Tag Archives: Edema

post mastectomy physical therapy

Post-Mastectomy Physical Therapy

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The word cancer is a scary one. Even though we all hope that it never becomes part of our lifetime of trials, more often than not, we know someone that has had, or is currently dealing with cancer. It is a testament to the medical community that so many women are able to wear the pink ribbon as a sign of triumph and pride, but we still mourn with those that wear it as a sign of remembrance and loss. More than once, while talking with women that have begun treatment for breast cancer, the topic of whether or not to have a mastectomy has come up. It’s not a decision taken lightly, often one with multiple concerns about what happens after surgery. Will the cancer be gone for good? Will it hurt? How long will it take to recover? A physical therapy post mastectomy program can help address these issues.

Physical Therapy can’t answer all of those questions, but one thing a physical therapy post mastectomy program can do is aid in the overall recovery process by focusing on regaining strength and increasing the range of motion in your shoulder and arm. Early intervention by a physical therapist can help women regain full function following mastectomy surgery, regardless of whether or not a woman has had reconstruction. Rehabilitation is always tailored to each patient’s specific needs. Not every patient experiences the same recovery, and as such physical therapists are prepared to help patients experiencing a multitude of symptoms – some have been highlighted below.

Size, location and the type of mastectomy are important considerations when choosing a type of treatment. Exercises to maintain shoulder range of motion and arm mobility may be prescribed as early as 24 hours after surgery.  These exercises are important in restoring strength and promoting good circulation. As rehabilitation progresses these exercises may be modified to meet new goals.

After mastectomy surgery, patients may experience tightness around the surgical site. This is caused by scar tissue formation. The result can be very dense tissue under the incision, which is painful and can restrict range of motion.  The restricted range of motion puts a woman at risk for a painful condition known as frozen shoulder. Early treatment by a physical therapist can help reduce the pain and help regain functional range of motion and strength.

Numbness and/or nerve sensitivity at the surgical site can develop post-mastectomy. Manual therapy can help restore sensation and relieve nerve pain. In severe cases, a chronic condition known as post-mastectomy pain syndrome may develop.  This is caused by scar tissue impinging on nerves. Physical therapy can be very effective at releasing scar tissue and reducing this nerve related pain.

Axillary node dissection can lead to a condition known as cording or axillary web syndrome.  Cording presents as a moderate to painful tightening, which appears as “cords” emanating from the armpit and extending down the arm. Cording significantly restricts range of motion and arm function. Manual therapy and therapeutic stretching helps to resolve this condition quickly.

Radiation treatment after mastectomy surgery can exacerbate posture and range of motion problems, causing fibrosis and skin tightness. Manual therapy can remediate these issues and may prevent them from ever becoming a problem.

The Benefits of Exercise and Physical Therapy post mastectomy treatment programs can differ greatly as seen above, but there are a few benefits that all patients can benefit from:

  • Improved shoulder range of motion
  • Improved shoulder strength
  • Improved functional mobility
  • Improved posture
  • Decreased pain at the surgical site
  • Decreased edema on the affected side
  • Improved sensation at the surgical site

Meeting with a physical therapist before surgery can help you feel more at ease and more confident in your overall recovery goals. It’s never too early to ask questions! To find a physical therapy clinic near you click here.

For more information on cancer related physical therapy programs click here:

    

 

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Lymphedema

What are the Signs and Symptoms of Lymphedema?

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Lymphedema

Lymphedema can occur in any body part. Some common early symptoms include:

  • Tightness, swelling or thickening anywhere in the extremity. Initially the swelling may fluctuate but over timeit worsens.
  • A burning sensation or tingling sensation radiating down the extremity.
  • Complaints of heaviness or aching of the extremity.
  • Inability to wear rings, jewelry, watches or clothing secondary to edema.

STAGE 1 – Reversible Lymphedema

  • Lymphedema disappears with bed rest and/or elevation especially over night.
  • Edema is soft and pitting, no resistance is felt. Indentations are easily made.
  • No or little fibrosis. No alteration of tissues.

STAGE 2 – Irreversible Edema

  • Protein enriched edema which does not decrease with elevation/nights rest.
  • Connective and scar tissue formation (i.e. fibrosis). Fibrosclerotic changes.
  • Non pitting edema, strong pressure is able to produce pitting.
  • Edema becomes hard. Indentions are difficult to make.

lymphedema

Precautions and Guidelines

  • Maintain a well balanced diet, with low sodium intake. Keep a healthy weight, avoid obesity. Good nutritional guidelines are provided by the American Heart Association and the American Cancer Society.
  • Keep the affected arm or leg, clean, and well moisturized. Lotion should be at a relatively low pH balance. The goal is to prevent skin breakdown.
  • Use antibacterial and hypo-allergenic soap when washing.
  • Avoid injections, vaccinations, flu shots, blood draws and IV lines in the affected extremity. Remember, if this is an emergency, it is more important to treat the patient than to worry about putting an IV in the affected arm.
  • If at all possible, avoid having blood pressure taken in the affected arm.
  • Many people enjoy having a manicure. There is always a risk with this but you can decrease your risk by keeping your cuticles moist with lotion and push them back instead of cutting them. You could also consider buying your own manicure set and have the salon use only your tools.
  • When cleaning the house, wear a good quality rubber glove when handling harsh chemicals such as ammonia, bleach, furniture polish, abrasive cleansers etc.
  • Avoid using a razor or depilatory creams for the armpit or leg hair. The safest tool would be an electric razor.
  • When cooking, wear long protective mitts (to the elbow) when taking food out of the oven and when boiling a pot of hot water.
  • It is important to avoid pet scratches, insect bites, spider bites etc. Using an insect repellent may be necessary but remember some brands are very harsh. Look for a natural insect repellent if possible.
  • Avoid sunburn at all cost! Especially if you have received radiation therapy.
  • Be aware of items that can cause a burn such as a curling iron, an iron, space heaters etc.
  • Avoid saunas, hot tubs, and hot showers. Avoid extreme temperatures, very cold or very hot.
  • Avoid lifting or moving heavy objects.
  • Avoid tight fitting clothing or jewelry.
  • Exercise, and be knowledgeable of how exercise effects the lymphedema.
  • Check your skin daily, and call your physician immediately if you notice any adverse changes in your lymphedematous body part or if you have fever and redness.

 

Additional Precautions for Leg Lymphedema

  • Proper shoe wear is essential in avoiding blisters and ingrown toenails, avoid high-heeled shoes.
  • Do not walk bare foot, especially outside.
  • Get all fungal infections treated immediately.
  • Do not receive injections to remove varicose veins in the affected leg.

This information is for educational purposes only. This information should not be used without consultation with your healthcare professional. If you have questions regarding the material or its application, seek professional assistance from your provider. This information is not intended to diagnose any medical condition or to replace healthcare professional consultation.

 

physical therapy during pregnancy

Physical Therapy for the Pregnant and Postpartum Woman

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If you are encountering problems during your pregnancy, don’t stress. Many women are able to find pain relief by going to physical therapy during pregnancy. A licensed physical therapist, specifically trained in women’s health, can evaluate and address the physical issues affecting you. Some of the techniques a PT would use in alleviating these discomforts are postural awareness/education, individualized stretching and strengthening programs, soft tissue mobilization/myofascial release (types of massage), breathing exercises, bladder education and pelvic floor strengthening. A PT can also assist you in implementing an exercise regimen that is safe and easy to take part in no matter what your level of fitness. All of this is performed in concurrence with your OB/GYN’s care.

Musculoskeletal complaints of the Pregnant Woman:
• Postural stresses (accentuated lordosis)
• Pelvic girdle instability pain
• Back pain or SI joint dysfunction
• Round ligament pain
• Nerve entrapment syndromes: carpal tunnel, tarsal tunnel, thoracic outlet syndromes
• Neck pain
• Foot or Ankle pain (especially overuse of the gastrocnemius muscles due to COG shifted anterior)
• Tendinitis: lateral epicondylitis and trochanteric bursitis
• Circulatory problems:
• Lower leg cramps
• Edema in lower extremities
• Groin / coccyx pain
• Urinary complaints (due to reduced bladder capacity as the fetus pushes on the bladder ): stress or urge incontinence

Musculoskeletal complaints of Postpartum Woman (effects of hormonal laxity):
• Diastasis Recti
• Symphysis pubis separation
• C-section scar or episiotomy scar adhesions/pain
• Pelvic floor Dysfunction: pain with sexual activity
• Postural stresses: nursing, holding and carrying baby
• Low back pain or SI joint dysfunction
• Urinary complaints (due to weakness of the pelvic floor muscles / trauma during labor and delivery)
• Stress Incontinence
• Urge incontinence

baby

EXERCISE CONSIDERATIONS:
Goals and benefits of exercise for the Pregnant Woman:
• Promotes good posture
• Increases or maintenance of aerobic fitness
• Improves muscle tone
• Improves sleep
• Prevents low back pain
• Reduces risk of gestational diabetes
• Improves physiological and psychological health
• Prepares mom for labor and delivery

Goals and benefits of exercise for the Postpartum Woman:
• Faster recovery from labor and delivery
• Increases endurance for taking care of self and baby

Make the right choice today. Ask your doctor how physical therapy can help you!

This information about physical therapy during pregnancy was written by by Rachna Mehta, PT, DPT, CIMT – Hamilton Physical Therapy Services, L.P. in Hamilton, NJ. Hamilton Physical Therapy Services is a well established provider of rehabilitation services in Mercer County since 1978. They take pride in offering personal and compassionate care with a patient-centered approach helping transform lives, one life at a time. For more information click here.