How Physical Therapy Can Address Lymphedema and Breast Cancer

As Breast Cancer Awareness Month and National Physical Therapy Month come to an end, we wanted to raise awareness about the important connection between the two – and the ways that a well-planned therapy program can help a common complication of breast cancer: Lymphedema.

What is Lymphedema? The National Lymphedema Network writes: “Lymphedema is an abnormal collection of high-protein fluid just beneath the skin. This swelling, or edema, occurs most commonly in the arm or leg, but it also may occur in other parts of the body including the breast or trunk, head and neck, or genitals. Lymphedema usually develops when lymph vessels are damaged or lymph nodes are removed (secondary lymphedema) but can also be present when lymphatic vessels are missing or impaired due to a hereditary condition (primary lymphedema).”

It continues: “Lymphatic fluid is normally transported out of a region of the body by an extensive network of lymph vessels. When the collection of protein-rich fluid persists in a specific area, it can attract more fluid and thus worsen the swelling. In addition to increased fluid in the area, the body experiences an inflammatory reaction resulting in scar tissue called fibrosis in the affected area. The presence of fibrosis makes it even more difficult for the excess fluid to be eliminated from the area. As a result, the increased fluid and fibrosis prevents the delivery of oxygen and essential nutrients to the area, which in turn can delay wound healing, provide a culture medium for bacteria to grow, and increase the risk of infections in or below the skin called cellulitis or lymphangitis.”

One important part of treatment can be to seek specialized care from a Certified Lymphedema Therapist/Therapist Assistant.

“Breast cancer obviously can bring a lot of concern and discomfort for anyone going through it,” says Suzanne Cavanaugh, PT, DPT, CLT-LANA, Area Manager and Physical Therapist at Pivot Physical Therapy. “From our point of view, we’re glad to know that a well-run physical therapy plan can make a real difference with patients in terms of helping improve comfort and restore mobility. It often helps patients know that there’s someone else they can talk to about these very real physical challenges — and the possible ways to help address them.”

So what role can a Certified Lymphedema Therapist/Therapist Assistant play?

  • Many patients seek care prior to surgery for education regarding lymphedema and lymphedema prevention.
  • These patients also can receive a preventative sleeve and instruction on garment wear and care.
  • They also can gain a home exercise program (HEP) for post surgery to help them achieve full shoulder range of motion. This approach allows the patient to ask question prior to surgery, but more importantly it gives them a contact if they need further therapy.

A full program can include Manual Lymph Drainage, Compression Bandaging and education regarding their condition and self management for after therapy, including receiving compression garments at the end of therapy.

“I have treated Lymphedema patients for the past 15 years and have seen many patients who have been misdiagnosed or have received therapy elsewhere that has not addressed their issued correctly,” said Pivot’s Katrin Gardarsdottir, LPTA, Cert CDT. “It is incredibly rewarding to be able to help those patient’s and to improve their quality of life.  Often people affected with lymphedema have difficulty with everyday tasks due to the size of their limb and to see them regain their independence and the boost that gives their self-esteem is gratifying.”

The American Physical Therapy Association further describes “complete decongestive therapy.” It states: “The initial step often includes manual lymphatic drainage, which feels like a light form of massage and helps improve the flow of lymph from your arm or leg. This is followed by compression bandaging that helps to reduce the swelling. Your therapist will carefully monitor the size of the limb throughout your treatment sessions.”

The post also notes that therapists can help patients begin their own care by:

  • “Developing a safe and sensible exercise program that will increase your physical fitness without unnecessarily straining your affected arm or leg”
  • “Updating your compression garments to ensure proper fitting, working with you to find the type of garment that best meets your needs”
  • “Educating you about proper diet to decrease fluid buildup in your tissues and skin care to reduce the risk of infection”

Further, after surgery, specific exercises – often under the care of a physical therapist – can also be helpful.

The American Cancer Society states: “No matter what type of surgery you have, it’s important to do exercises afterward to get the arm and shoulder moving again. Exercises help to decrease side effects of your surgery and help you get back to your usual activities.”

Of course, any consideration of exercise or other treatments during or after a cancer diagnosis should begin with a discussion with one’s medical provider.

But there is little doubt that, in the right circumstances, a Certified Lymphedema Therapist / Therapist Assistant can play an important role in helping breast cancer patients reduce discomfort, improve motion, and contribute to their return to best health.