Cancer Sucks. Recovery Doesn’t Have To. Let TOPS Help! Week 1

October is most importantly, Breast Cancer Awareness and Prevention Month. It also happens to be National Physical Therapy Month. Therefore, we felt it was appropriate to integrate the two and make a blog series based on how the two can integrate. It may seem a bit personal and private, yet it has extreme relevance on females dealing with shoulder pain, upper and lower back pain. This series will focus on surgical interventions of breast tissue and how physical therapy can help alleviate some of the associated pain symptoms.

Masectomy

Cancer is a scary topic and it brings with it a lot of uncertainty. Breast cancer occurs as a result of gene mutations and uncontrolled cell growth that can invade surrounding tissue in the chest wall including lymph nodes, areolar ducts, muscles that lay beneath the breast, as well as the ribs. If the cancer metastasizes (travels) too much or growth is out of control, then invasive surgery (Mastectomy) may be required to remove the cancerous cells as well as the surrounding tissue: lymph nodes and ducts and possibly musculature in some extreme cases.

Mastectomy presents challenges for any patient undergoing recovery because the tissue structure of the shoulder and breast region has been surgically altered, not only requiring healing of the surgical site, but also limitations of ROM dependent on the type of mastectomy and phase of healing. The most common and well researched mastectomy procedures are quite invasive.

Least to most invasive:

  • Total (Simple) – removal of all breast tissue, including: nipple, areola, & most skin
  • Modified Radical – all tissue removed in a Total (simple), along with lining of some chest muscles, lymph nodes in the upper arms, neck, and armpit.
  • Radical – all tissue removed in a Modified Radical mastectomy along with all lymph nodes and all chest muscles. (This type was most common for many years but is not rarely used unless the metastasis of cancer has spread through chest muscles).

There are some newer procedures that are less invasive and more sparing than even the Total mastectomy.

  • Skin-sparing & Nipple-sparing: these procedures allow for keeping as much superficial skin while removing the underlying pathologic tissue.

Although these methods may be riskier and not as researched, it allows for the patient to keep more of their body intact and keep their human dignity, which is important for any medical procedure.

Post-Mastectomy surgery, patients can suffer from lymphedema, swelling, phantom pain, range of motion, and strength deficits that physical therapy is very effective at improving.

What about Physical Therapy?? Can it help?? My doctor said I didn’t need to go, so should I??

These are questions we are asked frequently after a mastectomy. It is not well understood what a PT can do, if anything at all. However, from experience, as the testimonials will show in a few weeks, it absolutely can help.

PT can help post-mastectomy surgery by helping to minimize scar tissue build up. The surgical procedure is intimately related to the muscles of the chest and shoulder, which will get very tight, especially when someone is sitting with their shoulders forward. PT will help to lengthen those tissues and minimize the pulling feeling. It will help with shoulder pain, or minimizing the looming shoulder pain that almost always occurs. PT will also help to minimize back pain that starts since the individual is usually rounded forward, in a slouched posture, much worse than normal.

Furthermore, post-mastectomy, many women suffer from lymphedema issues in their hands and arms. There are specialists who are trained to help minimize this swelling and pain associated with swelling. There are many people and services here for your needs, please allow us to help you find who you are in need of!

In the upcoming weeks, we will discuss the anatomy of reconstructive surgery or enhancement surgery, and the general PT effects with that. Then, we will follow up with a much more intensive PT treatment blog. Followed by testimonials and personal experiences.

If you have any input or questions, please let us know. We are always here to help!

Cancer Sucks. Recovery Doesn’t Have To…Let Us Help!

Resource:

  1. Mastectomy

Pregnancy & Physical Therapy 101 – Week 5

Over the past 4 weeks, we have presented you with some basic information for pregnancy and return to activity after pregnancy. Every person is going to be different, and this is purely based on research and experience. Today we are completing this series with more technical information and with some of our resources.

If you would like more information, please contact us, so we can help you individually.

Pelvic floor research:

The overall pelvic floor muscle group has 4 primary functions:

  1. They are supportive and hold your organs up,
  2. They include sphincter muscles to prevent urinary and fecal incontinence,
  3. They contribute to sexual arousal and performance,
  4. And they assist in lumbopelvic stability

Pregnancy and delivery can lead to pelvic floor dysfunction

Think of what can happen if the pelvic floor no longer performs its vital functions well. If the organs of the pelvis are not well supported against gravity and cushioned against pressure, they literally begin to drop. This is known as pelvic organ prolapse.

  • Pelvic Organ Prolapse
    • Parity increases risk (Buchsbaum et al. Obstet Gynecol. 2006)
    • Found in 44% of parous women aged 20-59 (Samuelsson et al. Am J Obstet Gynecol. 1999)
    • Urinary incontinence
    • 4% greater in primiparous women (MacLennan, et al. Br J Obstet Gynecol. 2000)
    • 5-6 times more likely with vaginal delivery (Altman et al. Obstet Gynecol. 2006)
    • Reported by 25-75% women postpartum (Gregory, & Nygaard. Clininal Obstet Gynecol. 2004)
  • Dyspareunia
    • Pelvic floor muscle spasm and/or scar tissue following an episiotomy (MacLennan et al. Br J Obstet Gynecol. 2000)

If the superficial sphincter muscles grow weak or are impaired by labor and delivery, women may experience difficulty with evacuating and/ or retaining the contents of their bladder or bowel. This is known as incontinence.

If the pelvic floor muscles that power sexual activity grow weak or are impaired, sexual activity may become painful. This is known as dypareunia. This is not an end-all, be-all symptom. This is something that can be helped!

There is an abundance of information that has been provided over these past few weeks…ultimately, if you are unsure, please contact us, as we would love to help you with your individual needs!

And ultimately, congratulations on your new baby!!

Pregnancy & Physical Therapy 101 – Week 4

Don’t just take our word for it! Here are some success stories from new mommies who have utilized our services and have had improved symptoms, both during and after pregnancy. If you are feeling pain, discomfort, or are afraid to start working out, please do not hesitate to reach out to us! We are here to help 🙂

Pregnancy PT recommendation – I’ve been going to TOPS since its inception, the staff and I have been through a few surgeries, This time we took on pregnancy. Having had 2 shoulders, double mastectomy with reconstruction and a back surgery, I knew my body would need help on this 9 month journey. I didn’t want to do any damage to my joints or have undue stress on my back. As an avid swimmer gaining 30 plus pounds is a whole change and shock to my body. I would go in 1-2 times per week for maintenance therapy. As my weight increased and belly grew my pain and tightening of muscles would shift too. Amy and Chad were able to keep my pelvis in alignment, and break up my tightening fascia to allow me to continue to exercise at a high level. They also had programs designed to adjust with my progress. A very strong core and pelvic floor is key to a healthy pregnancy. I wanted to maintain these key muscle groups to reduce unnecessary stress on my low back, shoulders, and hips. Furthermore, pregnancy is full of leg cramps! Add working out on top and you are primed for the worst cramps of your life. As a pharmacist, I was taking my full vitamin regimen with extra calcium and magnesium to help with these cramps. You also can’t do too much salt when pregnant or you will swell. Again, my weekly PT sessions worked on my legs and the cramping was reduced. I can’t say enough about the staff at TOPS. I love them!

-Lindsey B.

At the beginning of my second trimester I started to have pain in my back and hips. Thinking this was normal pregnancy pain I just dealt with it for a few months. Finally, it got to the point where my belly brace was no longer helping and I went to see Amy at TOPS. She did a few manipulations, re-positioned my hips, and showed me some stretches which my husband could help with at home. This one appointment saved me lots of pain throughout my third trimester and I wish I would have gone in sooner. They even helped me after my C-section, with some strengthening moves, to build my core and pelvic floor back up. I defiantly recommend them to all of my pregnant friends now!!

-Ruth P.

To all of the new and soon-to-be-moms, hope this article helps! I’ve been working with my therapist to strengthen my core postpartum, but have been surprised that many women just jump into a workout routine without any help. Who knew crunches can be bad postpartum?? I didn’t, until I spoke with my therapist. Here is another article that supports and breaks down the benefits of physical therapy for new moms!

-Jenny B.

Abdominal Rehab article from Baby Center:
https://www.babycenter.com/0_abdominal-rehab-tone-your-postpartum-belly_10419294.bc

Pregnancy & Physical Therapy 101- Week 3

Based on these previously mentioned tips, here is first-hand experience from anew mommy, and her road back to running! Her story tells it all…

As a new Mom and runner, I was excited and anxious to get back to running. I knew I was in no physical shape to compete after giving birth to my son but I was anxious to use running as an outlet to have some “Mommy” time alone. I can vividly remember my first run. I knew it was not going to be pretty and only set my goal to complete two miles. Little did I know that that was a lofty goal! I made it half way and was ready for a walking “break.” Since my first run postpartum, I have gradually increased my mileage.

Here are some of her helpful tips that have helped her back out on the road (and treadmill)! You’re missing the road, the trail, the exhilaration and the freedom of going for a run. You’ve spent several months off from this activity due to your pregnancy and delivery. It’s time to return to running but where do you start?

  • First thing first, get your physician’s permission. Typically, you will follow up with your doctor 6-8 weeks postpartum. At this visit, ask your physician if it is okay to begin running again.
  • Start slow, run a short distance, and remember… it is okay to walk! Did you run or workout during your pregnancy? If you did, you may have a better base than someone who did not, but you should still take it slow as your body has gone through several changes. It only takes 48-hours of inactivity or decreased activity to start losing muscle so you most likely have lost muscle mass, strength, and cardiovascular endurance. Walking is ok! You can also do 1-minute on/off of run/walk. Cycle through 5-10 times based on how you are feeling.
  • Your body will feel different. While pregnant your body produced increased hormones: estrogen, progesterone, relaxin along with several others, which lead to ligament laxity. And if you breast feed you may continue to experience increased ligament laxity due to increased levels of progesterone. This laxity creates more mobility in the joints, especially in the pelvis, which may lead to pain in the lower back, glutes, pelvis, or pubic bones. Physical therapy can help you through these dysfunctions should they arise.
  • Once you begin running you may experience urinary incontinence or leaking. Do not be afraid to talk to your physician or physical therapist about this! While this is very common among new Moms it is not normal and can be addressed with exercise and/or physical therapy. Kegel exercises are a good place to start to strengthen the pelvic floor muscles to address the incontinence (see last week for detailed instructions on how to do this).
  • Talk to your pediatrician about running with your little one in a jogging stroller. Generally, you are able to start jogging with your little one when they have good head control, which is anytime between 4-6 months. Try to stay on a smooth surface and minimize bumps as your baby’s head control is still developing.
  • Remember to hydrate! Hydration is very important, especially if you are breastfeeding your little one. Many jogging strollers have a place for you to put a water bottle or if you don’t carry one then plan your route so there is a water fountain available.
  • Last but not least, enjoy this time!

Pregnancy & Physical Therapy 101 – Week 1

Our next blog series has been inspired by one of our former bada$$ employees! She decided to start a family, which many of you may remember, because she worked through much of her pregnancy!

Carolyn brings an amazing perspective because she understands the physical therapy side and can bring that knowledge, as well as personal experience, to these entries. We hope you find these as informative and helpful as many other pregnant and new moms have!

From Carolyn: 10 months ago I did not feel like I would ever get my abs back. I had diastasis recti, separation of the abdominal wall. After having two babies so close together, my stomach still looked pregnant months after giving birth. Finally it is going away because I modified my workouts. If you have diastasis recti make sure that you do NOT do traditional sit-ups or planks as they will make it worse. You need to strengthen your core from the inside out.

There is a test you can do to check to see if you have it so you can heal yourself without doing any further damage. The test is: Lie on your back with your knees bent, and the soles of your feet on the floor. Place one hand behind your head and the other hand on your abdomen, with your fingertips across your midline – parallel with your waistline – at the level of your belly button. With your abdominal wall relaxed, gently press your fingertips into your abdomen. Roll your upper body off the floor into a “crunch”, making sure that your ribcage moves closer to your pelvis.

Move your fingertips back and forth across your midline, feeling for the right and left sides of your rectus abdominis muscle. Test for separation at, above, and below your belly button.

If you suspect that you have it, come talk to us at TOPS to see how to best manage this situation. You can also talk to your health care provider on how to proceed further.

Take care of yourself first!!!

Next week we will be posting about safe exercises to perform, and in the future, we will post on a safe return-to-run program.

*For more information and constant updates/inspiration, please follow Carolyn Frye on Facebook. Also check back in with our blog, as we will be doing a series of information regarding this topic!

**Disclaimer: these posts are meant to be informative, but not diagnostic. If you have any further concerns, you can reach out to us, or to your medical provider. We will do our best to help.