Breast Cancer Physiotherapy and Rehabilitation Mississauga

Physiotherapy in cancer

    There is a growing evidence base reporting the physiological and psychological benefits of physiotherapy as a safe and effective adjunct to breast cancer treatment. With survival rates at an all time high the National Cancer Survivorship Initiative (NCSI) Vision (Department of Health) has stated that health professionals must now focus on meeting the unique needs of breast cancer survivors and improve accessibility to specialist services, including physiotherapy. A panel of experts convened by the American College of Sports Medicine concluded that exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life and cancer-related fatigue in several cancer survivor groups.

Preoperative Exercise Therapy (PET)

The most important finding of from research that PET based on moderate to intense exercise in patients scheduled for lung surgery has beneficial effects on aerobic capacity, physical fitness, and quality of life. Also, this may reduce postoperative complications and length of hospital stay.

The breast cancer patient is also quite susceptible to the development of symptomatic rotator cuff disease, which can be brought on through intrinsic factors such as age-related physiological changes to the tendons, or through extrinsic factors brought on from cancer treatment such as lymphedema as well as shoulder girdle resting alignment. Tension overload on the rotator cuff tendons may be increased secondary to increased volume and weight of the effected limb with the presence of lymphedema.

Complex decongestive physiotherapy

 Is the effective therapy for lymphedema? This is a treatment that incorporates skin hygiene, manual lymph drainage, and bandaging, exercises, and support garments. Manual lymphoedema drainage is a massage technique that involves the skin surface only. This follows the anatomical lymphatic pathway. Generally, the manual lymph drainage technique will begin centrally in the neck and trunk to alleviate any lymphedema in the main lymphatic pathway, so that drainage in the arm is facilitated. Complex decongestive physiotherapy has been suggested as the primary treatment for breast cancer patients.

Upper Extremity Rehabilitation

Preoperative, bilateral upper extremity function should be assessed to provide a baseline before treatments.

Postoperative Physiotherapy

• Should begin the first day following surgery.
• Gentle range of motion exercises should be encouraged the first week after surgery.
• Active stretching exercises can begin week 1 after surgery, or when the drain is removed, and should be continued for 6 to 8 weeks or until full range of motion is achieved in the affected upper extremity. Women should be instructed also in scar tissue massage.
• Postoperative assessments should occur regularly up to 1 year after surgery. Progressive resistive exercises, that are strengthening, can begin with light weights (1-2 pounds) within 4 to 6 weeks after surgery.
• Hand and Arm Care—for example, proper hygiene and avoiding trauma to the arm—is important to minimize risks of infection and lymphedema. Specific treatment-related and host-related factors contribute to the increased risks of complications.
• Minimizing the extent of axillary dissection, preventing infection, and avoiding obesity, for example, may help prevent the development of lymphedema.

     Generally, injections, vaccinations, venipuncture, and intravenous access in the axillary-dissected upper extremity have been contraindicated. There is some evidence (Level V) that these restrictions can be relaxed. Many suggestions regarding proper hygiene and trauma avoidance for the axillary-dissected upper extremity are sensible, but there is little scientific literature to support these restrictions.

Assessment and Diagnosis of Lymphedema at Curezone Physiotherapy

• Evidence supports early lymphedema diagnosis and referral for therapies to reduce patient burden.
• Pre-and postoperative measurements of both arms are useful in the assessment and diagnosis of lymphedema.
• Circumferential measurements should be taken at 4 points: the metacarpal-phalangeal joints, the wrists, 10 cm distal to the lateral epicondyles, and 12 cm proximal to the lateral epicondyles.
• Clinicians should elicit symptoms of heaviness, tightness, or swelling in the affected arm. A difference of more than 2.0 cm at any of the 4 measurement points may warrant treatment of the lymphedema, if tumor involvement of the axilla or brachial plexus, infection, and axillary vein thrombosis has been ruled out.

Interventions for Lymphedema by our Registered Physiotherapist

• Practitioners may want to encourage long-term and consistent use of compression garments by women with lymphedema.
• Compression garments should be worn from morning to night and be removed at bedtime. Patients should be informed that lymphedema is a lifelong condition and that compression garments must be worn daily.
• Patients can expect stabilization and/or modest improvement of lymphedema with the use of the garment in the prescribed fashion. The Supportive Care Guidelines Group endorses the recommendations from the Steering Committee for Clinical Practice Guidelines for the care and treatment of breast cancer.
• Compression bandaging, a systematic application of short-stretch bandages with various types of padding, is recommended for practice.
• Complex physical therapy, manual lymph drainage, compression and massage therapy are associated with volume reductions.

Physical Activity/Exercise

• It is reasonable to encourage all patients to engage in a moderate level of physical activity during and after cancer treatment, eg, 30 minutes of moderate activity most days of the week.
• Exercising several times per week (including walking, cycling, resistance exercise, or a combination of aerobic and resistance exercise) can be effective in reducing fatigue during and following cancer treatment. Some patients may require referrals to exercise specialists in fields such as physical therapy, physical medicine, or rehabilitation for assessment and an exercise prescription.
• Interventions for Patients after Treatment Maintain optimal level of activity. Consider initiation of exercise program of both endurance and resistance exercise. Consider referral to rehabilitation: physical therapy, occupational therapy, physical medicine.
• The exercise program should be individualized based on the patient’s age, sex, type of cancer, and physical fitness level. The program should begin at a low level of intensity and duration, progress slowly, and be modified as the patient’s condition changes.
• Other Considerations for Cancer-Related Fatigue The guidelines for fatigue are best implemented by an interdisciplinary institutional committee, including representatives from the fields of medicine, nursing, social work, physical therapy, and nutrition.

Curezone Physiotherapy, Mississauga is a team of providers providing treatments in various musculoskeletal health conditions including Lymphedema and pre and post exercise programs. 

Make sure you book your appointment today and get assessed by our physiotherapist now at 905 997 4333