Physical therapy for the
patient with breast cancer
Physical therapy treatment can be useful in addressing musculoskeletal impairments and lymphedema that can sometimes occur after treatment for breast cancer. Side effects of radiation and surgery can include development of tightness and adhesions that may limit mobility and function. Another side effect of these treatments is an increased risk of developing lymphedema, a chronic condition whereby protein-rich fluid accumulates in a particular body part. Breast cancer patients are at risk for developing lymphedema in their arm and/or chest on the affected side. Lymphedema therapists can help patients return to their pre-cancer level of function and educate them in strategies to decrease risk of lymphedema.
Helping patients to regain mobility and function
While completing treatment for breast cancer, many patients notice decreased mobility, strength and function. At this point in their journey, they are working to get back to the "normal" life they had prior to diagnosis. Physical therapists are trained to work with patients to address musculoskeletal impairments and dysfunctions, helping them reach their goals and improve functional ability and quality of life. With a referral from a physician, patients may begin physical therapy. The therapist performs an evaluation on each patient to determine impairments and goals and then works with the patient to develop an individualized treatment plan. Treatment may consist of patient education to learn more efficient ways to perform daily activities, therapeutic exercise to increase strength and mobility, neuromuscular reeducation to improve posture and muscle coordination, and manual therapy to decrease pain, decrease soft tissue restriction, break down scar tissue, and improve joint mobility.
Another area addressed by specially trained physical therapists is lymphedema. Lymphedema is an accumulation of proteins and fluid due to decreased functioning of the lymphatic system. In the United States, breast cancer treatment is the most common cause of lymphedema. Patients who have been treated for breast cancer are at risk for developing lymphedema in their arm, breast/chest or trunk on the affected side. While lymphedema is not curable or preventable, it is treatable and manageable. The ability to effectively manage lymphedema increases when it is diagnosed and addressed early.
Strategies to reduce risk of lymphedema
- Avoid having blood pressure measurements, blood draws and injections/needle sticks on the affected side.
- Avoid infections
- Wear gloves/long sleeves with yard work, heavy housework, etc.
- Use insect repellant
- Minimize risk of cuts/scrapes - in case of a cut, wash the area well, treat with an antibiotic ointment, and monitor for signs of infection
- Use sunscreen
- Keep the arm/chest clean, dry and moisturized
- Avoid injury
- Exercise regularly, but don't push past your own limitations
- Avoid extreme temperatures
- Avoid constriction
- Avoid tight gloves, jewelry and tight bands on wrist, arm, chest, etc.
- Avoid carrying purses or bags on the affected shoulder
- Avoid tight bras
- Consider wearing a compression sleeve and glove when traveling by air
- Maintain optimal weight, stay hydrated and avoid excessive salt intake
Complete Decongestive Therapy (CDT) is the current gold standard in the treatment of lymphedema. CDT consists of two phases designed to decrease lymphedema and manage the condition over the course of one's life.
Phase 1: Treatment (acute)
- Skin and nail care - to reduce risk of infection
- Manual lymph drainage - specific type of massage designed to increase lymph production and lymph flow
- Compression bandaging - application of layers of short stretch bandages and foam that create a compression gradient
- Creates low resting pressure and high working pressure, and allows bandages to be worn from one visit to the next.
- Prevents accumulation & increases ultrafiltration of fluid
- Exercises to increase lymph flow
- Self-care training
Phase 2: Independent management (long term)
- Compression garments for daytime - such as a compression sleeve and glove
- Compression bandaging or garment for night
- Skin and nail care - to prevent infection
- Exercises to increase lymph flow
- Manual lymph drainage - as needed
- Follow-up visits - as needed to ensure successful long-term management
Training of lymphedema therapists
Certified Lymphedema Therapists (CLTs) are licensed medical professionals who have completed 135 hours of coursework in Complete Decongestive Therapy (CDT). The education must take place through an approved program and include both didactic and practical components. Each practitioner must pass written and practical examinations in order to obtain certification as a CLT.
Once a CLT has practiced for one year, he or she is eligible to sit for a national examination to be certified by the Lymphology Association of North America (LANA). Upon passing this examination, the therapist becomes nationally certified by the LANA. His or her credentials are then denoted as CLT-LANA. In order to maintain this certification, therapists must complete a number of hours of continuing education in lymphedema.
Community Health Network currently has five CLTs, two of whom have also obtained national certification (CLT-LANA). These therapists are all part of the outpatient Rehab & Sports Medicine team and serve patients in the north, east and south markets of Indianapolis. These therapists work with the rest of the medical team to help each patient with breast cancer achieve an optimal level of function as part of their treatment and recovery.