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Amanda Cranston  | Cornerstone Physical Therapy

Amanda Cranston


Oncological Program FAQs

What is Prehab?

  • Establish baseline measurements
    • For ROM, strength, functional mobility
  • Preoperative limb volume measurements
    • in order to screen post-surgery for early signs of lymphedema
  • Overall goals of prehab include:
    • Improve treatment tolerance (surgery, chemo, radiation)
    • Reduce impact of symptoms post Treatment (surgery, chemo, radiation)
    • Improve patient compliance and engagement in treatment plan
    • Potentially shorten length of treatment

    Why start Rehab 3 weeks post-surgery?

    • Tissue Healing Phases
    • Patient is transitioning from inflammatory phase to proliferative phase of healing (2+ weeks - 2 months)
    • Immature collagen and elastin is forming and is much easier to work with than mature collagen

    Soft-tissue fibrosis is associated with:

    • Impaired lymphatic regeneration and lymphatic function
    • Impaired lymphatic endothelial cell proliferation
    • Abnormal lymphatic microarchitecture
    • Lymphatic fibrosis Fluid Dynamic Impairments Local injury to lymphatic system

    Decreased transport capacity

    • Inflammatory phase = inc. fluid load at injury site
    • Results:
      • Mixed edema (inflammation + lymph fluid)
        • stage 0/1 Lymphedema
      • Cording issues (Axillary Web Syndrome)
        • fluid becomes trapped in fibrotic tissue (lymphovenous stasis)
        • Results in tissue induration, possible seroma formation, also potential for lymphedema

Improve Functional Mobility

  • Improved shoulder flexion ROM with exercise 2-3 weeks post-surgery and Abduction ROM with exercise 4 weeks post-surgery
  • Pain, balance impairment, difficulty with ADL's, inability to return to work all contribute to unnecessary disability for the patient and increase the economic burden to the survivor and society.
  • Decrease Unnecessary Pain

    • Improve muscular mobility in order to prevent onset of Myofascial Pain Syndrome (MPS)
      • 50-60% of patients post mastectomy and lumpectomy develop MPS
    • MD Anderson study of 5,836 CA survivors found joint pain as 1 of the top 4 most frequently reported health problems
      • Joint pain- exacerbated with poor posture, immobility and muscle atrophy surrounding the joints
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