Samaher Saif Al-Yazal
Physiotherapist Jumana Ibrahim confirmed that breast cancer is one of the most common malignant tumors among women in the world, noting that it does not only affect the physical aspect, but its impact extends to the psychological and social aspects as well, which makes physical therapy an essential element in the comprehensive treatment journey, and not just a rehabilitative step after surgery.
Jumana Ibrahim said that the great development in the medical field in recent years has contributed to consolidating the position of physical therapy as one of the main components of the care plan for breast cancer patients, explaining that its role is not limited to rehabilitating muscles and joints only, but also extends to accelerating the recovery process, improving the quality of life, and restoring physical and psychological balance, in addition to preventing common complications after surgery, such as lymphedema. Shoulder stiffness and weak muscle strength.
She added that physical therapy plays a pivotal role in relieving pain, improving flexibility and balance, enhancing self-confidence, and helping the patient adapt to the physical and psychological changes associated with the disease, stressing that the presence of integrated rehabilitation support contributes to achieving better results on both the physical and moral levels.
Regarding the timing of starting physical therapy, Jumana Ibrahim explained that the recent recommendations of the American Physical Therapy Association stipulate the integration of physical therapy into all stages of the treatment journey, starting from the period before surgery, through a careful initial assessment carried out by the responsible physician and physical therapist, taking into account the individual differences of each case. She added that after surgery, treatment often begins during the first days to the first week, and then continues in the subsequent stages of rehabilitation until functions are fully restored. She pointed out that the primary goals of physical therapy with breast cancer patients include several main axes, the most important of which are alleviating pain and stiffness and increasing range of motion to avoid tissue adhesions, in addition to preventing or reducing lymphedema. It also aims to strengthen the muscles and restore the ability to perform daily activities, while ensuring that the patient is provided with psychological and physical support, ensuring her return to an active and independent lifestyle. Jumana Ibrahim touched on the physical complications that may appear after mastectomy or lymph node removal, indicating that the severity of these complications varies from one patient to another depending on several factors, including the type of surgery and treatment followed (whether radiation or chemotherapy), the patient’s general condition, and the extent of her commitment to the rehabilitation program. She added that the most common of these complications include: – Post-surgical pain, nerve pain, or sensory imbalances. – Problems with scars and tissue adhesions. – Lymphedema. – Reduced shoulder range of motion. – Muscle weakness and loss of strength. – Chronic fatigue related to cancer changes and treatment.
Regarding the prevention of lymphedema, she explained that the latest recommendations of the American Physical Therapy Association emphasize the application of an integrated decongestion protocol, which includes: – Manual lymphatic drainage by a trained and specialized specialist. – Multi-layer bandages or compression sleeves to reduce the size of the limb and prevent re-swelling. – Progressive movement exercises with deep breathing to stimulate lymphatic drainage. She stressed the importance of educating the patient about skin care to avoid inflammation and infection, as it is an essential step in preventing complications.
Jumana Ibrahim added that after a comprehensive initial evaluation of the case, the specialist usually begins with manual therapy and tissue movement, in addition to using flexibility and stretching exercises for the upper body. In some cases, electrical stimulation is used to help relieve pain and reduce pressure on surrounding tissue. She indicated that deep breathing exercises are one of the most important accompanying exercises, as they contribute to stimulating the muscles, improving the position of the rib cage, and enhancing the feeling of physical comfort.
As for the ideal time period to start exercises after surgery, she indicated that light exercises usually begin within 48 hours after surgery, and include breathing exercises and range of motion, unless there are complications that prevent this. As for more advanced exercises, such as resistance or stretching exercises, it is best to postpone them until after the wound has healed, that is, after approximately four to six weeks. She emphasized that the timing of initiation varies from one patient to another depending on multiple factors, such as the type of surgical procedure, the speed of healing, the quality of tissue healing, and the presence of any infections or persistent pain. Therefore, the exercise plan must be individual and precisely tailored to suit the needs of each patient.
She pointed out that Bahrain has witnessed in recent years a remarkable development in the field of rehabilitation and physical therapy, as advanced techniques such as hydrotherapy, manual therapy, and electrical stimulation therapy have been available in a number of specialized centers, which contributes to providing comprehensive and integrated care that supports the physical and psychological recovery of cancer patients. Regarding home exercises, she explained that the patient can practice them safely according to the plan developed by the specialist, which is based on an accurate individual assessment of the health condition.
