A Manual Therapy and Exercise Approach to Breast Cancer Rehabilitation Course
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1 2014 Annual Breast Cancer Rehabilitation Healthcare Provider Event A Manual Therapy and Exercise Approach to Breast Cancer Rehabilitation Course November 7 th and 8 th, 2014 Mercer University, Atlanta, GA Sponsored By: TurningPoint s Edith Van Riper-Haase Breast Cancer Rehabiltation Advocacy Fund Presentations are Available on TurningPoint s Website: myturningpoint.org Click on Course Link itsthejourney.org thevisualab.com
2 A Manual Therapy and Exercise Approach to Breast Cancer Rehabilitation Course Manual Therapy and Therapeutic Exercise for Upper Quadrant Issues in Breast Cancer: Lauren Bober, PT, Pilates Instructor Jill Binkley, PT, MSc, FAAOMPT, CLT This Presentation is available on TurningPoint s Website: myturningpoint.org From Homepage Click on Course Link
3 Evaluation and Treatment of Articular Restriction Passive Flexion, Abduction, ER, IR, HBB depending on active limitations with and without scapula stabilized G-H Joint Inferior glide in abduction and flexion Posterior-Anterior movement (P-A) in elevation A-C Joint Posterior rotation of lateral clavicle in neutral, abduction, supported elevation S-C Joint Inferior glide (elevation) Posterior glide (retraction) Scapular Mobility in Side Lying Quadrant Scouring for Impingement Stabilize scapula Passively move humerus into elevation and external rotation gently move back and forth toward and away from ear in arc
4 Soft Tissue Techniques Desensitization Post-surgical fluid / seroma Scar tissue Cording Reconstruction specific issues
5 Desensitization Light touch / various textures Education Requires daily attention home program
6 Post-surgical Fluid / Seroma Gentle massage / manual drainage Superficial Deep Progressively angle your fingers Seroma = fluid filled pocket Some need needle aspiration Some can be reduced with manual techniques (MLD) Fluid wave usually indicates larger amount of fluid
7 Scar tissue release Multiple sites surgical, ALND, drains, donor site, ports Most are deep and encompass multiple tissue layers Restrictions may be more evident in some postures Scar tissue tubes around drain tubes / port catheter Treat superficial to deep Treat in multiple directions Unlocking spiral Education for home program Massage ball
8 Cording Typical path of axillary cords Stretch + massage Positioning Segmental stretch Popping Low-level Laser Effect of radiation
9 Reconstruction Specific Latissimus Flap Flap portion through axilla Scapular mobility PNF clock Serratus push Multi-angle stretch
10 Reconstruction Specific Expanders Mobility of breast mound Length of pectoralis major and minor Education about location of expander / implant Alloderm attachments?
11 Reconstruction Specific TRAM Hardened areas of breast Scar tissue at umbilicus Length tension of abdominal mm.
12 Therapeutic Exercise Education is key arm yourself with evidence Early post-sx shoulder stretches Advanced upper quadrant stretches General UE strengthening Weak serratus anterior exercises Post-TRAM stretches Core strengthening Aerobic options
13 Post op With drains in place- ROM of the elbow, wrist, and hand hours after surgery Deep breathing exercises- beneficial for pain management and circulation of lymphatic fluid Teach to exhale on the effort phase of the movement Early exercise- Cervical, elbow, forearm, wrist ROM
14 Early post-surgery stretches Deep breathing Postural awareness Shoulder flexion wand Butterfly Scapula Squeeze Then Doorway pec stretch Wall angels
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17 Advanced UQ Stretches Add scapula, rib cage and trunk stretch Side bend with deep breathing Kneeling / child s pose Supine over bolster Supine over swiss ball
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19 General UQ Strengthening Emphasis on posture / scapular stability Core activation with all strengthening No upper limit Progress slowly
20 Weak Serratus Anterior Ex Serratus Push 45 degree angle push Wall push ups (?) Closed-chain exercises Postural education / Mirror / PNF Strengthen helper muscles Supine shoulder flexion into pillow Isometric internal /external shoulder rotation Prone or upright stabilize scap, small lifts
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22 Post-TRAM Stretches Lying flat Add arms overhead Seated trunk rotation, standing trunk rotation Hook-lying lower trunk rotation Quadruped cat / cow Sitting pelvic tilts Progress to supine over swiss ball Be sure to discuss sleeping posture!
23 Core Strengthening Initiating core contraction Head lifts Kegels Sahrmann progression hook-lying Pilates gentle core progression Reverse sit-up- supported or ½ roll down Reverse lateral sit-up Bridging Quadruped stability
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25 Aerobic Options
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