(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

Pregnancy Rehabilitation - Seattle, WA (SOLD OUT)

Feb 22, 2020 - Feb 23, 2020
Location: Pacific Medical Centers

Manual Therapy Techniques for the Pelvic Rehab Therapist - Pasadena, CA

Feb 22, 2020 - Feb 23, 2020
Location: Huntington Hospital

Pelvic Floor Level 2B - Alexandria, VA (SOLD OUT)

Feb 28, 2020 - Mar 1, 2020
Location: Inova Physical Therapy Center

Pelvic Floor Level 2B - Fort Worth, TX (SOLD OUT)

Feb 28, 2020 - Mar 1, 2020
Location: University of North Texas Health Science Center

Pediatric Functional Gastrointestinal Disorders - Charlotte, NC

Feb 28, 2020 - Mar 1, 2020
Location: Novant Health

Rehabilitative Ultrasound Imaging: Orthopedic Topics - Raleigh, NC

Feb 28, 2020 - Feb 29, 2020
Location: Rex Hospital

Pelvic Floor Series Capstone - Phoenix, AZ (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: 360 Sports Medicine & Aquatic Rehabilitation Centers

Pelvic Floor Level 1 - Salida, CO (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: Heart of the Rockies Regional Medical Center

Pelvic Floor Level 1 - Columbia, MO

Mar 6, 2020 - Mar 8, 2020
Location: University of Missouri-Smiley Lane Therapy Services

Pelvic Floor Level 1 - Princeton, NJ (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: Princeton Healthcare System

Pelvic Floor Level 1 - New Orleans, LA (SOLD OUT)

Mar 6, 2020 - Mar 8, 2020
Location: Ochsner Health System

Mobilization of the Myofascial layer: Pelvis and Lower Extremity- Grand Rapids, MI

Mar 6, 2020 - Mar 8, 2020
Location: Spectrum Health System

Bowel Pathology and Function -Salt Lake City, UT

Mar 7, 2020 - Mar 8, 2020
Location: Veterans Administration - Salt Lake City

Postpartum Rehabilitation - Washington, DC (SOLD OUT)

Mar 7, 2020 - Mar 8, 2020
Location: GWUH Outpatient Rehabilitation Center

Pelvic Floor Level 1 - Virginia Beach, VA (SOLD OUT)

Mar 13, 2020 - Mar 15, 2020
Location: Sentara Therapy Center - Princess Anne

Pelvic Floor Level 2A - Philadelphia, PA (SOLD OUT)

Mar 13, 2020 - Mar 15, 2020
Location: Thomas Jefferson University

Pelvic Floor Level 1 - Manchester, NH (SOLD OUT)

Mar 13, 2020 - Mar 15, 2020
Location: Franklin Pierce University

Meeks Method for Osteoporosis - Minneapolis, MN

Mar 14, 2020 - Mar 15, 2020
Location: Park Nicollet Clinic--St. Louis Park

Pelvic Floor Level 2A - Minneapolis, MN (SOLD OUT)

Mar 20, 2020 - Mar 22, 2020
Location: Allina Hospitals and Clinics

Nutrition Perspectives for the Pelvic Rehab Therapist - San Diego, CA

Mar 20, 2020 - Mar 22, 2020
Location: Comprehensive Therapy Services

Pelvic Floor Level 1 - Birmingham, AL

Mar 20, 2020 - Mar 22, 2020
Location: Shelby Baptist Medical Center

Mobilization of Visceral Fascia: The Urinary System - Carlsbad, CA

Mar 20, 2020 - Mar 22, 2020
Location: Tri-City Medical Center

Pelvic Floor Level 1 - Bellingham, WA (SOLD OUT)

Mar 20, 2020 - Mar 22, 2020
Location: PeaceHealth- St. Joseph Medical Center

Pelvic Floor Level 1 - Los Angeles, CA (SOLD OUT)

Mar 20, 2020 - Mar 22, 2020
Location: Mount Saint Mary’s University

Breastfeeding Conditions - Phoenix, AZ

Mar 21, 2020 - Mar 22, 2020
Location: Banner Physical Therapy and Rehabilitation

Breathing and the Diaphragm: Orthopedic Therapists - Sterling Heights, MI

Mar 27, 2020 - Mar 29, 2020
Location: Henry Ford Macomb Hospital

Breathing and the Diaphragm: Pelvic and Orthopedic Therapists - Sterling Heights, MI

Mar 27, 2020 - Mar 29, 2020
Location: Henry Ford Macomb Hospital

Pelvic Floor Level 1 - Corvallis, OR

Mar 27, 2020 - Mar 29, 2020
Location: Albany Sport & Spine Physical Therapy

Breast Cancer Rehabilitation - Alexandria, VA

Mar 28, 2020 - Mar 29, 2020
Location: Inova Physical Therapy Center