Client had breast cancer

[Bubbly Brit!]

My client of 3 months had breast cancer in May '05 and had a lumpectomy and axial disection. Since having the procedure, she has developed extreme tightness in her upper back, shoulders and neck.

I have used deep pressure on her, along with stretching, with limited, long-term improvement.

She has been seeing a pt who also has used traction at her neck.

How would you treat her? I also suggested she might want to explore acupuncture, and she is going to think about it.

Thanks for any suggestions.

 

[swimmer611]

What muscles have you been stretching and where have you been doing the DT work?

 

[dlyle76]

I'd recommend Lymphatic work from someone with advanced training/certification. Maybe someone in her PT office is certified? Having lymph nodes removed in the axilla can cause restricted lymphatic flow that affects the entire shoulder. Addressing this problem can provide profound relief on the "stiff" feeling & the tense muscles as well.

 

[Philip]

Sharon -

I'm mostly stretching arms/neck, releasing the pecs, the traps and scapula areas.

I've been using deep tissue in her upper back/neck region, along with stretching and rom neck and shoulders.

Thanks, Blisss, for your thoughts. I will ask her to check with her pt to see if anyone is available to do LD for her.

Donna

 

[a1j0f]

healer611, thank you for posting your question. While it is obvious that your intentions are good and you are truly concerned for the wellbeing of your client, please stop what you have been doing. I will share with you what I have learned about working with clients such as yours, and hopefully this will in turn be of benefit to your client.

The tightness that your client claims to be experiencing in her upper back sounds like a clear sign of lymphedema. If I were seeing this client, the first thing I would do is ask her to get checked out by her doctor, and if it is lymphedema, refer her to a Manual Lymphatic Drainage specialist.

EVERYONE PLEASE TAKE NOTE OF THIS - we as Massage Therapists CAN CAUSE LYMPHEDEMA in this population of clientele. Using DEEP PRESSURE (above level 2-3) in the quadrant where lymph nodes have been removed moves the lymph into a space where it cannot be processed, and thus it accumulates there and can result in lymphedema. Lymphedema is always a risk for people who have had lymph nodes removed, in fact, it is a risk for them for the rest of their lives. It can also come about from any number of activities such as heavy lifting with that arm or flying on a plane without bandaging.

Defining the quadrant affected -
Visualize a vertical line along the midline, a horizontal line at the waist, and another horizontal line below the clavicle and at the superior edge of the scapula. This creates 4 quadrants plus the head/neck. A single quadrant includes both front and back.

Lymph removal sites concerned -
Axillary, inquinal and neck.

A few rules of thumb to "do no harm" while working with clients who have been diagnosed/treated for cancer:

1. Avoid all circulatory work in the entire quadrant where the lymph nodes were removed. Very gentle acupressure holds are ok.
2. Avoid stretching in the affected quadrant, as well as any stretching in another quadrant which will pull on the tissue of the affected quadrant.
3. Avoid ROM in the affected quadrant.
4. If the client is in chemo, or is within one year of completing chemo treatment, only apply light circulatory massage at a pressure level of 2-3 on all areas of the body excluding affected quadrants. Again, gentle acupressure holds are ok.
5. Regular acupressure (level 6 or so) is ok on the BOTTOMS of the feet for all clients.

There are some very lovely, effective bodywork techniques that can be learned from a qualified, experienced Oncology Massage instructor and can be used when working through any seforum.xxxe of cancer. I am not an expert in this, however if anyone has any other questions about treating cancer patients, please feel free to PM me, and I would be happy share the information I have with you. You can also contact the following Oncology Massage specialists:

Isabel Adkins http://www.OncologyMassageMatters.com
Gayle MacDonald http://www.medicinehands.com/
Tracy Walton http://www.tracywalton.com/
Charlotte Michael Versagi http://www.beaumonthospitals.com/pls/portal30/site.web_pkg.page?xpageid=allied_onc_des

 

[Pompal 09.]

Cy,

Thank you so much for your information. I have already called my client and suggested that she see her oncologist to speak about this.

I was at the point where I knew something else was probably at issue, and I only regret not saying something to her sooner. I sincerely appreciate your information.

(Tracy Walton was a teacher of mine while in school, but I have not taken her Oncology training. Perhaps I should.)

 

[rapidrpm]

You're welcome. I hope your client feels better soon.

Cy

 

[common sence]

I would just like to add a few thoughts. First, I have had breast cancer and had lymph node dissection 11 years ago. I have never had lymphedema but I did have a lot of tightness in my arm and under my axilla. I agree that no deep tissue work should be done on the area that has had lymph nodes removed. It was always recommended to me that even the taking of blood or a blood pressure cuff should be avoided on that side.

I really like John Barnes Myofascial Release and as soon as I learned about MFR, I released all my breast cancer scars, and also the tightness in my upper arm and axilla. I have felt much freer since. However, do not use traditional forms of MFR as much of it would be too deep. Very gentle cross-handed releases or light, sustained compression on the affected area should help ease the tightness. Follow the fascia!

If you stop to think what the fascia has been put through during the surgery, it is not surprising that there are problem areas in the fascia.

I help to moderate a Breast Cancer Support Group. One lady had a lot of pain and got out of breath every time she tried to walk although she had been a runner before surgery.

I did some very light releases all around the areas that felt tight and she thought it felt much better. I suggested she try a walk first but she told me later that was able to jog that evening, without pain for the first time since her surgery which had been some months prior.

 

[Brendon]

Thank you so much for sharing, Marion. I have wondered what styles of work would benefit scar tissue most, so thanks for pointing me in the direction of John Barnes' MFR.

 

[oneclickwonder]

Breast cancer client

Without wanting to repeat the postings here too much,

I don't do a lot of lymphatic drainage work (being a male practitioner, I don't feel as comfortable with this modality). Having said that I had great success with a client who was recovering from breast cancer surgery. She had a large , uncomfortable fluid build up near her armpit and was referred to me for MLDM, and in one session we drained most of it away.

It was a very satisfying session, and she was lovely enough to send me a photo and thankyou card from her home state.

Just thought I'd share that in case you were interested or needing to be convinced about the lymphatic drainage benefits.

Best regards,
Luke.

 

[MrRawr]

Thank you, Luke, for your post.

You say you don't do much MLD since you are not comfortable doing it ... do you mean in this scenerio? Since she was referred to you, you must have had training in that modality. What other areas do you tend to use MLD (any specific populations?).

I would be interested in exploring what training is involved and where a specialist in MLD would work. From my initial exploration, I have found a number of MLD specialists are working in rehab centers.

Donna

 

[Gerph]

Thank you, Luke, for your post.

You say you don't do much MLD since you are not comfortable doing it ... do you mean in this scenerio? Since she was referred to you, you must have had training in that modality. What other areas do you tend to use MLD (any specific populations?).

I would be interested in exploring what training is involved and where a specialist in MLD would work. From my initial exploration, I have found a number of MLD specialists are working in rehab centers.

Donna

I know you addressed this question to Luke, but since I specialize in lymphatic work, I thought I'd respond as well. Generally in the U.S., there are two respected methods to become trained in lymph drainage:

Upledger's LDT Training Series (where I chose to get my training):
http://www.iahe.com/html/therapies/ldt.jsp

Vodder's MLD Training Series:
http://www.vodderschool.com

You can take the first level of either training, to see if you like it, before advancing on to certification. In order to work safely with lymphedema, over 100 hours of training is recommended. Both the Vodder School & Upledger have a lymphedema certification program.

Upledger also teaches a wide variety of other applications for lymphatic work. Generally, the works boosts the body's healing ability overall, and therefore can assist with the healing of just about any health condition you can imagine: allergies, digestive disorders, menstrual problems, skin conditions, all kinds of pain relief, inflammation, pre/post surgery, healing from injuries, etc. In my massage therapy practice, I specialize in lymphatic work. I offer 30-min to 90-min sessions, and work with people cumulatively on health issues. I also combine it with massage frequently, because LDT has a side-effect of relaxing the muscles, making the massage both easier & more effective.

I highly recommend LDT1 through Upledger. It's amazing. A wonderful side benefit of the training is that you learn to do lymphatic work on myself. It's a wonderful self-care tool.

 

[GUERA33]

MLD comfort

Hi Donna,

I just meant that as a male therapist, I'm happy to do remedial massage around the inner-thigh and front of the hips. When it comes to MLD, however, its just not the kind of touch I like to use around the anterior hip region on female clients. Thats not to say I don't think males should do it, its just a personal issue that I had with doing it.

As far as quals go, I just did a short course in MLD and don't claim to be an expert by any means - but I knew how to drain that region and just put what I knew into practice with fantastic results. I still do MLD regularly from the shoulders upward by the way.

Hope that helps! Best regards, Luke

 

[Mark D]

Blisss and Luke -

I am convinced the work is effective and will likely take Upledger's MLD Level 1 in April when it comes to my area. In the meantime I am going to try and get my hands on some of the reading material for that workshop.

There are many modalities that interest me and it's hard to choose which direction to go in. After working as an MT for almost 10 years, I am looking to slow down a bit and do less physical work. I want to do a more specialized type of massage and market myself as doing that. So at this point I am exploring possibilities such as MLD.

Again - thanks for your info.

 

[Rana]

dvd

Good luck with that Donna, I was just sent a DVD on MLD - I'll PM you when I've watched it and let you know if I think it would be of any help. Obviously no substitute for training but somtimes the more ways things are explained the better they sink in.

 

[Emee~23]

Thanks, Luke. Much appreciated!

 

[Jamal]

boob

I will be massaging a friend in Portland, OR who has had a breast removed (cancer) and has an implant. The thoroughness of this thread is impressive and appreciated. Thanks for the question and the considered responses, you are wonderful .