Audrey Lamberson, PT, DPT
Most patients recover quickly after breast cancer surgery and have no lingering problems. When problems do occur, they include:
- Difficulty moving the arm due to pain or tightness
- Mild weakness, which may be due to discomfort
Physical therapy administered soon after surgery can help resolve these problems quickly.
But lymphedema can develop from three months to 20 years after cancer treatment.
About one in five survivors of breast cancer who have had the lymph nodes in their underarm removed during breast cancer treatment will develop lymphedema. Identifying and treating lymphedema early helps to ensure more rapid and improved outcomes — although treatment provided later during the chronic stages of the disease can still help.
Physical therapists work closely with breast cancer survivors and other members of the healthcare team to help control swelling caused by lymphedema and facilitate a return to normal activities as quickly and safely as possible.
What is Lymphedema?
Lymphedema is swelling in the arms or legs due to a disruption of flow through the lymphatic system resulting in fluid accumulation under the skin.
The most common cause of lymphedema is the removal of lymph nodes. It also can be caused by an obstruction that blocks lymph fluid movement. (Lymph node surgery is often done as part of the main surgery to remove breast cancer, but in some cases it might be done as a separate operation.)
How Can a Physical Therapist Help?
A physical therapist can serve as an important member of the breast cancer survivor’s healthcare team by designing a specialized plan of care to help relieve and control swelling.
In the early stages of lymphedema, swelling is mild and can often be managed by techniques that encourage lymph flow such as:
- Compression garments
- Elevation of the affected limb
For more severe swelling, a physical therapist may use a treatment plan called complete decongestive therapy to help improve the flow of lymph fluid. This includes:
- Manual lymphatic drainage, which feels like a light form of massage
- A personalized exercise program
- Compression bandaging to help reduce your swelling
- Providing you with information on skin and nail hygiene to reduce the risk of infection
A physical therapist can carefully monitor the size of any affected limbs throughout treatment sessions. Once the size of the limb has decreased to the desired measurements, the therapist will:
- Develop a safe and sensible personalized exercise program for patients to do on their own. This program will help increase physical fitness without overly straining your affected arm or leg
- Update compression garments to ensure they fit properly and meet needs
- Provide education about the role of proper nutrition and skin/nail care in the can help reduce risk of infection
What Kind of Physical Therapist Do I Need?
Although all physical therapists are prepared by their education and experience to treat a variety of conditions including lymphedema, it may be wise to consider a physical therapist who has:
- Advanced knowledge, skills and experience treating lymphedema
- Training and certification in lymphedema management