Lymph Drainage Therapy for Breast Health at Beyond Basics Physical Therapy

Victoria LaManna, PT, DPT, CLT

lymphAs Breast Cancer Awareness Month comes to an end, we at Beyond Basics are working hard to help spread the word on the importance of regular self-examination and early detection. For further review, please see our blog post from earlier this month.

In addition to regular self-examination, regular breast massage is shown to help increase the circulation in your breasts. Therapeutic breast massage can also lessen discomfort associated with breast cancer treatments, help relieve post-surgical symptoms, and reduce discomfort during pregnancy, breastfeeding and weaning. Breast massage also contributes to improved skin tone while promoting relaxation and balancing your energy.
With regular massage, you will help diminish benign breast cysts while helping to flush lymph nodes and stimulating your glandular system. The breasts are soft tissue and do not have muscles to help them move, therefore they require assistance for improved circulation and lymph flow.
If you have been diagnosed with breast cancer and have undergone lymph node removal, mastectomy and/or radiation, you may experience lymphedema. About 15-20% of women who have axillary lymph nodes removed during breast cancer surgery will develop lymphedema. Working closely with your medical team to manage lymphedema is key! A Certified Lymphatic Therapist (CLT) can effectively apply gentle hands-on techniques to help enhance circulation and drainage.
Lymphedema is an accumulation of protein-rich lymphatic fluid in the tissues that contributes to swelling secondary to blockage in lymphatic flow when nodes or vessels are damaged. Individuals who have lymphedema may complain of discomfort in the affected limb, feeling of fullness in the limb, fatigue, or decreased flexibility. They may also complain of breast pain, tight-feeling skin, difficulty fitting into clothes, or tightness when wearing rings, bracelets, or watches. Venous insufficiency and obesity can contribute to lymphedema.

Complete Decongestive Therapy (CDT) consists of Manual Lymphatic Drainage (MLD) that aids in the circulation of body fluids, drains toxins from the body, stimulates the immune system and the parasympathetic system, reduces pain and/or muscle spasms, increases ROM, and decreases swelling. CDT can be used to treat conditions such as post-surgery and scars, fibromyalgia, chronic fatigue syndrome, infertility, painful periods, constipation, and irritable bowel syndrome. In conjunction, it is important to have an exercise program of stretching and strengthening to get the maximum benefits of CDT. After treatment, the patient may experience increased urinary frequency or increased amount of urine, increased sleep time or better quality of sleep, tension release and/or emotional release, or improved senses.

If you are seeking treatment, you need to see a licensed healthcare provider that is trained in Lymphedema Drainage Therapy. To find a specialist in your area, go to www.apta.org and click on “Find a PT”, specializing in LDT. Alternatively, you can search through the National Lymphedema Network or the Lymphatic Association of North America (LANA).

victoria2016Victoria LaManna, DPT, CLT, is our lymphedema expert. If you have had a mastectomy and are unsure about lymphedema care, she is an excellent resource. She will be able to instruct you in self- care and lymphedema prevention measures. Physical therapy can also help to release scar tissue in the breast and upper arm area, regain strength in the arm, and ultimately improve your function. Visit us, and read up on Victoria’s bio here, as well as on our website at: www.beyondbasicspt.com/lymphedema.

Breast Cancer Awareness Month

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Fiona McMahon, DPT

Have you noticed an increase in the amount of pink on just about everything the last couple days? The increase of pink everything is because October is Breast Cancer Awareness Month.  Breast Cancer is an extremely common cancer. According to the Nation Breast Cancer Foundation, 1 in 8 women will be diagnosed with breast cancer in their lifetime. Men can also get breast cancer, however it is much more rare for men to develop breast cancer. Luckily with early detection and treatment of early stage and localized cancer, the 5 year relative survival rate is 100%. That being said, early detection is crucial and it is important to catch breast cancer early to ensure the best possible outcome. Let’s take some time to review the signs of breast cancer and recommended screening protocols.

Signs and Symptoms of Breast Cancer

  • Change of Sensation/ texture of the Breast or Nipples
    • Lumps, change in texture in the breast, nipple, or underarm area
  • Change in appearance of Breast or Nipple
    • Swelling
    • Shrinkage
    • Dimpling
    • Change of nipple orientation
  • Discharge from nipple

Detection

bfab76550709826284e190dd6efc1a76Self Exam

  • Recommend for women of all ages
  • Should be performed every 12 months
  • Check in the shower: move the pads of your fingers over your breasts in a circular motion. If you find any lumps or skin abnormalities, visit your healthcare provider.
  • Visual exam: examine your breasts in the mirror. if you note any changes in your breasts such as bumps, skin changes, nipple orientation, dimpling, shrinkage, or swelling, visit your healthcare provider
  • Lying down: moving the pads of your fingers, check for breast abnormalities. Squeeze nipples to check for discharge. If you find any lumps or skin abnormalities, visit your healthcare provider.

 

Recommended Screening:

Mammogrammammogram-ultrasound-equally-effective-to-detect-breast-cancer

  • Recommended every 1-2 years for women who are 40 years old or older.
  • May be recommended for women who are under 40, but have increased risk of breast cancer.

 

Genetic Testing

brca12For some types of breast cancer, there is a very specific link to a person’s genes and her or his risk of developing breast cancer. BRCA1 and BRCA2 are genes that are responsible for the production of certain tumor suppressing proteins. In some populations there are mutations in these genes that disable their tumor fighting properties. These gene mutations are relatively rare and currently screening is recommended just for individuals with increased risk of harboring these mutations. According to the National Cancer Institute, individuals who are at higher risk and should consider genetic testing are:

  • Individuals who have a male relative who has developed breast cancer
  • History of BRCA related cancers within family history
  • People of Ashkenazi (Eastern European) Jewish ancestry
  • Breast Cancer diagnosed before age 50 in family
  • Multiple cases of breast cancer in family

Individuals that test positive for BRCA mutations may consider increased screening, prophylactic surgery or chemoprevention.

Mastectomy and Physical Therapy

Mastectomy, removal of the breast is currently the most common treatment for breast cancer. Some women chose to have their breasts reconstructed after their mastectomy and others do not. It is obviously a very personal choice.  Like any surgery, mastectomies require close postoperative care to ensure maximal function and recovery.

You may have read the last sentence, and thought, “What is the function of the breast, besides breast feeding and for sexual pleasure?” The breast lies in an important intersection in the body. The armpit (axilla) contains bundles of nerves, blood vessels, and lymph vessels that course through it, serving the arm down to the fingers. After mastectomy, their course can be interrupted by scar tissue, radiation damage (if your treatment included radiation), causing painful conditions such as nerve entrapments, frozen shoulder, and lymphedema, ( a backup of lymph fluid, if left unchecked can cause permanent damage and deformation of the arm).

victoria2016Victoria LaManna, DPT, CLT, is our lymphedema expert. If you have had a mastectomy and are unsure about lymphedema care, she is an excellent resource. She will be able to instruct you in self- care and lymphedema prevention measures. Physical therapy can also help to release scar tissue in the breast and upper arm area, regain strength in the arm, and ultimately improve your function. Visit us, and read up on Victoria’s bio here, as well ask on our website at:  www.beyondbasicspt.com/lymphedema

 

Breast cancer is extremely common, but luckily outcomes continue to improve, but early detection is key.  This October, let’s stand together to commit to regular self exams and educate the women in our lives to screen themselves as well. Let’s reduce the impact of breast cancer, one step at a time.

Sources:

http://www.nationalbreastcancer.org/. Accessed: September 24, 2016

National Cancer Institute. BRCA1 and BRCA2: Cancer Risk and Genetic Testing. https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q1. Accessed September 25,2016

http://www.beyondbasicspt.com/lymphedema

PH101: Pain and Sexuality: Is it all in my head?

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By Fiona McMahon, DPT

Sex should feel good… really, really good. But when it doesn’t, you may start to wonder, what’s wrong with me? Am I broken? Am I a prude? Am I frigid? Painful sex isn’t something we talk about. No one would look at you twice if you walked into work complaining of pain in your elbow, but if you walk into work complaining about pain in you vagina or penis, you may end up having a meeting with HR.

On October 6th at 7pm, we at Beyond Basics are breaking down those taboos and having an educational seminar, followed by an optional question and answer session at the end. We will discuss the many causes of sexual pain and how physical therapy can help.  The event will be hosted by one of our therapists, Stephanie Stamas, DPT, ATC. Stephanie will give a detailed seminar about pelvic health and take time to clear up some common misconceptions many people have concerning their bodies and sexual function.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth-101.eventbrite.com

Here is our line up of this and future classes

Pelvic Health 101 Fall- (003)

September is Prostate Cancer Awareness Month

Blue ribbon

Fiona McMahon PT, DPT

September is Prostate Cancer Awareness Month. Here at Beyond Basics Physical Therapy, we treat many men both before and after treatment for prostate cancer. We focus on restoring the health of the pelvic floor and tissue surrounding the prostate to restore normal sexual and urinary function. For more information about how physical therapy can help you or someone you love who is going through prostate cancer, read our blog on prostate cancer: https://beyondbasicsptblog.com/2015/04/07/physical-therapy-and-the-prostate/

Beyond Basics itself has an outstanding program in pre and post operative prostate care:

 

Beyond Basics Physical Therapy

Pre-op/Post op Prostatectomy Program

110 E 42nd Street, Suite #1504, NY, NY 10017

T: 212-354-2622

Beyond Basics Physical Therapy offers a unique and comprehensive rehabilitation program focused on the healthcare needs of people who have

  •      Incontinence or sexual dysfunction due to prostate surgery
  •      Pain and/or bladder retention, frequency or urgency due to prostate treatment (with or without surgery)

Our physical therapists that work with these clients have extensive training and knowledge in pelvic related issues.

Pre-operative: patient will be seen by a therapist to not only evaluate their prior function, but also give them exercises to do before and after surgery.  The evaluation will include:

  • Muscle strength testing including pelvic floor and lower extremities
  • Biofeedback evaluation using either internal rectal sensors or external anal sensors
  • Education on what to expect and things to do to optimize surgical outcomes
  • Overall posture evaluation

Post-operatively: patient will be seen 2-6 weeks after surgery. Treatment will include the following

  • Muscle re-education utilizing biofeedback
  • Bladder re-education/timed voiding
  • Postural education
  • Overall core stabilization when appropriate
  • Behavioral Modifications

We treat our patients for 60-75 minute sessions in private rooms and use state of the art biofeedback technology.   If you have specific questions, please do not hesitate to contact us.

As always, our programs are tailored to your specific needs.

Beyond Basics’, Victoria LaManna Receives Lymphatic Drainage Therapy Certification

victoria2016Victoria La Manna, PT, DPT, CLT of New York, NY successfully completed Norton’s School of Lymphatic Therapy’s Lymphedema Certification Program. The certification signifies advanced skill in the application of complete decongestive therapy (CDT) in the treatment of lymphedema.

Lymphedema is the abnormal accumulation of protein rich fluid due to a disorder of the lymphatic vessel or nodes. It is a chronic condition that will usually worsen over time if left untreated. Complex Decongestive Therapy is the conservative treatment of choice for lymphedema and is reimbursable in New York by medical insurance. CDT involves a regimen of manual therapy, medical compression (bandaging, wrapping of the area), skin care, aerobic conditioning, and isotonic exercises done during the therapy session and at home.

Manual Lymphatic Drainage (MLD) Therapy is a gentle hands-on modality used to stimulate lymph flow and its specific rhythm, direction, depth, and quality over the entire body. This technique is used to aid excess lymphatic fluid to healthy neighboring territories and return it to the intact lymphatic system. The effects of MLD consist of:
• Relaxation, analgesic, diuretic
• Increases performance of the lymphatic system
• Re-routes fluid from congested area
• Softens connective tissue

MLD may also benefit these conditions:
• Lipedema
• Phlebo-lymphostatic
• Post-trauma or post-surgical swelling and healing
• Chronic Regional Pain Syndrome (CRPS)
• Cyclic-Idiopathic Swelling
• Inflammatory Rheumatism
• Migraine Headache
• Sinus Headache
• Scleroderma
• Chronic Fatigue
• Fibromyalgia
• General Relaxation

Victoria La Manna, PT, DPT, CLT earned, and successfully received, the 140-hour Lymphedema/CDT Certification which fulfills the requirements to sit for the national certification testing with the Lymphology Association of North America (LANA). Dr. La Manna is an expert physical therapist at Beyond Basics Physical Therapy, which is located in midtown Manhattan. She began, and is currently the head physical therapist for, the Lymphedema Program, which addresses the upper and lower extremities and the trunk region in men, women, and children. She is a member of the Women’s Health and Orthopedic sections of the American Physical Therapy Association and the National Lymphedema Network. Victoria is also a member of the National Vulvodynia Association and the International Pelvic Pain Society.

Bring out the Laser! Cold laser (Low Level Laser) …that is!

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Fiona McMahon, DPT

When you think laser you may think of lasers for hair removal, tattoo removal, as surgical instruments, or if you are a child of the late 80’s early 90’s like me, you may think of Dr. Evil from the Austin Powers movies. These lasers are all examples of thermal lasers, ( ok, I didn’t check on Dr. Evil’s laser), which use heat to treat tissues. These examples may be all you think of when you think of lasers, but did you know that a different type of laser, cold laser, is a new and effective tool that the therapists at Beyond Basics are using to help treat their patients who suffer from a broad range of conditions from orthopedics injuries, pelvic pain to post operative recovery?

 

What is Cold Laser and how is it thought to work?

Cold laser or low level laser light therapy (LLLT) differs from the conventional lasers mentioned above in that they have a much lower light density than that of the lasers used in hair removal or surgery. Cold lasers do not emit heat, thus the moniker, cold laser.

Lasers were invented in the 1960’s and they were quickly used for therapeutic purposes.  1967 lasers were applied to the backs of shaved mice and the hair of the mice treated with laser grew back quicker than the mice that did not receive the laser treatment. Shortly after that study was conducted, lasers began being used to stimulate wound healing in non-healing ulcers.

Even though initial research on lasers started in the early 60’s, the mechanism by which lasers do their work is still not fully understood. There is strong evidence to suggest that laser therapy aids in ATP production ( the energy of cells), collagen production, cell turnover, and release of endorphins. The use of laser for therapeutic purposes was deemed safe by the Food and Drug Administration in 2002.

 

What can the use of cold laser help with?

Cold laser can be a brilliant adjunct to standard physical therapy treatment; however it is a component of treatment and does not correct the underlying factors that caused the original injury, therefore traditional physical therapy treatment of strengthening weak muscles and stretching and lengthening tight ones, correcting alignment, and improving overall fitness is essential to provide patients with truly long lasting results.

 

The use of laser has been found in many studies to be effective in reducing pain. In a meta-analysis conducted by Huang and colleagues, laser was shown to have a significantly  greater effect at lowering pain scores over placebo in patients with chronic low back pain.

 

In another study conducted in 2003, low level laser therapy was found to be more effective than placebo in reducing pain in patients with myofascial pain syndrome. In this study, both groups were given stretching exercises, but one group was also given  LLLT.  Immediately following the experiment and at the 3 week follow up pain levels were found to be significantly lower in the group that received LLLT.

 

Another study conducted by Foley et al, examined the “return-to-play” times for college athletes who were treated with laser versus their projected “return-to-play” times based off of historical data for the players’ given injuries. The study found that laser treatment shortened the “return-to-play” times by 9.6 days, which was statistically significant. The athletes required 4.3 laser treatments on average before they could return to their sports.

 

Laser is a great adjunct to traditional physical therapy and is a great help to patients where nothing nothing else has been effective. At Beyond Basics PT, LLLT complements our expert manual and orthopedic skills to treat pelvic pain, incontinence, post-surgical injuries, and orthopedic conditions. If you think LLLT may be right for you, make an appointment at Beyond Basics Physical Therapy today!

 

Foley J, Vasily D, Brandie J, et al. 830 nm light-emitting diode (led) phototherapy significantly reduced return-to-play in injured university athletes. Laser Ther. 2016; 25(1):35-42

 

Chung H, Dai T, Sharma S. The nuts and bolts of low level laser (light) therapy. Ann Biomed Eng. 2012; 40(2) 516-33

 

Hakgüder A, Birtane M, Gürcan S, et Al. Efficacy of low level therapy in myofascial pain syndrome: an algometric and thermographic evaluation. Lasers Surg Med. 2003;33(5): 339-43
Huang Z, Ma J, Shen Bin, et al. The effectiveness of low-level laser therapy for low-level laser therapy for nonspecific chronic low back pain: a systematic review and meta-analysis. Arthritis Res Ther. 2015; 17: 360.