Physical Therapy and Breast Cancer

Physical Therapy and Breast Cancer, Helps Identify Risk for Lymphedema
Last year, an estimated 230,480 new cases of breast cancer were diagnosed among women. Though recovery varies greatly for each patient, and not every one of these patients with breast cancer will require rehabilitation services post-treatment, swelling and range-of-motion problems following treatment can prevent them from returning to normal daily activities.

Treatment for breast cancer, which includes surgery, radiation and chemotherapy, causes many patients to experience pain and stiffness in the chest, shoulder and back muscles, as well as initial swelling and numbness near a surgical incision site. Other common side effects of breast cancer treatment include nerve irritation, as radiation and surgery can cause nerves to become swollen, which can result in numbness, pain or tingling sensations. Fatigue is also common and can easily overwhelm a patient. An integrated, multidisciplinary team of physicians, nurses, physical therapists and social workers can help identify a patient’s rehabilitation needs.

Kevin Kunkel, PhD, PT, MLD-CDT has been innovating the treatment of breast cancer and lymphedema for over 15 years and has published several articles and chapters on the subject.

One of the most effective ways to treat the side effects of breast cancer treatment is to begin a provider-approved course of arm exercises. Occupational and physical therapists can teach patients basic exercises that will stretch and strengthen the muscles of the chest, back, shoulders and arms, preventing stiffness and reducing pain. Increased flexibility can improve a patient’s posture, which helps with pain management. And a supervised, gradual return to exercise can also reduce both nerve irritation and fatigue.

“Patients can begin a physical therapy program after adequate healing of the incision,” “One of the benefits of rehabilitation and physical therapy is that exercise can help with fatigue, which is a very common complaint among patients with breast cancer.”

Recognition and prevention of lymphedema, a post-surgery complication risk, is also critical in breast cancer rehabilitation. Lymphedema manifests itself as swelling in one of the arms because of a blockage of lymph passages and the body’s inability to drain fluid from surrounding tissues. Flagler integrates the search for signs of lymphedema into her work with patients. Some patients first notice a swelling in the fingers or hands; it can occur in the first year or two after surgery or as much as 10 or 20 years later, though that is much less common. The treatment for lymphedema has four components: education about skin care, compression, manual lymphatic drainage or massage, and exercise. Compression is really the mainstay, and some patients must continue to wear a compression garment long-term to keep the swelling under control.

“Only a small percentage of patients are afflicted with lymphedema, but it is critical to recognize it immediately and begin treatment,”

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