Breast Cancer Rehabilitation

If you have gone through breast cancer surgery, you can usually expect to return to your pre-surgical level of motion and activity. If, however, you have problems such as decreased or painful shoulder motion, abnormally tight or tense muscles, back or neck pain, or arm or breast swelling, physical therapy can help.

Physical Therapy after Breast Cancer Surgery will address:

  • Soft Tissue Pain/Myofascial Restrictions

  • Lymphedema

  • Lymphatic Cording/Axillary Web Syndrome

  • Scar Tissue Tightness/Restriction

  • Tightness/Firmness from Radiation (Radiation fibrosis)

  • Weakness and Lack of Endurance (Debility/Deconditioning)

  • Joint Immobility/Pain (e.g., shoulder, back, neck)

These conditions can occur at any point in the cancer journey and we are committed to help you through them at every phase — from pre-surgery appointments helping you prepare for surgery to post surgery treatments helping you to regain/maintain strength, mobility, and fitness in survivorship.

Below are brief descriptions of each of the above and how we approach treating them. We are dedicated to help you through these conditions with targeted treatments, exercise, and education.

Soft Tissue Pain/Myofascial Restrictions

Fascia is a thin membrane of connective tissue that is found underneath your skin and covers all of the muscles and organs. Fascia acts to support structures in your body and allows for functional movement. It can be very tight after surgery, such as breast surgery, or injury and can cause ongoing pain or motion restriction. Because fascia lies over muscles, both the muscle and the fascia need to be able to allow for full movement of that body part. If the fascia is tight, the movement will be restricted and pain will occur.

Pain in a muscle may be caused by what is known as trigger points which are taut bands of muscle fibers that present as “knots” in your muscles. These trigger points may cause significant pain at the site of the knot or may cause radiation of pain into different areas of your body.

Manual therapy techniques such as myofascial release and soft tissue mobilization are very beneficial treatments I use to improve the flexibility of tight tissue, release knots, and help reduce pain and improve your functional mobility. When appropriate, I will perform dry needling as a additional treatment to relieve trigger points and muscle pain.

Lymphedema

Lymphedema is swelling which can occur in the arms, legs or sometimes in other parts of the body such as the breast. It occurs when the lymphatic system, which moves lymph fluid throughout the body to help fight infections and maintain fluid balance, is blocked or compromised. A common cause of lymphedema in the US is cancer surgery or radiation. Other conditions such as chronic venous insufficiency, non-cancer-related surgeries, and injuries can cause swelling. It is important to be able to differentiate between lymphedema and other types of swelling because the treatment techniques may be different. I have the experience to evaluate your swelling and develop the correct treatment plan for you. I am a certified Lymphedema therapist and was one of the first therapists in Indiana to treat this condition. I have trained and mentored therapists across the country in lymphedema treatment techniques.

My treatment approach includes lymph drainage massage, medical compression bandaging or other compression means, exercise, and skin care. My goal in therapy is to teach you self-management techniques and promote independence. While early intervention is recommended, it is never too late to begin treatment.

Lymphatic Cording/Axillary Web Syndrome

Though not expected, you may develop “cording” (also referred to as Axillary Web Syndrome — AWS) after breast surgery where a tendon-like band develops — usually beginning under the arm — and creates pulling into the elbow or sometimes into the hand. This cording makes range of motion very painful and the arm can be tender to touch. It is best to have this issue addressed as soon as it develops and definitely before you start radiation as the condition can worsen causing more difficulty in treatment. Going to a therapist who understands this phenomenon and how to treat it is key for the best recovery. Using a combination of manual therapy techniques, the right compression, and specific exercises can go a long way in providing the relief you need!

Scar Tissue Tightness/Radiation Fibrosis

As with any other type of surgery, you may find that you have pain at your incision site on your breast or under your arm. When a surgery incision heals, it can develop scar tissue, and we humans heal differently from one another. You may develop a scar that varies significantly from others — in size, thickness, or tightness. The scar may cause discomfort or pain, and you may not be able to (or want to) move the area as easily as you did prior to surgery.

You may also find that you have changes in your breast after radiation treatments such as firmness (fibrosis) or fullness which can be helped with physical therapy. Radiation therapy uses high-energy rays to target and destroy cancer cells (that’s a good thing), but it can sometimes affect healthy tissue in the area around the cancer cells. As you heal from the radiation therapy, the healthy tissue may be replaced with a fibrous tissue (fibrosis) that can present as firm, tight, or painful areas. As with scarring, fibrosis can vary substantially from person to person. Advancements in radiation treatment strategies over the years have significantly reduced the development of fibrosis, but it still occurs.

I treat scarring and fibrosis with gentle manual techniques to soften the tissue, stretch the tight fascia, and address the scar tissue restrictions with the goal of reducing pain and tissue restriction. I will recommend the right self-management tools to use, and I will also give you appropriate stretching exercises after your breast surgery to improve your functional mobility and help you return to your daily activities.

Deconditioning/General Debility

You may experience fatigue and lack of strength during your cancer recovery process. Surgical procedures, chemotherapy, and radiation can take a toll on you both physically and emotionally, making it difficult for you to have the energy or strength to do even common activities. Here at Achieve we understand the impact of this on your daily life and are here to help.

I will work with you to determine your specific needs, develop a custom program of activities and exercises, and help you implement routines to increase your strength and endurance so you can get back to the activities you desire.

Joint Immobility or Pain

After your breast surgery, you may experience shoulder pain or stiffness, especially if you have radiation to your armpit or chest area. You may also note an increase in joint pain in other areas of your body due to some medicines used to treat breast cancer. In these instances, it is important to address this onset of pain so that you are not limiting your movement — it is important to keep moving! Are you afraid to move your shoulder because it hurts? Are you afraid you will cause more issues if you move it too much? Has your posture changed? Knowing how much to do or how to modify tasks when needed is key for the best recovery.

I take a comprehensive approach to determine the potential cause of the pain and develop an individualized treatment plan which may include stretching, strengthening, soft tissue work, posture awareness, and education.