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.

Cancer Rehab Canada/LifeMark Donates $1,000 to Hearth Place Cancer Support Centre at Annual 5K Run

Cancer Rehab Canada's LifeMark Physiotherapy clinics participated in the 4th annual Hearth Place event

Hearth Place 5K on the Runway Takes Off

Several colleagues from Cancer Rehab Canada's LifeMark Physiotherapy Clinics in the Durham Region stood ready for takeoff at Oshawa's municipal airport to support runners in the 4th annual Hearth Place 5-kilometre event that took place on September 22. A total of $1,000 was donated by the group, as a sponsorship to Hearth Place's Cancer Support Centre.

Information on Cancer Rehabilitation Services Distributed to Hearth Place Run Participants

Cancer Rehab Canada/LifeMark was on hand to let the runners, their friends and family know about the benefits of cancer rehabilitation to address the pain, fatigue, joint restrictions, and cognitive & memory problems often faced by cancer patients. Led by Krista McIntyre, Clinic Director and Physiotherapist of LifeMark Physiotherapy Whitby, members of the Cancer Rehab Canada/LifeMark team gave out water and hand sanitizer, as well as literature on the ability to empower each cancer survivor to take control of their life and feel better, stronger and happier. Massage beds were also set up on site where the team provided complimentary 5-minute pre-and post-race massages to runners.

Krista McIntyre, Clinic Director and Physiotherapist of LifeMark Physiotherapy Whitby, offers supplies to participants

"The Hearth Place 5K on the Runway was a wonderful opportunity for Cancer Rehab Canada/LifeMark to let people know about our cancer rehabilitation services. We not only had a chance to meet with different survivors and practitioners, but felt that the community responded with great interest in our new specialty programs", said Krista McIntyre.

Clinic representatives at the race included Krista McIntyre, Clinic Director and Physiotherapist of Whitby, Nadia Ramprasad, Physiotherapist of Whitby, Luke Tavernier, Exercise Therapist of Whitby, Michelle Gray, Massage Therapist of Whitby, Joy Brooks-Desbarres, Clinic Director and Physiotherapist of Oshawa, Michelle Lees, Kinesiologist of Oshawa, and Graham Doig, Clinic Director and Physiotherapist of Ajax. The team also gave out pens, ice/heat gel packs, and lip balm to participants both before and after the race.

Over 700 participants took part in Hearth Place 5K on the Runway, raising $69,000 for Hearth Place

There were over 700 participants and overall donations raised for Hearth Place at this year's run totaled $69,000.

Hearth Place addresses the social, practical, emotional, educational and spiritual needs of people dealing with all types of cancer. It is a well-known cancer resource centre in Central East Ontario for its wellness programs focusing on coping with cancer, healing, living well beyond cancer, and cancer support.

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

Physiotherapy Can Help Childhood Cancer Patients Regain Quality of Life

Physiotherapy can help childhood cancer patients regain quality of life

Cancer Rehabilitation Can Help Childhood Cancer Survivors

It is important to recognize the role rehabilitation can play in helping childhood cancer survivors overcome the damage to their growing bodies from cancer treatments. Although childhood cancer survival rates have improved from 71% to 82% over the last 30 years, the impact of long-term effects of treatment can also be lessened through cancer rehabilitation.

Adverse Effects Related to Childhood Cancer Treatment Experienced Later in Life

There are currently 10,000 children living with cancer in Canada. As documented in the publication Cancer in Children in Canada, about 800 new cases of childhood cancer are diagnosed in Canada every year, with treatment consisting of a combination of chemotherapy, radiotherapy, and surgery. The report states that "approximately two-thirds of survivors experience adverse effects related to treatment later in life known as late effects."

Greater Awareness of Physiotherapy Needed for Childhood Cancer Survivors

Because cancer treatments have such negative effects on growing organ systems, childhood cancer survivors often develop chronic conditions that lead to being less active later in life. Rehabilitation techniques such as physiotherapy, chiropractic and occupational therapy can help to address the neurological, musculoskeletal and cardiovascular "late effects" in childhood cancer survivors. Cancer rehab can help cancer survivors get back to normal. The goals of physiotherapy are to develop, restore or maintain normal function as much as possible, teach ways of coping when normal movement cannot be restored, and adapt survivors' environments so that movement can occur as much as possible.

In a study Physical Therapy and Chiropractic Use Among Childhood Cancer Survivors with Chronic Disease: Impact on Health-Related Quality of Life, it was reported that long-term childhood cancer survivors do not seem to make use of rehabilitation services to increase physical function. This could be changed through greater awareness of cancer rehabilitation. The potential for active rehabilitation to restore movement so that childhood cancer survivors can participate more fully in daily life is still largely unrealized.

To locate a Cancer Rehab location near you please see our British Columbia, Saskatchewan, Ontario and Nova Scotia locations.

Cancer Patients Need a Plan to Help Them Get Back to Work

Cancer patients need a plan to help them get back to work

If you have completed cancer treatment and want to improve your abilities so you can return to work and leisure activities, you are a candidate for the Cancer Rehab Canada program. Here are a few things that you can expect on your first visit:

An Assessment Allows Your Rehab Team to Make a Treatment Plan

You will be assessed by a physiotherapist and/or occupational therapist on your first visit. Your functional status may also be assessed by a kinesiologist, testing for your ability to do things such as lifting, walking, squatting etc. From this information, together with your input, the rehab team will make recommendations and prepare an individualized treatment plan based on your needs.

What a Typical Treatment Program Can Involve

Your treatment sessions will likely vary in length, and your therapist will advise you of this after the first visit. Often sessions become longer as you are able to tolerate more exercise/work conditioning. Although treatment varies for each individual based on their goals, some of the more common type of treatment for cancer rehab may include:

• Exercise
• Work Conditioning
• Manual Therapy
• Cognitive Behavioural Therapy
• Lymphedema Management
• Acupuncture
• Education & Coping Strategies
• Techniques to Reduce Dizziness or Vertigo
• Pelvic Floor Treatment

What You Should Bring to Your First Appointment

We recommend that you dress in comfortable clothing that you can easily move around in, and bring running shoes and a water bottle if possible. Since some clients feel more comfortable using their own mats, so you can also bring your own “yoga” mat if desired.

Principles of the Cancer Rehabilitation Program

Client-centered, active rehabilitation and empowerment are the guiding principles of the program that is now offered at 24 LifeMark/Centric Health clinics.

Client Centered – individualized, evidence based care provided in your community

Active – increasing your physical activity will have the biggest impact on your recovery

Rehabilitation – includes a multi-disciplinary team of rehab professionals

Empowerment – providing you with the tools you need to regain control of your life

Contact us for more information at judy.boivin@lifemark.cajudy.boivin@lifemark.ca.