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Breast Cancer and Shoulder Exercises

14

Filed Under (Fitness, Scapular Stabilization, Shoulder Injury, Shoulder Pain) by Rick Kaselj



Today was the day to dig into what is new in the research world.

To be honest, I started it in yesterday’s blog post.

In yesterday’s blog post I talked about new research in muscle imbalances.

Yes, there is research about it. More and more keeps coming out.

Now to today’s research.

Harrington S, Padua D, Battaglini C, Michener LA, Giuliani C, Myers J, Groff D. (2011). Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants. J Cancer Surviv. 2011 Jan 12. [Epub ahead of print]

I know this is a little new for me, to be talking about breast cancer and exercise.

I have been having more questions about this of late, plus it reminds me of the group of breast cancer survivors that I trained while working in Penticton, BC, Canada.

The ladies were a group from a local Dragon boating team that were all cancer survivors.  It was amazing to train these ladies and they were so much fun.

Here we go into the research.

What They Looked At:


They compared cancer survivor shoulder function with healthy subjects.

They looked at active and passive shoulder range of motion for shoulder extension, flexion, external rotation at 0° and 90° of abduction, internal rotation at 90° of abduction.

Plus they looked at the strength of scapular upward rotation and abduction, scapular adduction and depression, internal rotation, flexion, external rotation, scaption, and horizontal adduction.

What They Found:

 
They found that there was a significant difference between the groups

Decreased Range of Motion in:

  • active flexion
  • active 90° external rotation
  • active extension
  • passive flexion
  • passive 90° external rotation

Decreased Strength in:

  • scapular abduction
  • upward rotation
  • depression
  • scapular adduction
  • flexion
  • external rotation
  • internal rotation
  • scaption
  • adduction

Take Home Message

 
Assessment of the Breast Cancer Client – They suggest that the above should be tested at the start of an exercise rehabilitation program for a client recovering from breast cancer.

Exercises to Focus In On – The above gives you an idea of the movements to focus on when it comes to your exercise rehabilitation program with a breast cancer survivor.

I have to step away from the computer, but I will go through these articles in a few minutes.

Yiasemides R, Halaki M, Cathers I, Ginn KA. (2011). Does Passive Mobilization of Shoulder Region Joints Provide Additional Benefit Over Advice and Exercise Alone for People Who Have Shoulder Pain and Minimal Movement Restriction? A Randomized Controlled Trial. Phys Ther. 2011 Jan 6. [Epub ahead of print]

Roy JS, Ma B, Macdermid JC, Woodhouse LJ. (2011). Shoulder muscle endurance: the development of a standardized and reliable protocol. Sports Med Arthrosc Rehabil Ther Technol. 2011 Jan 11;3(1):1. [Epub ahead of print]

I really enjoy looking at what is new in the research and learning how to better design exercise rehabilitation programs.

If you have any feedback, please do let me know by asking below.

Rick Kaselj, MS

P.S. – It looks like I won’t be able to get to the other two articles today.  Check back tomorrow and I will take them on.  Just want to let you know, I received this from a customer who got the Effective Rotator Cuff Exercise Program:

“I thought your effective rotator cuff exercises manual was great. It truly is an all inclusive look at the rotator cuff and covers even the minute details which can enhance your client/patient’s program. The information and easy to utilize exercise descriptions will be a big help with my patients.”
Kristen King, PT, DPT
Nashua, New Hampshire

Facebook comments:

Comments posted (14)

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Hey Rick!

Very interesting correlation!

Are there exercises programs designed specifically with cancer survivors in mind to counteract these limitations? Have they determined if the treatment of cancer was creating the problem, and if so, what treatment?

-Matt

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@Lean Muscle Matt

The exercise program would help them overcome the range of motion and strength issues.

The change in strength and range of motion is a result of the cancer treatment.

Rick kaselj

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I agree, I would have never guessed that there is a correlation between between ROM and shoulder strength in breast cancer survivors. I wonder why this is. And, is there a similar connection with other cancer survivors.

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Rick Kaselj Reply:

The range of motion and strength issues are due with the tissue that is taken out due to surgery.

It would be interesting to see how it is with other cancer survivors.

Rick Kaselj

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Rick, I’m with everyone here. Yes, it would be interesting to learn whether there is a similar correlation with other cancer survivors. Thanks for bringing this to light.

Tannis

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Rick Kaselj Reply:

Thanks Tannis.

Rick Kaselj

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Many of the changes that occur in the shoulder area of breast cancer patients are due to surgical intervention and the accumulation of post surgery scar tissue. Remember also that in some severe cases, part of the lats may also be removed- so knowing the type of surgery and how invasive it was is very important for the trainer. Secondly, breast cancer surgeries- whether lumpectomy, total mastectomy, or reconstrutive surgeries such as expanders or breast implants, are super painful! So, the patient often keeps the arm at the side post operatively and can develop frozen shoulder and the other above mentioned issues just from guarding that area due to pain. If you get a post breast cacner patient/client, they also may have been deconditioned prior to the cancer- so dysfunction is cemented in, and surgeries and therapies like radiation can make it worse.

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Rick Kaselj Reply:

Kathy,

Thank you so much.

That is great information about lats, different types of surgery, potential of frozen shoulder and client being reconditioned.

Thank you for sharing.

Rick Kaselj

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I underwent a double mastectomy in Jan 2010 and then reconstructive surgery Nov 2010, with 6 months of chemo in between. This involves cutting the pectoral muscle to remove breast tissue and in my case, inserting tissue expanders under the pec, and restitching. Therefore the pec is on constant stretch and will continue to be so as the implants are held in place by it.

If a woman has axial lymph nodes removed this causes further trauma to the area, and will give another scar and all that entails under the arm. So all in all a lot of trauma to the area, and think about the fascial implications of the pectoral muscle, serratus anterior being cut.

I used my Pilates knowledge to prepare for and recover from my mastectomy and I had full ROM in both arms 6 weeks post surgery, this is possible depending on how well conditioned your client was before hand.

Feel free to ask me any questions about this, I am happy to share my experience.

Melissa Turnock
Pilates Instructor and blogger
Sydney, Australia

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Rick Kaselj Reply:

Melissa,

Thank you so much for sharing your personal experience and how you used movement to help you recover.

Rick Kaselj

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I feel really bad for people with cancer, especially breast and testicular cancer. The connection between shoulder mobility and breast cancer is interesting, if not unfortunate. Thanks for this informative suggestion for those dealing with breast cancer.

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I am a certified yoga teacher and a breast cancer survivor. In November, 2010, I underwent modified bi-lateral mastectomies and had 30 lymph nodes removed from beneath my right arm. All women with invasive breast cancer have lymph node surgery done as part of their breast cancer treatment.

Most of the axillary lymph nodes are clustered in the armpit and their primary function is to drain waste fluid and micro-molecules from the system. The lymph nodes are about the size of a pin head and are hard to see and thus a section of tissue is removed from the armpit and the nodes are then harvested from the tissue and tested to see if any cancer cells are present. As a result of this surgery, some women develop arm motion restriction and axillary web syndrome after a sentinel node biopsy and axillary clearance.

Prior to any surgery, the woman is given a choice as to the type of reconstructive surgery she prefers. Those types of breast cancer reconstruction are:

1. Prosthetic (implant) reconstruction
2. Autologous reconstruction include: Latissimus dorsi flap (black flap; TRAM flap (abdominal flap); Free tissue transfer (free TRAM) and Perforator flaps (DIEP flap)

I chose a prosthetic (implant) as my reconstruction option, so during my mastectomy surgery, expanders with a dermal graft were placed between the edge of the pectoralis major and the chest wall. The purpose of the expanders is to stretch the pectoralis major and remaining skin creating a pocket so that implants may be inserted during a second (reconstructive) surgery. Usually two weeks after the mastectomy, the plastic surgeon will begin filling the expanders on a biweekly basis to start the stretching process. At first this is not too painful, but after several fillings the pectoralis can become painful.

As you can imagine, immediately after surgery, there is a lot of trauma and pain in the chest and armpits. Movement is limited but within a couple weeks you begin feeling better. As soon as I started feeling better, I began slowly moving and stretching my arms. Breathing exercises before and after surgery and during recovery are very important. Lifting the arms overhead was painful at first but you learn to breathe through and witness the process.

Just when you start to feel better (usually a month after surgery) you then begin chemotherapy. Chemotherapy sessions generally last from 3 to 6 months. After chemotherapy, then radiation. Doctors recommend that patients should NOT exercise on the day that they receive chemotherapy. Radiation therapy has it own array of implications with regard to exercising and range of motion. In many cases radiation thickens and scars the surrounding skin and tissue. As a result, range of motion is affected. Today, most doctors want you to start exercising as soon as possible after surgery. While under chemotherapy and radiation, it is important that the patient and the exercise instructor know the blood count. If its low, there is a risk of infection and while the patient should maintain some level of activity, strenuous exercise is not advisable.

There is another issue that affects about 49% of all breast cancer survivors and that is lymphedema. Due to the structural or functional impairment of the lymph system during surgery, the lymphatic flow is disturbed resulting in lymph accumulating and swelling the affected arm. Bacteria thrives on this protein-rich fluid, so lymphedema affected tissues are prone to infections. There is a lot of conflicting information on types of exercises for patients suffering from lymphedema. I have been diagnosed with Stage I lymphedema and I wear a compression sleeve and glove during wakening hours. It is important to note that if you have a breast cancer survivor as a client and you notice that one of the arms is swollen, you should immediately refer them to their doctor for treatment. A person with lymphedema should not exercise without their compression garments.

I certainly appreciate this discussion and hope that my input is helpful. I have been teaching yoga to cancer patients at local hospitals and medical facilities and find it so rewarding. Hospitals and many cancer centers around the country are conducting classes and programs for certified yoga instructors and physical therapist to work with cancer patients. If not, I bet you could talk your local hospital in putting together one for your area. Sorry for the long length of this message but it’s my passion! Peace!

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