First Coast Rehabilitation is often thought of treating only spines issues but actually we help folks with all kinds of dysfunction from head to toe.  We treat head/neck pain, shoulder pain, wrist and hand, back, hips, knees, ankles and feet, balance, debility, lymphedema, pelvic pain, TMJ and more.  We even treat cancer survivors.  In fact, we see many women who have pain following either a mastectomy or lumpectomy.  One patient I saw a few years ago came in saying, “I’m alive but in pain.  Don’t get me wrong, I’m happy to be alive but this pain is unrelenting”.  And although learned of her cancer just prior to surgery, as it often goes, she did not have pain.

 

Thank goodness for skilled surgeons but often the pain is not coming from the incision but instead, a dysfunctional muscle(s) and nervous system.  Both have become hypersensitized.  Both are overloaded and ultra-sensitive to noxious or painful stimuli, which can occur in many other diagnoses.  Chronic low back pain, neck/shoulder pain, headaches and even fibromyalgia, to name a few, have contributions of hypersensitivity.   In all these instances, the muscles and nervous system can be put under intense, repeated or sustained stresses.  When this happens, it is the perfect condition to develop myofascial trigger points.

 

Breast surgery is not different.  Stresses can be intense, repeated or sustained.

A research article published in 2010 by Torres Lacomba examined 116 women following breast cancer surgery over a twelve month period and found most who developed myofascial trigger points did so within the first six months. This was followed by a study conducted by Caesar Fernando-lao, who examined 64 women for 12 months and compared findings from those who underwent a lumpectomy to those who endured a total mastectomy.  He found there was no difference.  Both developed painful trigger points regardless of the extent of the surgery.

 

Certainly there is a lot going on up to, during and after the time of these procedures.  On top of that it may be the first time one learns cancer is involved.  Myofascial trigger points are therefore, not a top priority, not should they be and unfortunately are not addressed and later forgotten or missed.  Other things can cause pain – incisions, scar tissue, and axillary web syndrome.  But after surgery, pain producing myofascial trigger points can be easily diagnosed and treated.  They can be palpated and eliminated.

 

If you are 1, 3, 6 months post op and still having pain, it may be worthwhile to have a physical therapy examination.  It should include a palpation exam to identify myofascial trigger points.  The therapists at First Coast Rehabilitation are well versed with such an exam and may be able to help.  Call and make an appointment to see if we can help.

 

  • Torres Lacomba, et al. Incidence of Myofascial Pain Syndrome in Breast Cancer Surgery: A Prospective Study Clin J Pain, 26, 320-325, 2010
  • Fernández-lao, C. et al. Development of active myofascial trigger points in neck and shoulder musculature is similar after lumpectomy or mastectomy surgery for breast cancer. J Bodyw Mov Ther, 16, 183-190, 2012

Rob Stanborough has been a DN Senior Instructor of Dry Needling for Myopain Seminars since 2010, (www.myopainseminars.com).  He is currently the only Physical Therapist permitted to perform DN in the state of FL.  He is president and co-owner of First Coast Rehabilitation (www.firstcoastrehab.com), as well as co-author of Myofascial Manipulation: Theory & Application, 3rd ed by Proed Inc. He has presented on the topic of soft tissue dysfunction in a variety of venues.  Read previous columns posted on www.firstcoastrehab.com.