A British study confirms that with a targeted physical activity program, started early, it improves limb mobility and decreases pain
That disabling pain and swelling in the arm and shoulder that some women experience as a result of surgery for breast cancer, so heavy that it is difficult to perform simple daily activities such as carrying bags or driving, can be relieved by a targeted physiotherapy program. To confirm the importance and the concrete usefulness of starting to exercise promptly to prevent and stem lymphedema, a British study recently published in British Medical Journal
, which tested the validity of a specific rehabilitation program against standard practice, which currently in Great Britain consists in delivering information brochures on recommended exercises after the operation. The conclusions indicate that physical activity promotes circulation and, by reducing the sensation of swelling and heaviness, it improves the movements of the affected limb, reducing pain.
Why lymphedema is formed
When the surgeon is forced to remove the axillary lymph nodes as well as breast cancer, he can slow down the circulation of the lymph in the limb, which accumulates in the tissues, thus giving rise to lymphedema. This disturbance (less and less frequent thanks to the refinement of surgical techniques) due todisruption of the lymphatic tract and, in fact, the removal of the lymph nodes that act as a filter and “transit stations” for the lymphatic fluid, which when it can no longer make its way to the chest stagnates in the tissues of the arm, causing swelling and pain – he explains Paolo Veronesi, director of the Breast Program and of the Surgical Breast Division of the European Institute of Oncology in Milan -. The removal of axillary lymph nodes, once routine for all cases of breast cancer, is now much rarer thanks to the introduction of sentinel lymph node technique, which limits the need for lymph node removal to about a quarter of patients with early stage cancer. The intervention is much more conservative than in the past, when for example the pectoralis minor muscle was always removed. Although the risk of upper limb lymphedema is much lower than it once was, lymphedema remains a problem that can be disabling and that must be prevented and promptly addressed to give women the best possible quality of life.
Symptoms and remedies
Those who only perform the sentinel lymph node biopsy have a very low risk of developing lymphedema, while the chances are growing for those who undergo the removal of all lymph nodes, underarm radiotherapy treatment and for those who are overweight. The lymph that stagnates, giving rise to lymphedema, can gradually form over a few days or even several years after surgery. The most common symptoms are swelling (of the whole arm or only parts of it), a sense of fullness and heaviness in the affected arm, difficulty in lifting the limb, stiffening of the shoulder, reduced motor capacity or flexibility of the hand or wrist. Better to intervene early if you notice even a slight swelling – Veronesi advises -. Just talk to the surgeon, the oncologist or even the general practitioner, to get the most appropriate information on who to contact. To stem the disorder, the techniques that give the best results with experienced physiotherapists provide manual lymphatic drainage with massages followed by bandages or braces, when necessary, and a special gymnastics. Any type of movement, as long as it is harmonious and non-traumatic, is good for you, while immobility is counterproductive. They are fundamental as well skin care, because infections and inflammation increase the risk, e weight control, as excess pounds make lymphatic circulation more difficult.
The study: all the benefits of targeted physiotherapy
With treatment the swelling should subside and symptoms should improve, but in some cases it can take weeks or months before you notice any real improvement and therefore it is important to be constant in following the treatments. As the results of the new British study also show, physiotherapy and massage can help reduce the onset of lymphedema, as well as aerobic physical activity and stretching: rowing, dragon boating, Nordic walking, swimming and Tai chi are among the most effective sports. For their trial, the UK researchers enrolled 392 women who were divided in half into two groups and answered questionnaires on limb mobility, pain and general quality of life for 12 months. One half received only the information leaflet and exercise advice, while the other half participated in a special preventive program which, in women most at risk of lymphedema, includes the appointment with a physiotherapist one week after breast cancer surgery and the prescription of a series of targeted exercises. After one year, all parameters, both for arm and shoulder mobility and for pain reduction, were better in those who participated in the program. Coping with lymphedema as soon as possible, or proceeding immediately with appropriate exercises in the operated patients most at risk of developing it, makes the difference – we read in the concluding notes of the research -. Once the swollen limb is stable, with pathological changes in the tissues, it becomes more difficult to treat. And the problem is becoming more and more disabling for the patients.
December 9, 2021 (change December 9, 2021 | 17:48)
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