The impacts of breast cancer stretch far beyond the imaginable for many women. Cancer Rehabilitation Specialist, Kate Perkins, recently caught up again with colleague, and Breast and Shoulder Rehabilitation Specialist, Denise Stewart, to talk more about the many hidden scars of breast cancer and the process of healing.
What physical side effects are often referred to as ‘the hidden scars of breast cancer?’
The hidden scars of breast cancer commonly refer to physical by-products of breast cancer surgery including surgical scar tissue for lumpectomies and sentinel node biopsies, cording (a painful, rope-like mass causing loss of range of movement in the upper arm and shoulder), seroma (a build-up of post-surgery fluid) and radiation scar tissue.
A stretch on traditional recovery
Traditionally, a patient’s rehabilitation and recovery following breast cancer treatment was measured by their arm to shoulder flexion or shoulder abduction, so the research was always looking at individual flexion and abduction results.
Responding to feedback from her patients that they were still experiencing problems, even when their flexion and abduction results were positive, Denise Stewart introduced a bigger stretch measurement encompassing a Reach Out the Back Stretch and Assessment that took into consideration a fuller range of movement.
Through practicing these movement techniques, patients experience a marked increase in their shoulder range and a relief of tightness through the chest and axilla.
How does the Reach Out the Back Stretch and Assessment work?
The Reach Out the Back Stretch uses a clock analogy to gain optimum position and observe movement and tension in breast cancer patients. If a patient’s head is 12.00 and their feet are 6.00, at 10:00 and 11:00, when patients reach out the back, it stretches the skin and the breast tissue, if there is breast tissue, enough so that any impairments such as cording or seroma become more obvious. These are secondary outcomes following surgery that could sometimes be missed in traditional range of movement assessments.
The second part of the testing method revolves around movement, where your practitioner places their hand on the affected area during the testing to diagnose any obvious tension and physical impairments.
The clock analogy is so effective because it tests a full range of pec muscle movement, by observing every angle or ‘time,’ using a hands-on approach.
How does this technique assist the healing process?
The Reach Out the Back Stretch uses a ‘tension and relax’ process, common to yoga or gyms, that speaks to the tightness of the muscles. If it is tight muscle that’s stopping the range, then the relaxation of the muscle means you can go a little bit further to increase your range and movement. If tightness is being caused by scar tissue or adhesions like seroma, cording, or tightness in the skin, no further range of movement will be possible, therefore helping to identify and treat any hidden scars. The ‘relax’ component is actually the most important component of this technique.
Patients using this technique often notice improvements straight away, and after three months or more performing this technique regularly can also positively impact lymphatic flow.
Can breast cancer patients perform this technique themselves?
Breast cancer patients can perform this ‘tension/relax’ process individually by pretending their hand is up against a pane of glass and push against that imaginary pane of glass without actually going through it, to gain the optimum tension in their muscles. Then go through the process of tensing and relaxing the muscles to increase range and movement.
What is the pec minor and why is it important in breast cancer recovery?
Your pectoral or ‘pec’ muscles connect the front of your chest with your upper arms and shoulders. The pec minor is located underneath your pec major. If you put your finger on the beginning of your collarbone and then the end of your collarbone, it’s almost halfway between. You can tell it’s there because it’s vertical fibres and there’s nothing else in your body that contains vertical fibres in that area.
The pec minor is important because for patients who have had a lymph node dissection, many of the nodes in this area are nestled around the pec minor. During surgery, the pec minor can be ‘pulled away’ and will remain tight in response. If nodes are being removed, radiotherapy is also deeply affecting this area.
If patients can’t stretch back behind their ear, they can assume the pec minor has been affected. Often in these instances, the Reach Out the Back movement alone won’t be enough to aid recovery. In these cases, it’s necessary to have a practitioner perform hands-on work to help soften the tissue and get deeper to those muscles as well.
What other techniques can practitioners use to support the healing process?
Breast cancer rehabilitation practitioners can use a range of therapies and techniques to assist in the healing process. Common treatments include:
Low level laser therapy for the younger scar tissue (younger referring to the timeframe between treatment and rehabilitation);
Modern cupping techniques to lift the fibres away, rather than pushing them onto and each other to try and encourage movement; and
Gentle Myofascial Release techniques.
These techniques need to be performed regularly initially to ensure the pec minor and surrounding area is softened to enhance a wider movement range, then maintain tissue suppleness with ongoing maintenance.
How has the Reach Out the Back Stretch and Assessment evolved in recent times?
Due to the recent COVID-19 pandemic and the difficulties this caused for many breast cancer patients in accessing face-to-face treatments, creator Denise Stewart further developed a seated assessment, so that practitioners could more easily view patients performing the movement online.
Denise has further developed audio instructions for the movements, so that patients can perform the stretch as a guided sequence on a regular basis, forming a beautiful body meditation.
And she is currently working with US Practitioner Sara Kamalah to supply a standard touch pressure device to participants completing online training in the Reach Out the Back Stretch and Assessment to help train therapists around the world in this innovative technique, ensuring there will be a qualified therapist to support breast cancer survivors in every community.
Get in touch
Denise Stewart’s audio Reach Out the Back Stretch guided body meditation will soon be available to all members of the Bounce Back from Breast Cancer online community. Head to bouncebackfrombreastcancer.com/community to find out how you can become a member.
To find out how to recover faster before, during or after cancer
treatment contact Kate Perkins at
Cancer Rehabilitation & Lymphatic Solutions on 4312 7033 or email
To learn about a wide range of issues relative to breast cancer rehabilitation members can tune into our Talking with the Experts https://lymphaticsolutions.com.au/category/videos/ series.
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