as a result, and you become weak. Often, you don’t even realize that your arm is stiff and weak until you are tested. Other changes will occur in the tissue due to radiation. Radiation produces inflammation in the muscle tissue and the surrounding tissue; it is cumulative in nature, so may not show up for months after treatment. The tissue becomes thick and hard in nature, and mobility is lost in the scar lines. Physical therapy intervention is crucial for anyone who has had axillary nodes removed or tissue radiated.
Physical therapy for breast cancer includes a first visit evaluation for an hour with a breast cancer specialist. Then, an assessment will be made and goals established for your individualized program. This process should begin two weeks after surgery. This insures that a baseline is created, and then prevention techniques can be started.
In our program, Step Forward 4 Oncology Care, we utilize a four-step approach. The four steps include skin care; specific shoulder and neck exercises; specialized massage to re-direct lymph fluid, assist in reabsorption, and soften tissue scar lines; and compression therapy, which includes compression garments for your arm and chest wall and bandaging with compression, if needed.
Please do not wait to begin physical therapy with your breast cancer specialist; your long-term outcomes depend on how early you start your plan of care.
Sheree DiBiase, PT, is a breast cancer specialist certified with the International Lymphology Association. She and her staff have trained with Stanford University as breast cancer and lymphedema specialists. They can be reached in their Coeur d’Alene office at (208) 667-1988, and in their Spokane Valley office at (509) 891-2623. Lake City Physical Therapy.