Physical Therapy after Breast Cancer Surgery

Breast Cancer. We all seem to know a friend or family member who’s had it, or have had it ourselves. We also seem to be familiar with the methods associated with treating it...chemotherapy, radiation, medications, diet modification...but what about physical therapy? When you break a bone or sprain a ligament and are immobilized for a period of time you are automatically prescribed PT, why not when you are post-op breast surgery? We’ve asked the same question. Possible surgical procedures with diagnosis of BrCA:

1. Sentinel Lymph Node Biopsy (SNLB)

2. Axillary Lymph Node Dissection (ALND)

3. Lumpectomy

4. Mastectomy

5. Reconstruction (Expanders, Silicone or Saline implants, TRAM flap, LDF flap, gracilis flap, DIEP, SIEA, GAP)

Possible activity restrictions after surgical procedures:

1. No lifting arms above 90 degrees

2. No driving

3. No heavy lifting > 5lbs for several weeks

4. No lying on stomach

5. No wearing bras

6. No stretching anywhere from 1-6 weeks depending on procedure as per surgeon

7. No strengthening anywhere from 2-12 weeks depending on procedure as per surgeon

While these surgical procedures can be extremely helpful in addressing the cancer itself, any of these surgical procedures and the precautions that immediately follow can affect how well you can move your shoulder and arm while performing your daily activities. Activities like dressing, bathing, combing your hair, taking care of your kids and working out can be difficult from resulting pain, stiffness and weakness. Focus tends to be on the resolution of the cancer, however oftentimes the residual physical impairments are not addressed! So, what can physical therapists do to help?

• Manual Soft Tissue Mobilization: addresses neck, shoulder and upper back range of motion and flexibility loss secondary to soft tissue restrictions in muscle and connective tissue

• Joint mobilization: Restore proper joint motion to shoulders, cervical spine, rib cage and thoracic spine to normalize motion

• Scar work: decreases restrictions and sensitivity through gentle scar mobilization

• Flexibility and strengthening exercises to address shoulder range of motion loss and weakness

• Education regarding proper posture with activities of daily living and protection of surgical site

• Assess and treat lymphatic cording

• Recommend compression garments and provide referral to lymphedema specialist when necessary

What is an Initial Evaluation and treatment session at Zion PT like? Your physical therapist will introduce themselves and take you into a private treatment room where you will discuss your past medical history, interventions thus far and any restrictions recommended by your surgeon. You therapist will then do a physical evaluation performing the following:

• Circumferential measurements of the upper extremities to determine presence of lymphedema

• Scar closure and mobility assessment

• Posture assessment

• Upper body Range of motion testing

• Upper body Strength testing

• An in depth conversation regarding individual patient goals

• Outline a plan of care, frequency of treatment and foster communication with your surgeon/oncologist

Following the evaluation, individualized manual therapy and exercises to achieve all ROM, strength and function goals will be outlined and performed and you will be sent home with follow-up exercises and a plan of care at a frequency agreeable to both you and the PT based on your needs! We at Zion Physical Therapy are focused on optimizing quality of life for all of our patients! If you’d like to make an appointment with one of our skilled physical therapists, please call (212) 353-8693 or email schedule@zionpt.com