A Breast Cancer Patient's Rehab Story
There are lots of things that feed my passion for work. Usually it’s from the gratitude of my patients – I feel like I get just as much back as I give through my service to them. But on the other side, I get really fired up when I see someone being taken advantage of – something unfair that just shouldn’t be happening – especially to cancer patients.
Last week I witnessed this type of injustice with a patient we’ll call Jane. Jane was diagnosed with breast cancer. She had surgery just over a year ago followed by chemo. Jane showed me a note from the clinic she’d been attending for rehab. The note indicated Jane was receiving stretching exercises for her neck and strengthening exercises for her right shoulder using free weights and pulleys. Jane had been attending for months but wasn’t finding that she was improving.
Jane signed up for my Pre-Exercise Assessment and WELLFIT Cancer Exercise Program. When we talked, she said she just wanted to make sure that what she was doing was “right” and wants something that she can do at home.
The Pre-Exercise Assessment results got me fired up. Why was a rehab clinic giving Jane strengthening exercises when her shoulder movement was so limited? I was so upset for Jane. She had no idea what she was doing was wrong (and why would she – she’s not a therapist) and was trying her best to get better after going through the worst experience of her life.
When I tested Jane’s right shoulder range of motion Jane wasn’t even able to reach overhead. She thought she could because she developed great ways to accommodate. She leaned forward from the mid back, she bent her neck forward until her chin almost touched her chest, and then raised her elbow up beside her head. The actual amount of shoulder flexion wasn’t even 90 degrees, not even half of what’s considered full range of motion.
Here’s the issue with what I saw with Jane and why I’m so upset about her situation a year after surgery. Let’s talk the basics of rehab.
#1 is mobility
#2 is stability
#3 is strength
And yes – it’s that easy.
If there’s an injury, something that needs to be fixed on the body like the shoulder joint, the first thing a good rehab professional will do is an assessment. This HAS to include range of motion testing. Why? If we don’t know how the joint is moving we don’t know if there are any deficits to mobility.
There are lots of reasons why a joint may not move well and in Jane’s case, it’s due to surgery and then compounded by chemo treatment. To Jane, her right shoulder felt “really tight”.
Mobility is always the first thing that’s addressed in any rehab program – including cancer rehab. In Jane’s case, she didn’t have good range of motion but her therapist jumped right past #1 and #2 and went right to strengthening.
To get an idea of what strengthening does to the muscles, imagine the big muscle bound guy at the gym or on the beach with hands that can’t even touch the sides of his body. That’s because when you build strength, you actually break down the fibres within the muscles and they have to repair to get stronger. So if you keep breaking down and repairing the muscle without stretching, the muscle gets stronger but also shorter and tighter.
In Jane’s case, her therapist had her shortening her muscles when she wasn’t even able to move them to full range. So Jane was fighting a losing battle, trying to reach into her cupboard for her coffee cup, trying to wash her hair and wondering why things weren’t getting better and any reaching was actually getting more painful.
The first thing we’re going to address for Jane is mobility. She needs to get some movement in that shoulder so we’re starting with stretching exercises. The shoulder’s an amazing joint and has six different ways that it can move so there’s lots that can be worked on with stretching. (I am a little partial to shoulder rehab having gone through five shoulder surgeries myself).
One of the easiest ways to think about shoulder movement is thinking of your arms as windshield wipers. With your elbows tucked into the waist your arms move back and forth as wipers into internal and external rotation. With your arms at your sides, they can move in front of you and behind you like wipers into flexion and extension. If you leave your arms at your sides and move them from side to side (away from your body and across your body) this is abduction and adduction. There – the six movements of the shoulder.
If that’s as clear as mud or if you want to get some good information of the shoulder, I’ve created a Shoulder Movement Cheat Sheet. This explains all the different ways the shoulder can move – with pictures and explanations – as well as outlining daily activities that need good shoulder mobility.
To help, click the button below and grab your:
FREE SHOULDER MOVEMENT CHEAT SHEET.
Next week we’ll take a look at what I found with Jane’s stability – #2 in the order of rehab – and how we’re going to address this issue after we get her range of motion looked after.