The Basics of Breast Cancer and Physiotherapy

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
• Lymphedema

These symptoms explained:

1. Axillary Web Syndrome (Cording)

• 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.
• Cording is believed 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
  • 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.

2. Scar tissue tightness

• Scars are a natural part of your body’s healing, however, some can cause irritation or loss of range of motion, 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.

3. Reduced range of motion

• 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 normal daily activities like washing your hair or driving.

4. Radiotherapy tissue tightness

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

5. Cancer-related fatigue (CRF)

• CRF is a huge issue that affects 78-96% 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
  • Hinders chances for remission
  • Affects ability to continue with treatment
  • Can impact a patient’s social life and economic welfare by limiting their ability to participate in social and work-related functions
• 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.
• Research continues to show that physical activity causes no exacerbation of fatigue during treatment and leads to significant improvement in fatigue levels post-treatment
• It involves starting slowly and gradually building up – managing your ‘fatigue battery’

6. 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.

7. Lymphedema

• A buildup of fluid under the skin in the fatty tissues.
• Most commonly seen in the arms and legs but can also be present in the face and neck or abdomen and genitals depending on what area of the body was treated.
• Can be caused by cancer itself, surgery, radiation, or infection.
• There are many techniques that can help prevent and reduce lymphedema including wrapping, taping, massage and exercises.

How can specialized 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.
• Massage and other techniques can limit and reduce swelling in the extremities.
• Physio can help manage and relieve the pain that often accompanies these conditions.