by: Rob Stanborough, PT, DPT, MHSc, MTC, CMTPT, FAAOMPT
October is Breast Cancer Awareness month. It’s a time to celebrate with all the survivors and their families, remember those we have lost, raise awareness and fund research. I am fortunate in that none of the women in my family have encountered breast cancer but I have treated many survivors, none of whom expected this life disruption. They tell me it hit them like a sucker punch – coming out of nowhere. Their stories continue to amaze and inspire me, which is why I write this column.
One of my patients actually told me, “I’m alive but now I’m in pain.” In the next breath she seemed almost apologetic saying, “Don’t get me wrong, I’m glad to be alive but I didn’t think it would hurt so much after treatment.” The fact of the matter is, much of this pain is not from the surgery, the cancer, appears months after “healing” has taken place, and can be treated.
Surgery is trauma, even when it is lifesaving. Biopsies, lumpectomies and partial or radical mastectomies are trauma to tissue. Where there is trauma, there is potential for myofascial trigger points. Lacomba, et al, in Incidence of Myofascial Pain Syndrome in Breast Cancer Surgery: A Prospective Study (2010) showed nearly 50% of their breast cancer survivors experienced pain due to myofascial trigger points within the first 6 months of breast cancer surgery and in specific muscles. Fifty percent is a significant number of women who could be helped with physical therapy. The trigger points can be identified and treated rather quickly.
Myofascial trigger points, as I have written in previous columns are hyper-irritable nodules within a taut band of muscle. They are created through a series of events muscle imbalances, overloading of muscle, chronic tension in muscle and more, that create a chain reaction of chemical and chemical and receptors working abnormally. The results is ischemia or lack of blood and oxygen to the tissue, which causes pain. We know one can live weeks without food and days without water but one can only live minutes without oxygen. In an effort to protect itself, the muscle releases noxious (or painful) stimuli to signal the brain something is wrong.
Fernandez-lao, et al, in Development of active myofascial trigger points in the neck and shoulder musculature is similar after lumpectomy or mastectomy surgery from breast cancer (2012) showed the degree of invasiveness of surgery was not a predicting factor of myofascial trigger point development. They showed it didn’t matter if it was a lumpectomy or mastectomy. There was no statistical difference in the prevalence of myofascial trigger points when compared to a control group. These women were alive but in pain
These studies show how common it is for women to develop painful, myofascial trigger points following breast cancer surgery but does not show how easily they can be treated, which they can. These trigger points can be identified through palpation and released in a number of way. So, if you or someone is alive following breast cancer surgery, thank goodness. But if there is pain after the surgery has healed, it may be coming from myofascial trigger points, which can be easily treated.
Rob Stanborough is a physical therapist with over 20 years of experience. He is president and co-owner of First Coast Rehabilitation, as well as co-author of Myofascial Manipulation:Theory & Application, 3rd ed by Proed Inc. He is certified in manual therapy, a Fellow of the American Academy of Orthopaedic Manual Therapists and has presented on the topic of soft tissue dysfunction in a variety of venues. Read previous columns posted on www.firstcoastrehab.com.