Post-Double Mastectomy and Lymph Node Disection Surgical Scar Tissue, and Lymphodema Relieved with C
Client Info
Age: 58
Occupation: Corporate Management, and Yoga Teacher
Exercise / Type and Frequency: yoga 2 x weekly, walking.
Currently Receiving Treatment from Another Health Care Provider: physiotherapist-lymphedema specialist.
Pain Frequency: Pain in ribs, especially left side, and pain in the left armpit with certain movements, and when attempting to lift arm above shoulder.
Injuries or Motor Vehicle Accidents & Dates: MVA at age 16, no serious injuries at the time, but had a neck spasm a couple of months after the accident that sent patient to the hospital.
Surgeries & Dates:
Age 7 - Adenoidectomy
Age 25 - Several months after son was born patients menstruation became extremely heavy; at one point bleeding wouldn't stop for weeks so the physician did a D&C and during the procedure the uterus was punctured, and they discovered extensive scarring from endometriosis, and pelvic inflammatory disease due to an IUD, which they removed. Patient was admitted for one week and put on antibiotics. Subsequently was told conceiving another child would be very difficult.
Age 29 - had an ectopic pregnancy and required a laparotomy (~6" incision abdominally to remove the fetus).
Age 30 - had another ectopic pregnancy and same surgery again.
Later that year had a Bilateral tuboplasty - purpose of this surgery was to remove scar tissue from inside Fallopian tubes (went into the same incision /this was the third time)..
A few months later another ectopic pregnancy; this time the surgeons used an evolved method through laparoscopy instead - 3 small incisions instead of one large.
2012 at age 51 - right side lumpectomy, followed by chemo and radiation
2015 at age 54 - double mastectomy, preceded by chemo and followed by radiation.
2016 at age 55 - left arm lymphedema flare up.
Patient's Reasons for Seeking Osteopathic Treatment:
Pain and limited range of motion in left arm.
Scar tissue on chest feels uneven between the right and left. Patient explained that two different surgeons worked on the right and left sides, and the left side feels as though the skin was pulled tighter during suturing.
Would like additional relief for lymphedema in left arm to further support the work already being done by physio-lymphedema specialist.
Treatments
Initial Tests & Objective Findings During First Treatment:
Range of Motion: The left arm has restricted range of motion in elevation past the shoulder level. The right arm is somewhat restricted compared to normal range.
Strength and neurological tests are both negative.
Tissue on chest feels uneven between the right and left (as patient explained).
The scar in the left axillary region is deeply puckered where the lymph nodes were extracted creating a strong band of fascial restriction.
Palpation and pressure on certain areas on the rib cage produce sharp pain.
Treatment Techniques:
Prone:
Myofascial Release of scapular and paraspinal muscles.
Sacral mobilization.
Gluteal and back-line myofascial release.
Supine:
Myofascial Release of superior thoracic aperture, serratus anterior, pectoralis major and minor.
Counterstrain on Tender Points (Tp’s) for serratus anterior, pectoralis major and minor.
Muscle Energy Technique Post Isometric Relaxation (PIR) of pectoralis major and minor.
Lymphatic balancing of full torso and upper extremities.
Harmonic Oscillation of upper and lower extremities along coronal plane.
Result: patient reported some pain relief and increased range of motion immediately following first treatment.
Home Care Exercise: Structural Alignment Yoga Therapy - Shoulders, Neck & Spine Posture Optimization (Wall Fish Pose)
* Therapists' Note: This exercise is covered in my Structural Alignment Therapy Training, among a long list of amazingly effective exercises for various conditions. Learn more >>
Results After a Series of Treatments
Patient now has complete full range of motion in both the right and left arms.
The uneven skin between the right and left began to improve after the first treatment. After a few treatments the patient reported this was not longer an issue for her.
The puckering in the scar tissue in the left armpit is completely released and no longer causes restriction of motion or tissue tension.
The lymphedema in left arm has improved, and continues to improve, and is being monitored regularly.
Note: the lymphedema is an ongoing project, however this patient is the poster child of doing all that is possible in self care. She performs daily lymphatic massage with the assistance of her husband who reaches the areas where she cannot. She also performs my 'Lymphatic Balancing Sequence' daily which has not only further improved the lymphedema in her arm, but also in the rest of her body.
Clinical Impression
Pain and limited range of motion in left arm was due to myofascial imbalance and post-surgical scar tissue which caused deep fascial restrictions.
