Breast Cancer. How Physio can help.

The most common treatment for breast cancer includes chemotherapy, surgery, radiotherapy and hormonal therapy. Your treatment plan may include some or all of these, exposing you to some of the following side effects:

Some of the physical symptoms you may experience are:

  • Axillary Web Syndrome or cording
  • Post-surgical scar tissue tightness
  • Reduced range of movement
  • Radiotherapy tissue tightness
  • Cancer related fatigue
  • Capsular breast

These symptoms explained:

Axillary Web Syndrome or cording as it is more commonly known, can be a side effect of breast or axillary surgery.

  • Up to 72% of people undergoing axillary surgery (ALND) and approximately 20% of those undergoing breast surgery (SLNB) can be affected by cording. Most patients with Breast Cancer will require one of these surgeries.
  • Hypothesised to be caused by inflammation, thickening and eventual hardening of nearby bundles of blood and lymph vessels or scar tissue tightness in the surrounding area.
  • Symptoms:
    • See and/or feel a ropelike (below skin) structure extending through your armpit and/or into your arm. This generally begins near your scar and there may be one or many ‘cords’. It can also extend down the side of the trunk.
    • New sensation of pain and/or tightness/stretching through the area restricting your overall arm elevation, particularly to the front or side of your body
  • These symptoms typically present several days or weeks following your surgery, however it can also present several months later.
  • Can be problematic if the new loss of shoulder range is delaying your radiotherapy treatment as you are unable to reach the required treatment position.
  • Physiotherapy is extremely effective in resolving cording through hands on techniques and increasing your overall range, allowing you to return back into your activities of daily living at a quicker rate.

Post-surgical or radiotherapy scar tissue tightness

  • Scars are a natural part of your body's healing, however some can cause irritation and for some, they find their scars unsightly.
  • Following surgery and/or radiotherapy, you may have scar tissue that can feel tight, hard and lumpy. This can be around your surgical scar site but also throughout the entire region affected by surgery or radiotherapy.
  • Following reconstructive surgery, this can cause a change in breast and/or chest wall appearance, making it appear a little firmer or rounder, restricting your breast movement and your overall shoulder elevation.

Reduced range of movement

  • With the surgical and/or radiation trauma to the breast, tummy, back and/or shoulder regions you may experience a decrease in your range of movement in these areas due to soft tissue tightness.
  • This can affect your everyday normal way of life, eg washing your hair or driving.

Radiotherapy tissue tightness

  • Radiotherapy can make your muscles and joints in the involved area feel irritable and stiff. You may initially have some skin changes however you may not notice any loss of range/stiffness initially.
  • It is thought that the effects of radiotherapy can occur gradually up to 1-2 years post the completion of your treatment.
  • Regular exercise or stretching of the the involved shoulder through its entire range (i.e. swimming or tennis) is believed to help prevent these changes from occuring.

Cancer related fatigue 

  • Cancer related fatigue is a huge issue and effects 70-100% of cancer patients. It can be extremely debilitating.
    • Can persist for months or years following completion of treatment
    • Can interfere with simple activities of daily living
    • Hinder chances for remission
    • Affect ability to continue with treatment
    • Social and economic consequence
  • Many patients continue to believe that rest is vital for energy conservation during and after treatment however this has been shown to exacerbate the treatment related loss of function.
  • Physical activity in research continues to show no exacerbation of fatigue during treatment and significant improvement in fatigues levels post treatment
  • It involves starting slowly and gradually building up - managing your ‘fatigue battery’

Capsular breast

  • This typically presents with pain and stiffness in your reconstructed breast and over time you may notice a change in shape to your breast or loss of shoulder range. This can occur from internal scar tissue developing around your implant. 
     

How can specialist oncology physiotherapy help:

  • The good news is that cording can be significantly improved through manual releasing of the cords and gentle stretches. It commonly resolves itself within 2-3 months but you should notice an immediate improvement with your range of motion and functional ability with physiotherapy.
  • Physiotherapy helps with gentle scar release & muscle tightness, reducing your irritability and increasing your range through the area involved.
  • Soft tissue release and gentle stretches can give you back your range of motion. It is important that you are taught a home exercise program in order to prevent the radiotherapy effects to your breast and shoulder.
  • Megan Oster is able to build a personalised exercise programme to help with fatigue: focusing on your own goals and enabling you return to work, sport and life. 

Emotional support

Coming to terms with the physical and psychological changes in your body can be hard. Megan has years of experience and can assist by reducing the physical changes to your body whilst empowering you through a bespoke exercise plan, giving you a sense of control during a time where you have so little. These testimonials say it all.

The specialist oncology team are based out of Chelsea; if you would like to speak to either Megan or Gemma in confidence then please send them an email.