Breast Cancer Rehabilitation Helps: 5 Common Side Effects
Being diagnosed with breast cancer is a pivotal moment for many. It triggers a flood of emotions and a series of events that can include blood tests, biopsies, consultations, and decisions about what type of treatment to pursue. Some of these events have the potential to negatively effects how you feel and function. While treatments such as surgery, chemotherapy, and/or radiation therapy can be lifesaving, they often leave patients with new deficits. You may find yourself with limits in range of motion, strength, and lymphatic function. You may also experience a buildup of scar tissue and fibrotic tissue related to surgery or radiation therapy. But did you know that breast cancer rehabilitation can provide patients with the tools and techniques they need to combat these new deficits?
Breast Cancer Rehabilitation Helps Range of Motion
Breast cancer patients often experience a decrease in shoulder range of motion following surgery or radiation therapy. Decreased range of motion can significantly impact a person's daily life, making it difficult to bathe, reach objects, and even drive. Your therapist will help you determine if you have limitations in range of motion and if so, what the cause is. She will measure your range of motion to determine the level of deficit present. And she will assist you with determining a plan of action to regain functional range of motion. If your range of motion is limited due to tight muscles, she may use tools and techniques to decrease muscle tightness, including:
- instrument assisted soft tissue mobilization tools
- low-level laser (light) therapy
- cupping
- deep manual techniques
- stretching
Your therapist will develop a home exercise program for you that includes specific stretches to decrease muscle tightness, as well as increase range of motion. If you have significant damage that prevents you from regaining functional range of motion, your therapist will give you suggestions and training on using adaptive equipment, such as a long-handled reacher or a sock-aid, to allow you to maintain independence and continue to participate in activities of daily living.
Breast Cancer Rehabilitation Helps Strength and Endurance
Some patients experience a decrease in hand and arm strength following breast cancer treatment, making it difficult to open containers and packages, lift or carry objects, and complete daily activities without fatigue. Your therapist is trained to safely and effectively lead you in exercises to regain your strength. She will develop a home exercise program for you with detailed exercises that you can do between therapy sessions. This will allow you to make as much progress as possible. Your exercise program will be updated as you make progress towards your strength goals. Your therapist will also teach you energy conservation techniques and task modifications to reduce the amount of strength and energy required to complete tasks and to reduce fatigue.
Breast Cancer Rehabilitation Helps Lymphedema
Breast cancer patients undergo procedures that alter their lymphatic system. Lymph node dissection, surgery, scaring, radiation and chemotherapy all change the ability of fluid to move in and out of the tissues. This altercation is called Stage 0 Lymphedema. Lymphedema is a chronic condition that will worsen and progress from Stage 0 all the way up to Stage 3 without intervention. Progression through the stages of lymphedema can happen quickly, or progression may not occur until years after your treatment. Some people experience sudden swelling at the very beginning of treatment, while others have a slow but steady increase in limb volume.
Stage 0 Lymphedema: At Stage 0, there is no outward sign of swelling or tissue changes, but lymphedema therapy is still important. At Stage 0, your therapist will take baseline measurements of your limb volume, teach you self-massage and exercises that will help prevent progression, and alert you to signs that you may need more intervention.
Stage 1 & 2 Lymphedema: Some people are fortunate and never progress from Stage 0 lymphedema. However, some go on to develop Stage 1 or 2 lymphedema. At Stage 1, you can tell something is off. Your limb may feel heavy, and you may notice swelling, but with elevation, it returns to “normal”. By Stage 2, the swelling no longer resolves, and permanent tissue changes are taking place. Lymphedema therapy is critical at Stage 1 & 2 to minimize permanent tissue changes.
Stage 3 Lymphedema: By Stage 3, your tissues have undergone significant and permanent change. There is laydown of fat cells and fibrosis that can cause the limb to look disfigured. But even at this stage, lymphedema therapy is important. Breaking up fibrosis is a key focus in Stage 3 lymphedema, as is reducing risk of infection and identifying the correct compression garments and exercise routine.
With all the stages of lymphedema, your therapist will provide Complete Decongestive Therapy (CDT) to move the stagnant fluid out of your tissues and help restore normal fluid movement. Complete Decongestive Therapy includes:
- Manual Lymphatic Drainage: A specific, very gentle massage intended to promote lymphatic flow.
- Compression: Compression bandaging, compression garments or a combination of the two that puts external pressure on the tissues to prevent fluid from accumulating. Many patients will also benefit from the use of pneumatic compression. Patients can trial pneumatic compression during therapy sessions and if appropriate, therapists can assist patients with obtaining home pneumatic compression devices and provide patients with training on using those devices independently.
- Exercise: gentle exercises designed to take advantage of the fluid movement that occurs when your muscles pump
- Skin care: because lymphedema causes your skin to be oxygen deprived, your skin will tend to become dried and fragile. Your therapist will help you identify skin care routines and products that will strengthen your skin and keep it healthy
As your lymphedema changes, it is important to follow up with your therapist so she can update the approach you take to managing it. She will help evaluate your compression to make sure you have the right size and fit as well as the right amount of pressure as your body changes. She will keep up to date with new products as they come on the market and help determine which compression options are right for you.
Nutrition can also impact swelling and lymphedema therapists are knowledgeable on which foods to increase and which to avoid. They will provide the information you need to adjust your diet successfully.
Wounds can be another issue for some patients with lymphedema. Lymphedema therapists are trained to recognize signs of infection and will help you know when to see a doctor if infection is suspected.
However your lymphedema presents and however it progresses, the key is to work with an experienced lymphedema therapist. Look for a therapist who possesses knowledge about each stage of lymphedema and has the equipment and skills to optimize each piece of CDT to meet your needs. Look for a therapist who will teach you how to perform each step of CDT independently or with the help of a caregiver and customize her teaching style to how you learn best.
Breast Cancer Rehabilitation Helps Scar Tissue
Breast cancer patients who undergo mastectomy or lumpectomy surgeries may develop dense scar tissue that can be sensitive, painful, and/or restrict motion. Therapists can utilize tools and modalities - such as those previously mentioned for loosening tight muscles – to loosen and break up scar tissue. They will also perform manual techniques such soft tissue mobilization and myofascial release to realign and desensitize scar tissue. Your therapist will teach you scar massage and desensitization techniques that you can perform at home.
For some patients, “cording” or axillary web syndrome becomes an issue. This happens when blood vessels or lymph vessels become scared. To many, it feels like a rope or cord under their skin. It typically runs from the axilla or arm pit down the inner arm to the elbow or even down to the wrist. Cording can be very painful and can limit a patient’s range of motion. If cording is an issue for you, your therapist will apply modalities such as low-level laser to soften the scar followed by deep manual techniques and stretching to break up scar tissue and decrease the cording. She will also teach you to perform manual techniques and stretches at home to continue progress between therapy sessions.
Patients who require radiation therapy can develop fibrotic tissue or, in the extreme, radiation fibrosis. Fibrotic tissue is thickened connective tissue that has become scared and replaces normal tissue. Like other scar tissue, fibrotic tissue requires therapeutic intervention, including modalities such as low-level laser to soften the tissue followed by deep manual techniques and stretching, to decrease the impact it has on the patient. With intervention, fibrotic tissue can be softened and become more flexible over time. And, as with range of motion and strengthening, doing your home program between therapy sessions will help speed up your progress.
Breast Cancer Rehabilitation Gives You Hope
Breast cancer patients may face many challenges during or following treatment. But a good breast cancer rehabilitation program can provide you with not only the support you need to overcome those challenges but also arm you with hope. By making you aware of the possible negative side effects of your treatment and teaching you what to do to combat them, you will be equipped to not only battle your own challenges, but help others battle theirs too.
Therapy Achievements wants to team with you. Our experienced breast cancer rehabilitation therapists are ready to advise and guide you. Don’t struggle alone. Call for an appointment today.