Coping with Pain Post-Breast Cancer Reconstruction
Several months ago, a woman in her 50’s came to see me for neck pain. While I was doing her intake and her health history, we discussed her being a breast cancer survivor.
Recently I helped out a colleague for a morning, giving coverage in a beautiful multidisciplinary office. It was an interesting change of pace since I didn’t know any of the patients when I started working on them, there was not time to do an in-depth intake, more a cursory glance at their files and a short how are you doing conversation. One patient that I met was a woman in her early 40’s, with an athletic build and very cheerful personality, I will call her Sarah.
Sarah told me she had frozen shoulder for nearly a year. Frozen shoulder is a condition that affects your shoulder joint. It usually involves pain and stiffness that develops gradually, so for Sarah It started in April of last year. The onset was after a workout where she admittedly overdid it, her shoulder felt sore. Over the next few days it got progressively more sore until she could barely move her arm. She saw her medical doctor, but he was unable to help her. She then began physical therapy, chiropractic and acupuncture treatments in June.
When I saw her it was April, a year after onset. She had little to no pain, but her range of motion left something to be desired. When she raised her arm laterally, she couldn’t get her upper arm close to touching her ear. On the other side she could do it without problem. She also had very limited range reaching behind her back. Sarah had been pleased with her treatment to this point, but indicated she was open to anything to increase her range of motion.
While seated I tested the muscles on the back that help the shoulder blade to move, and there was some tightness so I released the rhomboids and supraspinatus. Pectoralis was tight on the front so I released that as well. There was some improvement after that. Considering the range of motion issues, she was having I had her lay down and we worked on subscapularis. Following the release, I had her sit up again and she was almost at 100% range of motion. The final muscle to clear up was levator scapula. Following that she could reach her arm up laterally perfectly. Her range reaching behind her back was double what it was when she came in. She was absolutely thrilled.
I believe it was subscapularis muscle that really made the difference in this treatment. It is a difficult and uncomfortable muscle to have work done on so as practitioners we tend to avoid it. I have found that dry needle trigger point needling of that muscle is the least uncomfortable and most therapeutically effective method I am aware of to treat a tight subscapularis, and the results are often instantaneous as well as lasting.
