Could a single session with a physical therapist improve women’s arm movement following breast cancer surgery? Apparently so.
The authors of a new study presented at the American Society of Clinical Oncology’s Cancer Survivorship Symposium on Monday February 12 in San Francisco found that a tailored physical therapy exercise program sped the return of range of motion after axillary node dissection, in which lymph nodes, many near or under the arm, have been removed.
“We were pleasantly surprised that women in the intervention group reported full range of motion sooner than women in an education-only group,” says Electra D. Paskett, PhD, the codirector of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center in Columbus and the study’s lead author.
The multicenter study is part of a phase 3 randomized clinical trial called the Lymphedema Education and Prevention Study, which seeks to determine whether education with or without specific exercises taught by a physical therapist can help prevent arm swelling in women who have their lymph nodes removed.

Lymphedema: A Common and Distressing Complication

Most women treated for breast cancer have lymph nodes between the breast and underarm examined or removed to check for signs of cancer spread. The procedure can cause fluid to build up in the tissues, however. The swelling, called lymphedema, can make it hard to move the arms and limits range of motion for months or longer. The condition is considered one of the most disabling and distressing complications of breast cancer treatment, affecting up to 56 percent of patients at two years following surgery, according to the National Cancer Institute.
“I speak from experience that it can be debilitating, because you can’t raise your arm over your head, which is full range of motion,” says Dr. Paskett, herself a breast cancer survivor. “Think of everything you do that requires that, such as putting a shirt on over your head.” Some women with lymphedema are forced curtail common activities or even stop work.


Physical Therapy Helped Patients Find Wider Range of Motion Without Fear

In the study, 568 women with breast cancer were randomly assigned to one of two groups. One group received educational materials on how to recognize and prevent lymphedema. The other women got the same materials but were also sent to a physical therapist for a session of individualized arm stretches and breathing exercises.
Before surgery, fewer women in the education-plus-exercise group than the education-only group reported having full range of motion in their arms. Yet women who visited a physical therapist still saw faster gains in their mobility.
One year after surgery, more women in the exercise group reported full range of motion in both arms (91 percent left arm; 90 percent right arm) compared with women who just got educational brochures (84 percent and 83 percent). After 18 months the exercise-only group had caught up, with 93 percent of women in both groups regaining full range of motion.
At the one-year mark, the exercise group saw range of motion in the affected arm improve by 32 percent on average compared with just 6 percent in the education group. At 18 months the exercise group reported a 37 percent bump in scores compared with 13 percent in the education group.
“Some women are very hesitant to move their arm further than it wants to go, and it usually doesn’t want to go further because they’ve had surgery there,” says Paskett. “Being able to go to a physical therapist who can tell you, ‘It's okay to move your arm. Yes, it's going to be stiff and hurt, but it will help you get your range of motion back’ will help women regain their full range of motion quicker than if they dealt with it on their own."

Should Physical Therapy After Breast Cancer Surgery Become Standard?

Paskett hopes the research eventually will lead to a change in the standard of care for women after breast cancer surgery. Many are not referred to physical therapy for help in sidestepping such problems.
“If we can send women to just one physical therapy appointment after they’ve had node dissection, they will recover their range of motion quicker,” Paskett says. “This is important because it restores physical functioning to women as well as improving their quality of life.”