Post-surgical mastectomy patients can experience a wide variety of issues—either singularly or in combination—including pain, altered sensation in the hands or surgical site, restricted range of motion or even secondary lymphedema.
One particularly vexing issue is axillary web syndrome (AWS), also known as cording. “AWS typically presents as a tightened, externally visible and palpable ropelike structure restricting movement and producing pain,” explains Paul Lewis, a registered massage therapist and 2014 Silver Award winner in the Massage Therapy Foundation’s Practitioner Case Report Contest. “This typically develops under the skin of the inner arm, usually starting at the axilla from where post-surgical scarring has occurred and extending across the medial aspect of the arm to the elbow, and sometimes down to the wrist and thumb.”
LEWIS CREATED A PLAN BASED ON A COMBINATION OF INPUT FROM THE CLIENT AND HIS OWN FINDINGS UPON ASSESSMENT.
The Plan
Lewis created a treatment plan based on a combination of input from the client and his own findings upon assessment. “First, the client completes a health history form and we discuss the client’s goals and concerns,” he says. “Following that, a clinical assessment is performed to determine where the source of the issue stems from rather than simply focusing on the symptoms.” According to Lewis, the massage sessions expand on Swedish massage by incorporating movement. “Using one hand to gently knead the soft tissue, the other hand is used to passively increase (lengthen) and
lessen (shorten) tension on the tissue via changes in limb positioning and limb angle, utilizing the muscle’s line of pull and attachment,” Lewis explains. “The treatment pressure applied is very minimal.” To help with restricted range of motion, Lewis gave the client self-care exercises to perform between sessions. “I teach an easy-to-remember exercise called ‘L’ circles to help with restricted range of motion and mobility in the shoulder region,” he explains. “These exercises affect the muscles attached to the scapula.”
The Results
The client saw results in two sessions, experiencing both a reduction in pain and an increase in range of motion. “I can extend my arm fully without that familiar, annoying tugging pain just below my elbow,” she explains. “The whole web or cord system seems to have relaxed to the point where I can basically move my arm how I want. The wrist and elbow areas were the most annoying in terms of pain, and these are where I am feeling massive relief.”
Words of Wisdom
Lewis cautions massage therapists that if they are unsure how to handle clients with post-surgical mastectomy issues, they should refer out. “When treating these clients, remember they have been through quite a bit so far, and so good communication between client and therapist is very important when developing a treatment plan and deciding what structures you’re going to address,” he adds. “You need to make sure, too, that you are listening to your client’s feedback as you work.”
About Paul Lewis
Paul Lewis is a registered massage therapist in Mississauga, Ontario, Canada, and developer of Dynamic Angular Petrissage method.
He received the Silver Award in the Massage Therapy Foundation’s 2014 Practitioner Case Report Contest for his study Dynamic Angular Petrissage (DAP); A Novel Therapeutic Approach for Axillary Web Syndrome (Cording/Webbing).
