October 22, 2020

Thank you again to all those who participated. We appreciate you sharing your knowledge with us and your peers!

Please do not hesitate to comment below, we would love to receive more insight from you. This is an ever-evolving practice, and our goal is to not only connect physical and occupational therapists, but also encourage the spread of knowledge.

What are the best exercises you recommend for breast cancer recovery?

Most of the recommendations included passive and active exercises to increase your range of motion in your chest, back, and shoulders.

The top exercises mentioned:

1.       Butterfly Stretch in supine with lateral flexion and spinal twist

2.       Doorway Stretches

3.       Scapula Wall Slides

4.       Using an exercise ball and rolling it up and down the wall and side to side

5.       Full Body Stretch Supine

6.       Wall climbing with the goal being to get the armpit to touch the wall

7.       Shoulder Pulley Exercises

Gentle stretching and deep breathing were continuously noted to make sure the patient does not over do it or push themselves too hard in the recovery process. There is a lot of focus on their core and posture correction exercises to help stabilize the patient’s body. Other healing techniques mentioned were compression garments, massage, lymphatic drainage, yoga, and gentle strengthening activities once the patient has progressed in their healing process.

Are there programs that focus on breast cancer recovery?

40% of those who responded were aware of these programs

What programs are you aware of?

1.       SABC

2.       PROM

3.       AAROM

4.       AROM and Strengthening

5.       Breast Cancer Certification

6.       Lymphedema Training

7.       PORi

What does shoulder dysfunction /pain have to do with breast cancer?

Here are a few notable responses from our subscribers:

“Shoulder joint is a complex joint which involves scapula, clavicle and shoulder joint itself. All these joints are interrelated with each other. Moreover, they also have muscle attachment with origin and insertion related with the breast. Not only this, the axillary lymph nodes, and its nerve supply is related with shoulder joint. So, when there is any surgical procedure related to breast then it directly affects the shoulder complex and thoracic which leads to shortened muscles, postural impairment, pain and decreased in ROM in shoulder joint.”

“Sometimes when lymph nodes are removed and radiation is incorporated into the treatment plan, patients can develop coding or axillary web syndrome. This involves tightness in the armpit and can run down the arm to the wrist. If this happens many patients present with increase tightness and pain and will often times not use the arm. Not using the arm can cause muscles to shorten, increase scar tissue and can lead to shoulder dysfunction. Radiation treatments can often times lead to tissue restrictions, disruption with the lymphatic system in that area. The chest muscles present with increase scar tissue and muscle shortening can occur. Radiation not only kills off cancer cells, but it damages muscle, tissue, and vessels in the radiated area and penetrates to the scapula region, making those muscles tight resulting in limiting scapula mobility which can lead to shoulder dysfunction. Overtime if these areas are not stretched and strengthened limitations with function may occur.”

“Breast cancer itself can be related to soft tissue imbalances.  Surgical intervention causes additional trauma and subsequent swelling, scarring and further soft tissue imbalances as a result of the normal healing process.  Early PT intervention following surgery is important in maximizing outcomes.”

“Soft tissue restrictions throughout the thoracic area significantly impact shoulder mobility whether the client is post lumpectomy, mastectomy with or without reconstruction.”

“Many ladies protect the arm and area too long and this leads to tightness and decreased range and strength of the arm and shoulder. It becomes a vicious cycle.”

“Edema, muscle loss, lymph node loss, connective tissue restrictions as well as psychological aspects of recovery result in shoulder dysfunction in breast cancer survivors. Also, the destructive results of chemotherapy and radiation causing additional problems.”

“May relate to scar tissue, adhesion under arm, discomfort, pectoral stretch of breast reconstruction”

“After having a procedure there could be limitations in active mobility adherence in soft tissue preventing the mobility. Guarding and fear of movement due to the pain and fear of hurting the procedure.”

“Excision of breast tissue would affect not only pectoral muscles, but also scapular and back muscles. Rotator cuff muscles and their attachments would be affected by mastectomy.”

“Pain and scarring resulting from aggressive surgery.”

“Shoulder dysfunction/pain can be a complication of breast cancer surgery. I am an advocate of pre habilitation.”

“Can be correlated to impingement, lack of blood flow and or innervation”

“Breast cancer surgery affects shoulder mobility and function. Guidance needed to avoid over working the shoulder in the early stage to prevent Lymphedema and axillary cording, and then needed later to maximize strength mobility and function.”

Do you use Shoulder Pulleys when treating post mastectomy patients?

73% of those who responded said yes

If you answered no, why not?

Here are a few responses:

“According to me, shoulder Pulleys aggravates the pain. First of all, the shoulder biomechanics plays important role here. The humeral head hits the acromion process, which could lead to secondary complications of impingement syndrome and severe pain in overhead activities. Sometimes, patient overdo the abduction and forward flexion. Second of all, its AAROM which is not at all assisting the patient for long term. I would suggest Wand exercises which is done by patient and not by pulleys.”

“I do not believe that most clients use the pulley system effectively. They substitute other muscles and movements for the motion needed. Most therapists are not able to supervise all exercises and the clients substitute and do not receive the benefit of the pulley ROM system. I prefer active assistive ROM using the other arm.”

“I incorporate hands on manual technique in my practice and find that my clients benefit from the power of touch. I incorporate a lot of myofascial release, scar tissue massage. I use TheraBand because of the resistance. I believe that the standard pulley could be useful in the beginning stages but patients are afraid and have increase pain at this point.”

“Pulleys would not be appropriate for initial ROM or strengthening.  There is a possibility of further injury affected muscles.  I would prefer wall exercises, a finger ladder and TheraBand (red and yellow).”

“Sometimes I would use a pulley.”

“I find them too intimidating for clients.”

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