Manual therapy for Axillary web syndrome
Axillary Web Syndrome (AWS) has been estimated to be prevalent in up to 85% of women receiving surgical treatment for breast cancer. The result of AWS leaves the patient with a restricted upper extremity, pain, and associated ‘cording’ signs. This article examined the benefit of specific manual therapy for improvements in pain and function.
The authors of this study looked at the effects of manual therapy, specifically dynamic angular petrissage to treat ‘cording’ or soft tissue adhesions associated after breast cancer treatments.
The patient in this study presented following simple mastectomy with axillary surgery (sentinel node biopsy plus axillary dissection). No further mention of chemotherapy or radiation was made. Around 4.5 weeks post-intervention, the patient was presenting with a ‘cording’ which extended down the length of the affected arm. The patient noted having a nodule near the incision site, and noted her upper extremity was restricted and was experiencing pain up to 5/10 on the Oxford Scale.
Interventions were provided in the form of massage therapy by a trained and licensed massage therapist. The author describes the specific technique used as: “Termed dynamic angular petrissage, it builds on established methods of Swedish massage, petrissage and non-petrissage techniques, and incorporates passive-relaxed movement (…) Digital pressure is maintained at the barrier while simultaneously lengthening the tissue using the distal limb in a passive, eccentric manner.” Additionally, joint mobilisations through active range were done throughout the affected upper extremity, as well as lymphatic drainage massage.
There were 2 treatment sessions (lasting 1.5 and 1.0 hours, respectively) spaced 8.5 weeks apart. Gains with functional movements and active range of motion were measured and showed return to function, improved upper extremity movement and decreased pain after these 2 sessions.
This article demonstrates an effective treatment approach for the management of AWS and associated pain and functional restrictions. However, the authors acknowledge that not one single standard of care currently exists. Throughout the world, AWS is managed differently, and under varying degrees of lymphatic treatment certification.
Several limitations exist in this study; it is a case study without control for the proposed mixed treatment of lymphatic massage, range of motion, and soft tissue massage. Thus it is difficult to determine which aspect of care was most beneficial. However, this study emphasisized that manual therapy can be a type of effective tool for the treatment of AWS.
The reader should be nevertheless be cautioned on the level of certification needed in their part of the world to treat clients with lymphatic impairments, as certification for this type of manual therapy varies globally.
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> From: Lewis et al., Int J Ther Massage Bodywork 9 (2017) 28-37. All rights reserved to The Author(s). Click here for the online summary.