Physical Therapy Role in Cancer Treatment
If you or a loved one has recently been diagnosed with cancer, I certainly hope you have had the opportunity to work with a physical or occupational therapist as a part of your cancer journey.
Just like doctors specialize in the heart (cardiologist), feet (podiatrist) or kidneys (nephrologist), there are physical therapists (PT) that specialize in Cancer Care and lymphedema (a swelling complication that can result after removal of and/or damage to lymph nodes over the course of cancer treatment). These super hero PTs who specialize in cancer rehabilitation are compassionate encyclopedias for their clients as they go through something new, painful, scary. They are a wonderful resource for cancer questions, concerns and what-ifs. Best of all, unlike doctors, that spend 15-20 minutes with you, you will typically get to spend 60 or more minutes with a physical therapist for an evaluation and for all of your follow up treatments. 60 minutes dedicated to YOU and your HEALING!
It is my STRONG recommendation that you discuss with your medical team getting into the care of a specialized PT or Occupational Therapist (OT), while you are discussing your cancer treatment options. PTs can help answer questions about what is expected BEFORE, DURING and AFTER treatment so you can better prepare.
FACT: I REALLY thought I had done my research on what to expect after a Mastectomy. I knew there would be 6 weeks of limited movement, inability to lift more than 5 pounds, possibility of pain, swelling, scarring. I WAS NOT aware that I would have profound muscle guarding and extreme stiffness that would prevent my arm from moving like it had just weeks before. It was horrifying to discover that after 2 weeks of keeping my arm below 90 degrees (shoulder height), it would take MONTHS of exercising 3 times a day to get 'normal' movement back to my arm. I am a very limber, young, healthy PT, and still shocked I was not informed of how traumatic this surgery could be. In hindsight, I should have called the Cancer Clinic where I was getting my surgery and had a pre-op conversation with a PT to discuss what I could expect. In my opinion, it should be MANDATORY to have PT start before treatment so the patient is well informed. UPDATE: I later found out that most oncology centers see their clients pre-surgery for measurements, strength and ROM testing, as well as education on how to prepare for surgery and exercises do to at home intermediately post-op. This is the NORMAL course of care, but this got screwed up/delayed due to COVID-19 closures.
I fully believe PTs and OTs can be a source of light, guidance and healing for all the treatments an individual going through cancer may face. For some, cancer treatment may be chemotherapy, which could impact your energy levels, body weight, strength, or cause body aches, nausea. PTs may be useful to help lessen the side effects of the drugs, place you on a customized light exercise schedule and help you manage your day with 'energy conservation' techniques. For others, treatment may include radiation therapy, which significantly impacts the skin at the site of treatment. It may cause a great deal of stiffness, sensitivity, redness, and PT could help you manage and educate you on how to best take care of your skin and underlying joints. A PT could complete very gentle movements or massage-like techniques to help manage pain and stiffness. Most folks will likely be going through a minor (lumpectomy) to a major surgery (mastectomy) which will impact how you move. In the case of surgery, PTs and OTs can really help you with managing wound healing, scar mobilization, gently stretch your muscles and retrain your shoulder how to move (or what ever body part was operated on). No matter what the treatment is, there is a role for a rehabilitation specialist to help you heal along the way. I think a rehabilitation specialist may even expedite healing and significantly improve the way you move!
After my surgery, all of the Cancer Center clinics were closed due to state orders from COVID-19. I was a BIT freaked out by this. I felt I was really missing out on quality care and worried I would not recover my function in the best possible way alone. I have a few lovely ladies to thank for steering me in the right direction during this crazy time.
Mrs. Julie Kwong, PT of Lady Bits Physical Therapy, a dear friend, classmate and fellow entrepreneur gave me recommendations on gentle movements I could be performing at home once my drain was removed and the surgeon gave me the okay. Julie informed me that she had taken this incredible Breast Cancer course with Susannah Harmann, PT of Your Core Physical Therapy and I should check her out! DIVINE timing and IDEAL recommendation!! Thank you to the moon Julie!!
I immediately sent Susannah an email and got on her schedule right away for a free 20 minute virtual consult. At this point I had not seen a PT since my Mastectomy surgery and I was 15-16 days post-op. Within that 20 minute session, I felt uplifted, supported and encouraged. I was gently guided on the best beginning exercises I should be performing at home to start gaining my range of motion back and wonderful self massage techniques I would NEED to perform on myself since there were NO PT clinics open in my area. I signed up for another 60 minute virtual session a week later to discuss body positioning for sleep, progress my exercises, expand upon my self massage, learn about lymphedema products and preventing seromas. I went from feeling I would never be myself again, to feeling I had all the tools in my belt! That I would get through this, and that I was not alone. I may be biased, but PTs are the Fricking best! The second best part of working with Susannah was learning she would be hosting an On-line Breast Cancer course for professionals. I signed up and learned EVERYTHING a health care professional should know about taking on the care of someone diagnosed with cancer. I have been thoroughly empowered through her KICK PINK course
and am happy to say that I could now take on the complex care of a client with Breast Cancer! This not only helped my professional development, but my personal adventure with Breast Cancer!
About 4-5 weeks after Mastectomy my local Cancer Center called to inform me that they would be opening up, FINALLY! I later I found out my breast surgeon DEMANDED the PT office open back up so us gals could get our much needed therapy! My Physical Therapist Michelle Whitney called me personally to explain all the red tape that had to be dealt with to open up an outpatient clinic during a pandemic. She assured me of all the hygiene processes, minimal staff on site and spacing of patients that would occur to keep us (immuno-compromised) patients safe. She was immediately a source of calm, empathetic guidance.
On evaluation day, we took the important measurements of my range of motion, strength and swelling in my arm, comparing that to my non surgical side. We began gentle stretches from day one and I got to finally experience the massive impact manual therapy (the PT version of massage) can have on the body in just one session. I got the benefit of working with Michelle, and only Michelle 2 times a week for 6 weeks. Our 60 minute in person sessions were Fantastic! I was slowly progressing from gentle stretching, to gentle resistance training, to finally returning to planks. push ups and down dogs (my prior level of function!!). Michelle had to constantly, CONSTANTLY remind me to be PATIENT, to slow down, to ask for help and give myself time and permission to HEAL! That I WOULD recover function. That I would get back to working on other people myself and wouldn't be in such discomfort my whole life. SHE WAS RIGHT! After every session with Michelle, I felt more uplifted, more flexible, stronger and more aware of what was going on in my body (and mind). Thank you kindly Michelle for your support in those weeks when the world was scary and unknown, you showed up like a super hero!
My rehabilitation team was amazing, supportive and allowed me to return to the life I have always lived; doing upside down yoga poses, gardening, learning new skills like surfing, backpacking and being a physical therapist. The impact of the rehabilitation team within the scope of oncology care is significantly underrated and now my mission is to help others understand the IMMENSE POSITIVE IMPACT a PT can have on the life of someone diagnosed with Cancer.
Thank you for reading! I love seeing comments below=)
Be well,
Shelby