(646) 355-8777

Herman & Wallace Blog

Breast Oncology: Not “One-Size-Fits-All” Rehab

Summer can make women cringe at the thought of baring most of their bodies yet finding just the right coverage for their breasts. Some scrounge for padded tops to pump up their actual A cup. Some seek the greatest amount of coverage to support every ounce of skin. And still others search for flattering tops to accentuate cleavage and minimize tan lines. Just like one swimsuit does not fit every woman, only one aspect of post-breast cancer rehab is not generally sufficient. A combination of exercise, mindfulness, and myofascial release may need to be implemented for optimal recovery.

Ibrahim et al., (2017) produced a pilot randomized controlled trial considering the effects of specific exercise on upper limb function and ability to return to work after radiotherapy for breast oncology. The study involved 59 young women divided into an exercise group or a control group that received standard care. The Disability of Arm, Shoulder, and Hand (DASH), the Metabolic Equivalent of Task-hours per week (MET-hours/week), and a post hoc questionnaire on return to work were all used and recorded over 6 time periods after the 12-week post-radiation targeted exercise program. Women who had a total mastectomy still had upper limb dysfunction, but no there was no statistically significant difference in DASH scores between groups. Both groups at 18 months had returned to their pre-illness activity levels, and 86% returned to work (at just 8.5 fewer hours/week). The authors concluded exercise alone does not change the long-term outcome of upper limb function post-radiation.

Mindfulness-based cognitive therapy (MBCT) for persistent pain in women after treatment for primary breast cancer was explored by Johannsen et al., in two 2017 articles, one concerned with clinical and psychological mediators and the other focused on cost-effectiveness. Each study included 129 women with persistent pain from breast cancer, placed in a MBCT group or a wait-list control group. The first study showed attachment avoidance was a statistically significant moderator, with subjects who had a higher attachment avoidance having lower pain intensity after MBCT. In the subjects undergoing radiotherapy, MBCT had a smaller effect on pain than those not having radiotherapy. The authors’ next study focused on the minimal clinically important difference (MCID) on pain intensity. Baseline and 6 months post-treatment data on healthcare utilization and pain medication were analyzed from national registries. The average total cost of the MBCT group was 730 euros less than the control group, and more women in the MBCT group had a MCID in pain than those in the control group.

DeGroef et al., (2017) performed a randomized controlled trial to assess the efficacy of myofascial techniques for breast cancer survivors who experienced upper limb dysfunctions. Fifty women post-unilateral breast cancer received either 12 sessions of standard physical therapy with myofascial therapy or 12 sessions of standard physical therapy plus a sham intervention during a 3-month period. After intervention, no significant differences between groups were found for active shoulder range of motion, lymphedema, handheld dynamometer strength, scapular statics and dynamics, shoulder function, or quality of life. The authors concluded shoulder ROM and function in both groups showed positive effects up to 1 year follow-up, but myofascial therapy provided no additional benefit in breast cancer patients.

Treatment for any patient should be individualized, based on deficits found clinically, whether they are physiological, anatomical, or psychological. Having a beach bag overflowing with techniques and tools, each ready to be used when the appropriate time comes, makes for a more competent therapist and a better rehabilitation outcome for patients. There simply is no “one size fits all” in breast oncology rehab.

YOU can be a major contributor to a breast cancer patients medical care team. Learn new skills by attending Physical Therapy Treatment for the Breast Oncology Patient this September in Boston, MA.


Ibrahim, M, Muanza, T, Smirnow, N, Sateren, W, Fournier, B, Kavan, P, Palumbo, M, Dalfen, R, Dalzell, MA. (2017). Time course of upper limb function and return-to-work post-radiotherapy in young adults with breast cancer: a pilot randomized control trial on effects of targeted exercise program. Journal of Cancer Survivorship: research and practice. http://doi:10.1007/s11764-017-0617-0
Johannsen, M, O'Toole, MS, O'Connor, M, Jensen, AB, Zachariae, R. (2017). Clinical and psychological moderators of the effect of mindfulness-based cognitive therapy on persistent pain in women treated for primary breast cancer - explorative analyses from a randomized controlled trial. Acta Oncology. 56(2):321-328. http://doi:10.1080/0284186X.2016.1268713
Johannsen, M, Sørensen, J, O'Connor, M, Jensen, AB, Zachariae, R. (2017). Mindfulness-based cognitive therapy (MBCT) is cost-effective compared to a wait-list control for persistent pain in women treated for primary breast cancer-Results from a randomized controlled trial. Psychooncology. http://doi:10.1002/pon.4450
De Groef,A, Van Kampen, M, Verlvoesem N, Dieltjens, E, Vos, L, De Vrieze, T, Christiaen, MR, Neven, P, Geraerts, I, Devoogdt, N. (2017). Effect of myofascial techniques for treatment of upper limb dysfunctions in breast cancer survivors: randomized controlled trial. Support Care Cancer. 25(7):2119-2127. http://doi:10.1007/s00520-017-3616-9

Benefits of working with the breath
Preventing Pre-term Delivery: What Do Women Want?

Upcoming Continuing Education Courses

Pelvic Floor Level 2B - Satellite Lab Course

Apr 10, 2021 - Apr 11, 2021

Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Mequon, WI Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Health In Balance Physical Therapy

Pelvic Floor Level 1 - Satellite Lab Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Bozeman, MT Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Great Northern Physical Therapy

Pelvic Floor Level 1 - Self-Hosted

Apr 10, 2021 - Apr 11, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2B - Annapolis, MD Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Encompass PT

Pelvic Floor Level 2B - Marietta, GA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Southern Pelvic Health

Pelvic Floor Level 2B - Torrance, CA Satellite Course

Apr 10, 2021 - Apr 11, 2021
Location: Women's Advantage Inc

Lumbar Nerve Manual Assessment and Treatment - Remote Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Fort Smith, AR Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Arkansas Colleges of Heatlh Education

Pelvic Floor Level 1 - Missoula, MT Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Florence therapy and wellness

Pelvic Floor Level 2B - Doylestown, PA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Central Bucks Physical Therapy LLC

Pelvic Floor Level 2B - Ann Arbor, MI Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Probility Physical Therapy

Pelvic Floor Level 2B - New Orleans, LA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Ochsner Therapy and Wellness/Ochsner Health System

Pelvic Floor Level 2B - Worcester, MA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Central Mass PT & Wellness

Pelvic Floor Level 2B - Buffalo, NY Satellite Course

Apr 10, 2021 - Apr 11, 2021
Location: CorrEra Physical Therapy

Pelvic Floor Level 2B - Self-Hosted

Apr 10, 2021 - Apr 11, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - Greenville, SC Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: His Therapy

Pelvic Floor Level 1 - Fultondale, AL Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: TherapySouth Fultondale

Osteoporosis Management - Remote Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Derby, CT Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Griffin Hospital

Pediatric Incontinence and Pelvic Floor Dysfunction- Remote Course (SOLD OUT)

Apr 16, 2021 - Apr 18, 2021
Location: Replacement Remote Course

Pediatric Incontinence - Grand Rapids, MI (Rescheduled)

Apr 17, 2021 - Apr 18, 2021
Location: Mary Free Bed Rehabilitation Hospital

Pregnancy Rehabilitation - Remote Course

Apr 17, 2021 - Apr 18, 2021
Location: Replacement Remote Course

Manual Therapy for the Abdominal Wall - Remote Course

Apr 17, 2021
Location: Short Form Remote Course

Pudendal Neuralgia and Nerve Entrapment - Remote Course

Apr 17, 2021 - Apr 18, 2021
Location: Replacement Remote Course

From Challenged and Concerned to Centered and Empowered

Apr 18, 2021
Location: Short Form Remote Course

Pelvic Floor Level 2B - Houston, TX

Apr 24, 2021 - Apr 25, 2021
Location: Texas Children’s Hospital

Pelvic Floor Level 2B - Garden City, NY Satellite Course (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Metro Physical & Aquatic Therapy