Guest Columnist: Gary E. Mattingly, PT, PhD
Donna, Mary, Patty, Louise are four physical therapy patients. These four women have many things in common. All were diagnosed with breast cancer, all had mastectomies, all had radiation and chemo, all lost their hair, and all had complications resulting in tight painful shoulders.
Currently, conventional management for early stage breast cancer is mastectomy with either sentinel lymph node biopsy and/or axillary dissection. In addition, radiation therapy, chemotherapy, and hormone treatments may be used as additional therapies. Of those who have surgery, 7 out of 8 experience some ongoing problems with shoulder/arm function. Sometimes these problems are minor and other times these problems can have a major impact on the individual’s life. The shoulder and arm problems identified by women after treatment for breast cancer include arm and breast swelling (lymphedema), shoulder stiffness, weakness, pain and numbness. Most of these problems are present within 3 months of surgery and many do not resolve up to 2 years after surgery. Most of these symptoms are attributable to surgery involving the axilla (arm pit) and to radiation treatments but sometimes shoulder /arm complications can arise from lumpectomies or even simple biopsies.
Shoulder/arm problems caused by treatment of early breast cancer is associated with reduced quality of life. These problems cut across many aspects of quality of life including role, emotional, social, and physical functioning as well as body image and lifestyle. Women with these problems experience long-term difficulties in everyday activities which most of us take for granted, such as an inability to sleep on the affected side, drive, dress, and wash one’s hair. For some women, these impairments become a psychological burden possibly due to the belief that they may never return to full capacity. As a result, for many women, the “cure” produces another whole layer of health problems.
Physical therapy can be very effective in treating these shoulder/arm problems. Treatment for these shoulder complications always begins with a complete evaluation of the shoulder to determine the source and extent of the problem. A program is next developed to regain the lost shoulder motion and to reduce the pain and the swelling in the shoulder. Depending on the severity of the problem, treatment may last a few weeks to several months.
If you are experiencing shoulder problems following breast cancer treatment there are many things that you should do. First, make sure that your doctor is aware of these problems. Not everyone that undergoes breast cancer treatment has shoulder complications. Next, listen to your doctor. The doctor will give you simple exercises to address the problem. If you continue to have problems, physical therapy should be the next step. Seek out a physical therapist that has experience treating these specific problems.
The following are exercises that might prove helpful in treating shoulder problems associated with breast cancer treatment. Before you attempt these exercises, ask your doctor if these exercises are appropriate for your particular case.
Overhead Wand - For this exercise and all the following exercises you will need a light-weight pole or wand. Many common items can work quite well as a wand including a wooden dowel, plunger, old broom handle, a ski pole or cane. While lying on your back on the floor or on your bed, hold the wand with your hands being a little wider than shoulder length apart. With elbows straight, slowly raise the wand over your head. Stop the movement when you begin to feel a gentle stretch. Hold the stretch for 20 seconds. At no time should you experience pain.
Side to Side Wand - While lying on your back, grasp the wand with your hands being a little wider than shoulder length apart. With the wand reach straight up toward the ceiling. Next move the wand as far as you can to the right. Stop the movement when you begin to feel a gentle stretch. Hold the stretch for 20 seconds. At no time should you experience pain.
Behind the Back Wand - While standing with the wand behind your back. Move the wand up your back as high as possible. Stop the movement when you begin to feel a gentle stretch. Hold the stretch for 20 seconds. At no time should you experience pain.
Dr. Gary Mattingly is a physical therapist with a doctorate degree in anatomy. He is a professor at the University of Scranton, Physical Therapy Department. His research and clinical practice is almost exclusively dedicated to the shoulder. Recently, he has presented his research on the evaluation and treatment of frozen shoulder in post-mastectomy patients at a national medical meeting.
Visit your doctor regularly, and listen to your body.