Increasingly shorter inpatient hospital stays after breast surgery pose a great challenge for physiotherapy. In order to prepare for all necessary measures, it is recommended that preventive education about the further procedure and physiotherapy is given before the operation. The tasks of physiotherapy in the postoperative care of breast cancer patients include In addition, further outpatient physiotherapy and rehabilitation sports should already be initiated in the hospital.
- Clarification (if there was no preoperative contact)
- Storage
- Analgesic measures
- Movement Exercises
- Creation of an exercise program for at home
- Edema Prevention
- Guidance for everyday activities
- Stress Relief
The following measures refer to the therapy from the first day after surgery until discharge. Already before the operation – either still outpatient or already inpatient – it is recommended that the patient and the physiotherapist establish contact at an early stage, who will carry out the treatment after the operation. This appointment serves on the one hand to get to know each other and to reduce anxiety, and on the other hand to provide information about the physiotherapeutic treatment after the operation.
In preparation for the conversation, the physiotherapist should ask the surgeon about the findings and the planned procedure. The cooperation with the attending physician, the nursing staff, the psychologist, the dietician… is a matter of course, especially in the breast cancer centers, where regular interdisciplinary team meetings are held. Since the surgical therapy of breast cancer and the accompanying (chemo-/antibody) therapy of the tumor carries the risk of complications, which either occur immediately or can often only be visible after years, it is of great importance to initiate the avoidance of subsequent problems in the early stages of therapy.
- Goals of postoperative physiotherapy?
- When does physiotherapy begin?
- What does it contain?
- Behavior in case of pain
- Information on independent practice
- What happens after the inpatient stay?
- Edema (congested tissue fluid, more common in overweight women) in the affected arm
- Emotional disorders in the affected arm
- Scar complaints
- Movement restrictions in the shoulder joint on the operation side, development of an impingement syndrome or a frozen shoulder (painful shoulder stiffness) still possible 1-2 years after surgery
- Fibrosis – formation of a fibrous, low stretch replacement tissue
- Loss of strength in arm, trunk
- Misalignment of the fuselage as compensation
- Impairment of the lung capacity
The conversation should always start with a conversation! The pain-relieving measures include, in addition to positioning the arm and the thoracic and cervical spine, a very soft, sufficient massage in the arm, neck or shoulder blade area, pumping exercises of the hand and light movement exercises, starting with elbow and shoulder blade movements. Post-operative positioning of the arm and upper body: Post-operative positioning is used to relieve pain and prevent strain posture, to reduce impending restrictions in movement and to prevent lymphedema.
The upper body should be positioned as flat as possible, with the pillow only under the head. The arm lies most relaxed on a pillow with the forearm on the stomach, but should always be positioned as flat as possible next to the body and in an outwardly rotated position. Prevention of pneumonia and thrombosis:
- Breathing exercises, especially instructions for independent, several times a day practice, inhalations
- Use of the vein pump through strong up and down and circular movements of the feet with relaxed knee joint several times a day.
- Out of bed as quickly as possible, walks across the hospital corridor several times a day.
The main focus of the movement exercises in the early phase after the operation is to observe the pain threshold.
The exercises can be started directly on the 1st day postoperatively. We start with supporting (assisted by the physiotherapist) movement exercises, which are gradually transformed into independent active exercises.Wound healing must not be disturbed by the exercises, otherwise there may be increased scarring with the consequence of restricted movement and disturbed lymph drainage. Physiotherapy must therefore be performed with appropriate caution.
Between the sequences of exercises a perception and relaxation phase should take place. The intensity of the treatment depends on the results of the operation, the individual condition and the respective instructions of the physician. the patient From day 3 postoperatively, the shoulder joint can be spread out up to approx.
90°, from day 8 the lifting of the arm and the rotational movements are forced, active movement without support must be instructed and carried out by the patient herself several times a day. These details vary according to the clinic and the surgical findings. The full range of motion of the shoulder joint should be achieved by 14 days postoperatively and/or as soon as the drains have been removed.
- Hand and forearm movements
- Pump exercises with ball
- Movement cervical spine
- Movement of the affected shoulder blade from supine and lateral position
- Movement of the affected shoulder joint, directions of movement are lifting, spreading and external rotation of the arm from supine position, starting positions: supine position, lateral position and seat
- Instructions for your own exercise program several times a day
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