After completion of the in-patient treatment and the post-operative physiotherapeutic treatment, in most cases a follow-up healing treatment follows. As the general condition, the patients’ ability to cope with stress and the condition of the surgical area have improved, the measures of early therapy are significantly intensified depending on the current medical treatment. Possible side effects of drug treatment or other complications must be taken into account.
Passivity is replaced by activity. Activity under the guidance of the physiotherapist in the individual treatment is supplemented by intensive practice in the group. Since the average age of breast cancer is about 60 years, there is often already limited shoulder joint mobility and a restriction of everyday movements before the operation.
This concerns in particular lifting, spreading and turning movements to the outside (example, directing hair). These movement restrictions can increase after the breast surgery. General principles:
- For the exercises it is recommended to check the physiotherapist and/or a mirror
- The pain threshold shows the movement limit and should be observed
- Breathing should continue calmly
- Repetition, series and duration of the exercises can be chosen individually
Edema treatment
Sequence: forwards/backwards and to the right/left and into the rotary movement
- Physiotherapist removes connective tissue from the chest
- Deepening of inhalation and exhalation, the diaphragmatic activity creates a suction effect
- Direction of breathing into the different thoracic areas under guidance and several times a day independently
- Combination of deep inhalation and exhalation with the movement exercises of the arms and upper body Movements of the upper body towards the stretching position
Removal of the axillary lymph nodes can lead to a restriction of lymph drainage from the affected arm with subsequent swelling of the hand and arm. For mild lymphedema, lymph drainage and exercises are usually sufficient. For more severe congestion, external compression treatment with bandaging and stocking must be performed at the same time.
Lymphatic drainage works with gentle manual massage grips that mechanically support the absorption of tissue fluid into the lymph channels and thus promote the drainage of lymph fluid. The swellings are visibly and noticeably reduced. Lymph drainage also leads to general relaxation and regeneration by reducing sympathetic nervous system activity (part of the autonomic nervous system that stimulates the body), prevents scarring, supports the immune system and has an analgesic effect.
All kinds of sports activities have a positive effect on the lymphatic drainage. Breathing exercises, loosening of the shoulders, active movements of the cervical spine and moderate strength training of the upper body combined with strength exercises for the legs are suitable for actively and specifically increasing the lymphatic drainage. The increase in blood circulation caused by movement with corresponding metabolic activation also promotes drainage due to the widening of the vessels.
In the case of lymphedema, progressive dynamic strength training with supra-threshold training stimuli is recommended. By contracting the skeletal muscles, veins and lymph vessels are compressed and lymph drainage is supported centrally. Intensity and range of motion are determined by the strength requirements, pain and scarring and are individually adjusted according to the patient’s ability to cope with stress.
Progressive strength training means to continuously increase the training stimulus over a longer period of time and to set supra-threshold training stimuli in order to achieve a reactive muscle build-up. Constant training stimuli would have the consequence that the body adapts and only a maintenance but no increase in muscle strength is achieved. Intermediate checks of the strength development provide information on whether the increase in load was chosen accordingly and whether the training stimulus is sufficient.
Dynamic strength training means that the resistance (equipment or body weight) is overcome during movement. This trains in particular strength endurance and coordination. Patients should always train under observation so that excessive demands can be recognized immediately and appropriate action taken.The exercises are aimed at the whole body with emphasis on large muscle groups in the corresponding regions of lymphedema.
From the 6th week after the operation, the tissue is sufficiently resilient for the strength endurance exercises to be intensified. The average number of repetitions of the exercises is approx. 8-12.
Static strength exercises in the treatment of edema are not recommended, as the muscle tension causes the pressure in the blood vessels to increase too much.
- Starting position The affected arm lies on a wedge cushion. Exercise Both hands close strongly to fists, hands are led towards the shoulder, opening the fists and stretching the arms towards the ceiling, return to the starting position.
- Starting position Back position or seat Exercise execution Both hands are fisted, beginning with the bending of the fingers.
The arms are raised and crossed towards the ceiling and held in the decongested position for 2-3 breaths. The diaphragm activity supports the decongestive effect of the arm position.
- Starting position Sitting, the affected arm is raised above 90° shoulder elevation. Exercise Perform strong pumping movements with the hand.