Alexander Technique and Physical Therapy
The Alexander Technique


 
 
 

Physical Therapy

following the Diagnosis of Breast Cancer,
when Postural, Orthopedic, or Neurologic symptoms occur following surgery,
or at the Onset of Lymphedema (upper or lower extremity)

A comprehensive rehabilitation program in Physical Therapy is beneficial to the Breast Cancer Patient before and after surgery. An initial evaluation determines baseline shoulder function, circumferential limb measures, posture and flexibility, and fitness/activity level. The patient is instructed in post-surgical range of motion (ROM), resistive and aerobic exercises, lymphedema precautions, and guidelines for return to daily activities.

Following surgery, assessment findings include objective values on post-surgical ROM, strength and any girth changes of the involved upper extremity. Treatment protocol includes manual stretching and soft tissue massage of the shoulder girdle complex, instruction in proper posture, stretching and flexibility exercises that can be performed immediately following surgery, and an individualized program (based on the initial evaluation) to include aerobic exercise and resistive and flexibility conditioning through the use of free weights and cross-training on aerobic equipment.

The following lists areas affected by breast cancer surgery that may affect function, as well:

ANATOMY AFFECTED BY BREAST CANCER SURGERY
(In addition to breast tissue and axillary dissection/loss of lymph nodes)

Anatomy affected by mastectomy:
  1. Gleno-Humeral Joint
  2. Pectorialis Muscle
  3. Scapular Musculature
  4. Latissimus Dorsi Muscle
  5. Brachial Plexus
  6. Muscular and breast asymmetry
  7. Muscular guarding

     

     

 

 

 

Orthopedic and Postural Implications:
  1. Adaptive, harmful postural habit
  2. Neck pain
  3. Back pain
  4. Limited Range of Motion
    1. Arm
    2. Neck
    3. Upper back
    4. Low back

Neurologic Implications:

  1. Limb weakness; peripheral numbness

The physical therapist monitors participation in a supervised and progressive exercise program allowing the woman to take an active role in her physical recovery. The physical therapy program includes the Alexander Technique to restore a sense of control over the physical and emotional wellness of the patient in a manner that engages her body and mind.

Other components:

  1. Sit to and from Stand awareness exercise and variations.
  2. Exercises for mobility: head/neck, shoulders, arms.
  3. Exercises for arm strength.
  4. Gentle stretching for thoracic outlet.
  5. Breathing exercises: deep abdominal; accented exhalation
  6. Aerobic exercise component.

The goal: to accelerate healing and improve functional use of the arm and return to function in every aspect of life.

Re-assessment of the patient at the end of a 10-week period determines progress: changes in function, posture, flexibility and strength.

LYMPHEDEMA MANAGEMENT (Upper and Lower Extremities)

When a breast cancer patient develops a sense of heaviness, discomfort, or swelling in the arm or breast on the affected side of the surgery, an evaluation with a physical therapy lymphedema specialist will identify and classify the likely onset of lymphedema and determine precautions and the proper course of treatment.

Edema of lymphedema is unique. It is not just "water" accumulation. Lymphedema is the swelling in the tissue of protein-rich fluids including the more "solid" components of heavier protein molecules, broken cells, and bacteria cells. If left to stagnate the lymph fluids may cause changes in skin texture: pitting and fibrosis, a breeding ground for potential infection. If left untreated, the person with lymphedema is vulnerable to infection of cellulitis or lymphangitis.

The physical therapist specialist in lymphedema designs an appropriate program of treatment based on medical history, assessment, and consideration for the patient's condition, ability, and life style. Typically, the physical therapy protocol, referred to as Complete Decongestive Physiotherapy, includes: massage technique (Manual Lymph Drainage), compression bandaging of the limb, instruction in therapeutic exercise, deep breathing, and self-massage.

The same assessment principles dictate the treatment protocol for Lower Extremity Lymphedema. Whether due to venous or lymphatic insufficiency, following surgery or radiation therapy, a program of manual lymph drainage, compression, and exercise helps the patient reduce the limb and instruction in self-management skills helps maintain gains.

In addition a comprehensive fitness program, including flexibility, resistive, and aerobic activities may be recommended for the lymphedema patient according to ability and life style considerations. It is also wise to follow up with evaluation at scheduled intervals to take girth measures of the affected and unaffected limb and assess edema or skin changes and determine the success of the self-management protocols and make necessary adjustments should conditions change. Copyright, Idelle Packer, 2007

Resources:
Smith JK, Miller LT. Management of patients with cancer-related lymphedema. Oncology Nursing Updates: 1998;5:1-12.

summary, Breast Cancer Related Lymphedema
Anatomy of Lymphatics
Kinesio Taping for lymphedema

Photos of a physical therapy visit with Martha Ruppert, cancer survivor

"Often it's not apathy but lack of knowledge among health care professionals that leaves lymphedema untreated."
      Linda T. Miller, PT, Recovery in Motion, Breast Cancer Physical Therapy Center, Philadelphia, PA