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Mastectomy: Sensitive after radiotherapy?

Research shows that radiation fibrosis is a severe problem for some breast cancer survivors, but more people have a collection of “adverse” sensitivity symptoms like pain, weakness, pins and needles, and joint and limb stiffness; these sensations can last for months and year.

Have you wondered if there were some rehab treatments that would help change these sensations?

Today, I was reminded about why I need to spread the word about radiotherapy and after- care options. A new patient to my clinic explained how she was now 12 months after mastectomy surgery and had just been “all cleared” with her first 1 year check- up. That’s great news!

Yep, the not so good news is coming. Since completing radiotherapy four months ago, things started to change again: touching her own chest became problematic, increased neck stiffness that was interfering with driving and her arm never regained full and big movements.

Sensitivity to touch at the chest is a common side effect, especially after nodes are removed from the axilla area, and especially after radiotherapy.

In the first weeks after radiotherapy, many women have to deal with some degree of radiotherapy burns. Usually, after 4 weeks there are noticeable improvements. But less known and less obvious changes are developing: scarred local blood vessels, muscle changes and skin that becomes thick in some places and super thin in other places.

Research is now able to demonstrate that people who’ve had radiotherapy and many axilla nodes (ALND) removed, have long standing chest muscle changes. A recent study following breast surgery and radiotherapy found there’s a change in the way the main chest muscle, the pectoralis, operates especially after axillary lymph node removal: the muscle is tighter when it should be relaxed and it’s stiffer when only doing a 10% contraction; that’s when compared to healthy “matched” subjects.

Another study of the pectoral muscle on the side of breast surgery and radiotherapy found similar changes; the muscles were seen in real time, using MRI and computer volume measures, to be thinner while the other shoulder muscles showed no change in volume.

These finding are exactly what I see in the clinic. Women after breast surgery, especially mastectomy, ALND and radiotherapy, present with overworked pec muscles that aren’t strong enough or long enough to keep the shoulders back and the head up.

Alongside with overly tight muscles, women notice that their sensation to light touch and deep touch changes. It’s easy to jump to the conclusion that the local nerves must have been damaged.
But this mightn't be the case.
What we’re learning now is fascia, which is the white connective tissues within and between the muscles and connecting to the skin, actually have more sensing properties than nerves.

Based on this new fascia knowledge, the tight and stiff changes that have been found at the chest muscles will also reflect local fascia tightness. Therefore fascial tightness may be responsible for some portion of the experiences of feeling less sensation and altered sensation, like numbness, deep pressure pain and stiffness.

Unfortunately, solutions to manage these fascial and muscle changes have been received attention in breast cancer research. But there has been a huge growth in fascia research in the fields of anatomy, chronic pain management and elite sports performance.

By following the leaders in fascial studies and chronic pain I’ve been able to tease out the methods that'll be more suited to the pectoral muscle and chest area, and be gentle enough to be use after breast surgery and radiotherapy.

Because, you can imagine that some of the more foreful manoeuvres used on young sportspersons just wont cut it, when applied to breast or tight chest tissues.

Of the treatment approaches I’ve reviewed, my most favourite one to use for radiotherapy and chest stiffness is Lewit Barrier Release (LBR). Professor Karel Lewit was an internationally recognized Neurologist from Europe and introduced the world to his approaches in 1999 when his book Clinical Rehabilitation was translated from Czechoslovakian to English.

I was not lucky enough to travel to Prague to study under Prof Lewit directly, but in the early 2000’s studied under his Rehabilitation team members- Pavel Kolar (Dr PT) and their English speaking Neurologist.

It was an amazing time for me! The training workshops were conducted in Czechoslovakian, with English translation made by the Neurologist.

Because I was already working with lymphoedema patients, I knew what I was looking for; I needed new treatment methods to help my patients with really poor shoulder movement and really terrible mastectomy scarring.

Prof Lewit and his team introduced me to the art of gentle release of skin and scar tightness which was mostly well away from the site of pain; his saying was “he who treats at the site of pain is lost”.

I have found this applied to the pain and stiffness experiences after breast cancer and radiotherapy. Most people like my new patient, report of neck pain, shoulder blade pain and usually very last on the list is deep pain at the chest. To date I've only had a handful of people come to me saying they have a problem at their front chest scar and muscles.

So I agree with the late great Prof Lewit, you don't treat where the pain is.

Even though this gentle fascial and scar method has been used by health professionals for well over 30 years, it hasn’t been scientifically proven for the management of post breast cancer radiotherapy fibrosis. So, in keeping with the use of evidence based medicine, I use before and after treatment testing for each person when I use this technique. Testing for changes in improved ease and range of arm movement and feeling for skin elasticity changes, allows both me and the patient to evaluate how effective the treatment has been.

What I’ve found in my clinic experience is that mild, moderate and severe radiotherapy fibrosis can be reduced: tissues can soften and stretch more. BUT, everyone’s radiation changes are different: the tightness may never disappear or resolve completely, the fibrosis process doesn't go away, and having two lots of radiation can make changes much less significant.

There is so much more to share!

Looks like I’ll need to write more blogs on breast cancer radiation changes, because I want to tell you more about neck stiffness, prepping for breast reconstruction after radiation and the new info about micro-tension release at the local arteries and nerves.

In summary, my message is: mastectomy, ALND (axillary node) surgery and radiotherapy changes the sensation of stiffness, pain and tightness in the tissues of the skin, fascia and muscles at the chest, where the radiation was delivered.

There are gentle fascial treatment methods that can be trialled at these very fragile and sensitive tissues. But is important that your health professional evaluate fascial release treatments, like LBR, for breast cancer related radiation stiffness; if the skin and the connective tissues soften, then the patient and the health professional observe and feel freer arm movement and better stretch at the skin.

Do you have stiffness and chest sensitivity?

Connect with Denise now by email to arrange face to face services in Brisbane or online private self care sessions

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