What is Lymphedema?

Lymphedema Experienced as a Side Effect by Many Breast Cancer Survivors

Lymphedema is a protein rich swelling caused by a defect or blockage in the lymphatic system. It is seen as a side effect experienced by many breast cancer survivors who have undergone cancer treatment. Lymphedema presents with a feeling of heaviness or achiness of the affected limb because of the accumulation of lymphatic fluid within the lymphatic vessels and affected lymph nodes. The reason lymphedema is so dangerous is the risk of developing infection in the affected limb. Areas affected by lymphedema are prone to infection, since bacteria can grow easily in protein-rich lymphatic fluids.

Laurel Osborne, RMT performs lymphatic drainage at LifeMark Physio on Bay

"Best Kept Secret in the World of Cancer"

Even though its dangers are widely acknowledged within the medical and clinical communities, lymphedema is still not an everyday term. According to the Lymphedema Chronicles, lymphedema is the best kept secret in the world of cancer. "Many women do not even hear the word lymphedema nor receive any instructions for precautions to lessen their risks of developing lymphedema. Additionally, for the women who do develop lymphedema, they are hard pressed to find information let alone where to find treatment," cites author Carol Enters.

At LifeMark Health/Cancer Rehab Canada, we urge early rehabilitation treatment for cancer patients and cancer survivors to lower their risk of developing lymphedema. It is vitally important to manage signs and symptoms early, and through physiotherapy exercise, manual lymph drainage, bandaging and other education and techniques, lymphedema can be effectively managed.

Lymphedema is Manageable With The Proper Treatment

"Lymphedema is a manageable condition. With the proper treatment measures and ongoing home care, lymphedema can be reduced and maintained so that swelling remains minimal", says Laurel Osborne, RMT at LifeMark Physiotherapy on Bay.

As an integral part of the immune system, the lymphatic system fights infection and removes toxins from body tissues.

Lymphedema can happen when lymph vessels are damaged and damaged lymph nodes cannot handle the lymph fluid. If lymph nodes aren't functioning properly, the vessels can no longer stretch and they become enlarged, causing pressure on the lymph vessels. When this goes on for a long time, the vessels can no longer carry lymph fluid, so the lymph collects in nearby tissue.


To find a Cancer Rehab Canada near you, visit the list of British Columbia, Saskatchewan, Ontario, or Nova Scotia locations.

Standing Room Only For Cancer Rehab Training

Increased Demand from Patients Prompts Clinicians to Seek Out Cancer Rehab Training

"Tell me and I forget, teach me and I may remember, involve me and I learn." - Benjamin Franklin

12 physiotherapists, 5 occupational therapists, 7 kinesiologists and 1 massage therapist take cancer rehab training

As a final taste of summer was sweeping across most of the country, 25 professionals from LifeMark/Centric Health came together at LifeMark Meadowvale during the last weekend in September. The purpose of the gathering was a one-day introductory course on Cancer Rehabilitation. "Many of the clinicians have recognized the lack of specialized cancer rehab services as well as the increased demand from patients, so they are eager to learn how they can improve their knowledge and rehab skills for cancer patients," said Judy Boivin, Clinical Practice Lead for Cancer Rehab Canada.

This is the third time Cancer Rehab Canada has offered the course in Ontario since March 2013, and it has been fully registered each time, with some participants being put on a waiting list.

The group consisted of 12 physiotherapists, 5 occupational therapists, 7 kinesiologists and one massage therapist.

Taught by Judy Boivin and Swapnil Rege, both registered physiotherapists, the session's content included:

• Pathophysiology of cancer
• Cancer treatments such as chemotherapy and radiation
• Side effects experienced by cancer survivors
• Rehab techniques that have been proven to be beneficial in treating these side effects
• The importance of safety considerations when working with cancer patients
• Latest research confirming the need for cancer rehab

Cancer Rehab Services - Transitioning from Illness to Wellness

Special emphasis was made on the provision of rehab services for all cancer patients to help them resume their normal lives as quickly and fully as possible. So many people need help in the "survivorship phase" transitioning from illness to wellness.

The hands-on educational session was hosted by LifeMark Meadowvale, and participants traveled from as far away as Windsor and Ottawa to be involved in the training.

LifeMark/Cancer Rehab Canada now has 30 clinics able to offer this standardized cancer rehab program in their own communities across Ontario.

To find a Cancer Rehab Canada near you, visit the list of British Columbia, Saskatchewan, Ontario, or Nova Scotia locations.

Minimizing the Effects of Breast Cancer Through Cancer Rehab

Getting Back to Living - Not Just Surviving - After Breast Cancer

Even after surviving breast cancer, many patients find that although the treatment has ended, the cancer experience has not. The impact of cancer treatment and surgeries on psychological, emotional and physical well-being affects individuals in many ways causing problems such as:

• Pain
• Fatigue
• Decreased strength and mobility in shoulders
• Muscle aches
• Tingling in hands and feet
• Lymphedema

Cancer Rehabilitation Helps Minimize the Side Effects

The risk of developing lymphedema, or swelling in the arm, can be minimized through early cancer rehab treatment. A specially trained Physiotherapist can help to minimize the risk of developing lymphedema through exercise and education. It is vitality important to manage signs and symptoms early. Manual lymph drainage, provided by a certified therapist, has also been shown to effectively treat lymphedema and should even be considered proactively to prevent it in the first place.

Patient receives acupuncture after undergoing cancer treatment

Other benefits of cancer rehabilitation include exercise prescriptions to reduce the pain and fatigue that may be a result of the radiation or surgery that breast cancer patients have received.   Massage therapy, acupuncture and TENS can be used successfully to manage pain and parathesia, in addition to reducing stress. By seeking rehabilitation early, the research has shown we can prevent complications from occurring down the road, such as shoulder tendonitis or frozen shoulder. 

Restoring breast cancer survivors' previous level of function is a primary goal of cancer rehabilitation, and each client will have a tailored treatment plan to meet their individual goals.

Breast Cancer Affects 1 in 9 Canadian Women

Breast cancer survivors can minimize the risk of developing lymphedema through cancer rehabilitation

According to the Canadian Breast Cancer Foundation, breast cancer affects 1 in 9 Canadian women in their lifetime, and it is estimated that in 2013 23,800 Canadian women will be diagnosed with breast cancer. Non-modifiable risk factors are listed as gender and age, personal & family cancer history and genetics, early menstruation and late menopause, breast density and breast conditions. Lifestyle choices included in the list of modifiable risk factors are smoking, body weight, physical activity, alcohol use, exposure to hormones (the Pill, in vitro fertilization, and hormone replacement therapy), among others. 

If you are a breast cancer survivor or a friend or family member of a breast cancer survivor, please visit one of our British Columbia, Saskatchewan, Ontario, or Nova Scotia locations.

Treatment of Axillary Web Syndrome

by Swapnil Rege, MSc PT
Clinic Director & Physiotherapist - LifeMark Health Brampton

Technique Improves Shoulder Range of Motion While Decreasing Axillary Cording

Several years ago, while on a shadowing placement, I had a chance to visit a non-profit cancer treatment clinic. We were shown a very simple technique to treat axillary web syndrome that significantly improves range of motion of the shoulder and decreases the axillary cording. I have used that technique successfully for every axillary web syndrome client I have seen since. Over time, I have established my own routine for treating these individuals.

What Causes Axillary Web Syndrome?

Axillary web syndrome is thought to be caused by a disruption of the lymphatic network following sentinel axillary node biopsy or axillary lymph node dissection [1], which in lay terms means the removal of nodes of the lymphatic system that are most likely to contain cancer cells. This type of biopsy can be used to help determine the stage of cancer or extent of cancer in the body.

Traditional treatment methods, which are still effective, include assisted range of motion exercises of the shoulder with pulleys, and passive range of motion performed by the therapist and scar tissue massage.

The presentation of axillary web syndrome includes:

• Reduced abduction of the affected shoulder, worse than limitation in flexion. Pain will be reported with both movements (worse with abduction)
• Palpable and/or visible axillary cord in the affected side. The cord generally runs from the axilla and can extend medially all the way to the wrist. In many cases, the cord may not be visible. Do not discount the presence of axillary web syndrome if you do not see the cord. If your client has had breast cancer surgery and has limited shoulder range of motion, I would pursue the treatment as a trial
• Subjective complaints of pulling in the axilla and medical aspect of the arm
• Significant difference in median nerve glide tension between the affected and unaffected arm

Swapnil Rege, MSc PT, demonstrates treatment of Axillary Web Syndrome

Treatment of Axillary Web Syndrome Includes the Median Nerve Glide

The treatment includes:

1. Moist heat to the cord 8-10 minutes with extra padding and frequent visual inspection of the site to avoid burns due to sensory impairment. Make a clinical judgment on whether you want to use heat. It will depend on time since surgery, skin integrity, inflammation present, etc.
2. Client perform AAROM exercises of the affected shoulder, 10 repetitions in flexion and abduction with a 5 second hold at a comfortable level
3. Manual median nerve glide on the unaffected side - 1 repetition, followed by median nerve glide on the affected side - 1 repetition. Do this sequence until you have completed 5 median nerve glides on each side
4. AAROM of the affected shoulder as described previously
5. Patient-directed median nerve glide on the wall. Start with unaffected side - 1 repetition, followed by nerve glide on affected side - 1 repetition. As with the therapist-directed medial nerve glide, continue this procedure until the client has completed 5 repetitions on each side.
6. Ice post-treatment if required. As with the application of heat, precautions need to be taken prior to applying ice.
7. Education on home program:

• AAROM exercises of the affected shoulder: provide pulleys for home or alternatively can do wall-walking exercise
• Patient-directed median nerve glide, 5 repetitions each side, 2-3 times per day
• Heat and ice application as appropriate

You may choose to complete the protocol differently than what is presented above. However, the key is to complete the median nerve glide. There are no research studies to date about the efficacy of median nerve glide with treatment of axillary web syndrome and hence this is considered anecdotal evidence.

This treatment, if done correctly, resolves the axillary web and significantly improves shoulder range of motion within one to two treatments. Do not be discouraged if you see significant improvements on one day and significant regression the following day. In my experience, this is common and within 2-3 weeks, resolves completely. I encourage patients to complete the exercises for one additional month after complete resolution to ensure no reoccurrences.

View the video of Swapnil Rege, MSc PT demonstrating the treatment of Axillary Web Syndrome at http://youtu.be/XGuVBaCHTgI !

To find a Cancer Rehab Canada near you, visit the list of British Columbia, Saskatchewan, Ontario, or Nova Scotia locations.

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[1] Moskovitz AH, Anderson BO, Yeung RS, et al. Axillary web syndrome after axillary dissection. Am J Surg. 2001;181:434–9.