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ORIGINAL PAPER
Mind the gap: treating post-surgical scar tissue in post-mastectomy patients – a randomized clinical trial
1
Department of Rehabilitation, Greater Poland Cancer Centre, Poznan, Poland
2
Institute of Health Sciences, Collegium Medicum University of Zielona Gora, Zielona Gora, Poland
3
Department of Physiotherapy, University School of Physical Education Poznan, Faculty of Physical Education in Gorzow Wielkopolski, Gorzow Wlkp., Poland
4
St. Wojciech Hospital – Greater Poland Medical Center, Poznan, Poland
5
Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poznan, Poland
6
Department of Physiotherapy, Poznan University of Medical Sciences, Poznan, Poland
7
Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Centre, Poznan Poland
Submission date: 2023-08-07
Acceptance date: 2023-11-09
Publication date: 2024-09-09
Corresponding author
Maciej Górecki
Department of Rehabilitation, Greater Poland Cancer Centre, ul. Garbary 15, 61-866 Poznan, Poland
Department of Rehabilitation, Greater Poland Cancer Centre, ul. Garbary 15, 61-866 Poznan, Poland
Physiother Quart. 2024;32(3):45-51
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Post-mastectomy physiotherapy typically includes massage, exercise, and stretching, but often fails to treat post-surgical scar tissue, a significant contributor to long-term disability. This study aimed to compare conventional therapy with myofascial manual therapy for treating post-surgical scar tissue in post-mastectomy patients and to determine the effectiveness of these treatments.
Methods:
The study was an experimental controlled study with pre- and post-testing of two parallel groups. Forty-eight women experiencing shoulder and/or upper torso impairment following mastectomy were randomly allocated to either a control group (n = 21) or a myofascial therapy group (n = 27). Conventional physiotherapy involving exercise and massage or myofascial therapy was used. Pre- and post-therapy measurements included muscle length, pain intensity, range of motion (ROM), and scar mobility.
Results:
Myofascial therapy was superior to conventional physiotherapy in reducing the percentage of patients with below-normal muscle lengths at several sites. Significant decreases from baseline were observed in the treatment group for the pars clavicularis, descending trapezius, pars sternocostalis, latissimus dorsi, and levator scapulae muscles. Myofascial therapy also improved mobility in the scar area, with increases of 3 mm relative to the xiphoid process and 4 mm relative to the coracoid.
Conclusions:
Our study indicates that myofascial interventions improve upper limb ROM and muscle elasticity in the upper limb girdle of post-mastectomy patients. These findings provide empirical evidence supporting the benefits of myofascial intervention over conventional physiotherapy in the treatment of post-surgical scar tissue in this patient group.
Post-mastectomy physiotherapy typically includes massage, exercise, and stretching, but often fails to treat post-surgical scar tissue, a significant contributor to long-term disability. This study aimed to compare conventional therapy with myofascial manual therapy for treating post-surgical scar tissue in post-mastectomy patients and to determine the effectiveness of these treatments.
Methods:
The study was an experimental controlled study with pre- and post-testing of two parallel groups. Forty-eight women experiencing shoulder and/or upper torso impairment following mastectomy were randomly allocated to either a control group (n = 21) or a myofascial therapy group (n = 27). Conventional physiotherapy involving exercise and massage or myofascial therapy was used. Pre- and post-therapy measurements included muscle length, pain intensity, range of motion (ROM), and scar mobility.
Results:
Myofascial therapy was superior to conventional physiotherapy in reducing the percentage of patients with below-normal muscle lengths at several sites. Significant decreases from baseline were observed in the treatment group for the pars clavicularis, descending trapezius, pars sternocostalis, latissimus dorsi, and levator scapulae muscles. Myofascial therapy also improved mobility in the scar area, with increases of 3 mm relative to the xiphoid process and 4 mm relative to the coracoid.
Conclusions:
Our study indicates that myofascial interventions improve upper limb ROM and muscle elasticity in the upper limb girdle of post-mastectomy patients. These findings provide empirical evidence supporting the benefits of myofascial intervention over conventional physiotherapy in the treatment of post-surgical scar tissue in this patient group.
REFERENCES (28)
1.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49; doi: 10.3322/caac.21660.
2.
Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, Bonaventure A, Valkov M, Johnson CJ, Estève J, Ogunbiyi OJ, Silva GAE, Chen W-Q, Eser S, Engholm G, Stiller CA, Monnereau A, Woods RR, Visser O, Lim GH, Aitken J, Weir HK, Coleman MP. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391(10125):1023–75; doi: 10.1016/S0140-6736(17)33326-3.
3.
Hojan K, Milecki P. Opportunities for rehabilitation of patients with radiation fibrosis syndrome. Rep Pract Oncol Radiother. 2013;19(1):1–6; doi: 10.1016/j.rpor.2013.07.007.
4.
Browne JP, Jeevan R, Gulliver-Clarke C, Pereira J, Caddy CM, van der Meulen JHP. The association between complications and quality of life after mastectomy and breast reconstruction for breast cancer. Cancer. 2017;123(18):3460–7; doi: 10.1002/cncr.30788.
5.
Lara-Palomo IC, Castro-Sánchez AM, Córdoba-Peláez MM, Albornoz-Cabello M, Ortiz-Comino L. Effect of myofascial therapy on pain and functionality of the upper extremities in breast cancer survivors: a systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(9):4420; doi: 10.3390/ijerph18094420.
6.
Lacomba TM, Mayoral del Moral O, Coperias Zazo JL, Gerwin RD, Goñí AZ. Incidence of myofascial pain syndrome in breast cancer surgery: a prospective study. Clin J Pain. 2010;26(4):320–5; doi: 10.1097/AJP.0b013e3181c4904a.
7.
Lacomba TM, Mayoral Del Moral O, Coperias Zazo JL, Yuste Sánchez MJ, Ferrandez J-C, Zapico Goñi A. Axillary web syndrome after axillary dissection in breast cancer: a prospective study. Breast Cancer Res Treat. 2009;117:625–30, doi: 10.1007/s10549-009-0371-8.
8.
Pavan PG, Stecco A, Stern R, Stecco C. Painful connections: densification versus fibrosis of fascia. Curr Pain Headache Rep. 2014;18(8):441, doi: 10.1007/s11916-014-0441-4.
9.
Lauridsen MC, Christiansen P, Hessov I. The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: a randomized study. Acta Oncol. 2005;44(5):449–57; doi: 10.1080/02841860510029905.
10.
Chamorro Comesaña A, Suárez Vice[nte MD, Docampo Ferreira T, Pérez-La Fuente Varela MD, Porto Quintáns MM, Pilat A. Effect of myofascial induction therapy on post-c-section scars, more than one and a half years old. Pilot study. J Bodyw Mov Ther. 2017;21(1):197–204; doi: 10.1016/j.jbmt.2016.07.003.
11.
Castro-Martín E, Ortiz-Comino L, Gallart-Aragón T, Esteban-Moreno B, Arroyo-Morales M, Galiano-Castillo N. Myofascial induction effects on neck-shoulder pain in breast cancer survivors: randomized, single-blind, placebo-controlled cross-over design. Arch Phys Med Rehabil. 2017;98(5):832–40; doi: 10.1016/j.apmr.2016.11.019.
12.
Oliveira MMF, Gurgel MSC, Miranda MS, Okubo MA, Feijó LFA, Souza GA. Efficacy of shoulder exercises on locoregional complications in women undergoing radiotherapy for breast cancer: clinical trial. Braz J Phys Ther. 2009;13(2):136–43; doi: 10.1590/S1413-35552009005000017.
13.
Lewit K, Olsanska S. Clinical importance of active scars: abnormal scars as a cause of myofascial pain. J Manipulative Physiol Ther. 2004;27(6):399–402; doi: 10.1016/j.jmpt.2004.05.004.
14.
Day JA, Stecco C, Stecco A. Application of fascial manipulation technique in chronic shoulder pain – anatomical basis and clinical implications. J Bodyw Mov Ther. 2009;13(2):128–35; doi: 10.1016/j.jbmt.2008.04.044.
15.
Page P, Frank C, Lardner R. Assessment and Treatment of Muscle Imbalance. The Janda Approach. Windsor: Human Kinetics; 2010.
16.
Harris SR. Axillary web syndrome in breast cancer: a prevalent but under-recognized postoperative complication. Breast Care. 2018;13(2):132–5; doi: 10.1159/000485023.
17.
Leidenius M, Leppänen E, Krogerus L, von Smitten K. Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg. 2003; 185(2):127–30; doi:10.1016/s0002-9610(02)01214-x.
18.
Mazor M, Lee JQ, Peled A, Zerzan S, Irwin C, Chesney MA, Serrurier K, Sbitany H, Dhruva A, Sacks D, Smoot B. The effect of yoga on arm volume, strength, and range of motion in women at risk for breast cancer-related lymphedema. J Altern Complement Med. 2018;24(2):154–60; doi: 10.1089/acm.2017.0145.
19.
Majed M, Neimi CA, Youssef SM, Takey KA, Badr LK. The impact of therapeutic exercises on the quality of life and shoulder range of motion in women after a mastectomy, an RCT. J Cancer Educ. 2022;37(3):843–51; doi: 10.1007/s13187-020-01894-z.
20.
Fourie WJ, Robb KA. Physiotherapy management of axillary web syndrome following breast cancer treatment: discussing the use of soft tissue techniques. Physiotherapy. 2009;95(4):314–20; doi: 10.1016/j.physio.2009.05.001.
21.
Harrington S, Padua D, Battaglini C, Michener LA. Upper extremity strength and range of motion and their relationship to function in breast cancer survivors. Physiother Theory Pract. 2013;29(7):513–20; doi: 10.3109/09593985.2012.757683.
22.
Bac A, Jędrzejewska A, Woźniacka R, Golec E. Long-term evaluation of selected parameters of shoulder girdle and quality of life in post-mastectomy women. Polish J Physiother. 2011;3:261–71; doi: 10.5604/16420136.970909.
23.
DeLany J. Neuromuscular therapy treatment in post-mastectomy care. J Bodyw Mov Ther. 1999;3(1):5–10; doi: 10.1016/S1360-8592(99)80035-7.
24.
McAnaw MB, Harris WK. The role of physical therapy in the rehabilitation of patients with mastectomy and breast reconstruction. Breast Dis. 2002;16:163–74; doi: 10.3233/bd-2002-16122.
25.
De Groef A, Van Kampen M, Vervloesem N, De Geyter S, Christiaens MR, Neven P, Vos L, De Vrieze T, Geraerts I, Devoogdt N. Myofascial techniques have no additional beneficial effects to a standard physical therapy programme for upper limb pain after breast cancer surgery: a randomized controlled trial. Clin Rehabil. 2017;31(12):1625–35; doi: 10.1177/0269215517708605.
26.
Kim JH, Lee HS, Park SW. Effects of the active release technique on pain and range of motion of patients with chronic neck pain. J Phys Ther Sci, 2015;27(8):2461–4; doi: 10.1589/jpts.27.2461.
27.
Stecco C, Tiengo C, Stecco A, Porzionato A, Macchi V, Stern R, De Caro R. Fascia redefined: anatomical features and technical relevance in fascial flap surgery. Surg Radiol Anat. 2013;35(5):369–76; doi:10.1007/s00276-012-1058-0.
28.
De Groef A, Van Kampen M, Verlvoesem N, Dieltjens E, Vos L, De Vrieze T, Christiaens M-R, Neven P, Geraerts I, Devoogdt N. Effect of myofascial techniques for treatment of upper limb dysfunctions in breast cancer survivors: randomized controlled trial. Support Care Cancer. 2017;25(7):2119–27; doi: 10.1007/s00520-017-3616-9.
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