Physical TherapyPhysical Therapy
Information provided by Nancy J. Roberge, PT, DPT, M.Ed.If a person loses an arm or a leg, physical therapy is part of the standard rehabilitation process. But if a woman loses her breast, physical therapy is not routinely suggested. This is unfortunate, because early intervention by a physical therapist can help women regain full function following mastectomy surgery. Some of the specific post-mastectomy problems physical therapy can alleviate are described below. These problems can occur whether or not a woman has had reconstruction.
After mastectomy surgery, you may experience tightness emanating from your surgical site. This is caused by scar tissue, which is the body's way of healing from surgery. The result can be very dense tissue under your incision, which is painful and which can restrict your arm's range of motion (ROM). The restricted ROM puts you more at risk for a painful condition known as frozen shoulder. While a physical therapist (PT) may not be able to restore one hundred percent of your pre-surgery level of shoulder function, early treatment by a PT will make it more likely that you'll regain functional ROM and strength.
You may also have numbness and/or nerve sensitivity at your surgical site. Manual physical therapy can help restore sensation and relieve nerve pain. In severe cases, a chronic condition, known as post-mastectomy pain syndrome, may develop. This can be caused by scar tissue impinging on nerves. Physical therapy can be very effective at releasing scar tissue and thus reducing nerve-related pain.
Your body's balance and symmetry can be significantly altered after a mastectomy. This is something many women aren't prepared for. A PT can help you address this problem.
If you've had either a sentinel node biopsy or an axillary node dissection, your armpit area may be painful and movement may be restricted due to scar tissue. You may also develop axillary web syndrome, also known as cording. Cording presents as a moderately to severely painful tightening, which appears as “cords” that emanate from your axilla and extend down your arm, restricting ROM and arm function. Over time, this condition may resolve on its own, but with a PT's help, using manual therapy and therapeutic stretching, it's likely to resolve much more quickly.
If your treatment includes five to seven weeks of daily radiation after mastectomy surgery, this may further exacerbate posture and ROM problems by causing fibrosis and skin tightness. Manual therapy by a physical therapist can remediate these issues and, if initiated early, may prevent them from ever becoming a problem. After radiation, your skin may also be prone to excessive dryness and susceptible to cuts and abrasions. A PT can advise you about a good skin care regimen.
If you've had lymph nodes removed, especially if lymph node surgery is followed by radiation, your risk of lymphedema is higher than for other women. Many PTs believe that early physical therapy intervention after surgery and radiation can reduce that risk. While there are not yet studies proving this, the theory is that manual therapy to minimize scar tissue and fibrosis, along with education on risk-reducing strategies (including a good skin care regimen), will help prevent lymphedema.
Finding the right physical therapist is critical to getting the appropriate care. You should ask your doctor for a referral to a PT who works with oncology patients, ideally one who specializes in working with breast cancer patients. Many health insurance plans will cover a course of physical therapy after breast cancer surgery. To find a PT in your area who works with the oncology population, call the American Physical Therapy Association (800-999-2782), Oncology Section, or utilize their website's Find a PT section, where you can search for a PT with oncology expertise.