The Ayrshire Acupuncture Clinic

For nearly 10 years Alexandra has specialised in treating post breast surgery complications within the NHS with myofascial release techniques in her capacity as a physiotherapist.  During this time she worked closely with the breast care team and helped developed this service in Ayrshire.  She now works full time in private practise and offers this treatment in her clinic in Ayrshire to women who have had breast surgery and who have noticed problems such as decreased range of movement, a feeling of tightness, restriction or pain post surgery or radiation therapy.  In some cases the patient’s shoulder range of movement can be limited and their radiotherapy treatment  delayed  as they are unable to achieve and maintain the required position.  In many cases only one or two sessions of myofascial release (MFR), would be enough to allow the person to achieve this position and their treatment can go ahead as planned.  MFR can be useful both following surgery after the wound has healed or months or years later – it is never too late to try MFR.

Myofascial Release

Myofascial release (MFR) is a gentle form of manual therapy which facilitates the stretching and release of fascia.  Fascia is the soft tissue component of the connective tissue system that penetrates and surrounds muscles, ligaments, blood vessels and neural structures (Chaitow and DeLany, 2003). MFR may help reduce soft tissue restrictions, improve blood flow and relieve pain by influencing cellular mechanisms.

MFR encourages people to develop body awareness and this may help women recognise how experiences such as surgery, stress and anxiety can affect their posture.  This may prevent development of postural problems which can contribute to long term morbidity and impact on quality of life. 

Post Mastectomy Complications

Following breast cancer surgery many patients experience musculoskeletal problems involving the shoulder, arm and chest wall which can significantly impact on their quality of life (Sclafani et al, 2008).  There are a number of factors related and independent to breast cancer treatment which alone, or in combination, may lead to decreased upper limb function. A recent systematic review suggested up to two thirds of patients report shoulder restriction or pain following surgery and radiation for breast cancer (Lee et al, 2008).  The upper limb complications women may experience include reduced range of movement and muscle strength, pain, anxiety, cording, scarring, weakened tissue, fibrosis, brachial plexus neuropathy and the risk of lymphoedema (Ozalp et al, 2003, Johansson et al, 2001, Ryttov et al, 1988).

Palpation

We use the art of palpation and light touch to address these post breast surgery complications. The definition of palpation is ‘to caress, to care for, and the art of exploring the structures beneath the skin’.  With myofascial release we can feel what is beyond.  Palpation is the art of using touch to examine the body and the normal or abnormal function of the tissue/organ underneath can be discovered.

We use non-intrusive palpation which permits examination without provoking resistance. The therapist can experience a sense of ‘melding’ with the patient. Less is more!

Light touch

While some forms of therapeutic massage might be too strong or heavy for the patient who has undergone breast surgery and/or radiotherapy, myofascial release involves light touch and light forces and the therapist remains as unobstrusive as possible, using a gentle technique that uses approximately 5 grams of pressure.  The therapist holds a particular stretch for 90 to 120 seconds, applying pressure gently in the area of restriction until the release is felt, then takes up the slack and waits again until the signs of tissue release are felt. As the tissue releases there is a softening and relaxation when the technique has come to successful fruition.   Sometimes the restriction might not be directly over the scar tissue itself, but can be in the surrounding area,  over the whole or part of the upper quadrant or into the neck muscles or upper arm.  

Factors involved in tissue release:

1. A relaxation of nervous reflexes which have produced an increase in tissue tone.

2. Tissue change from elastic resistance to viscous compliance – a lengthening of tissue fibres with mechanical memory for return to the original dimensions.

3. Increased passage of fluids through the tissues under treatment.

4. Increased flow of energy through the tissues under treatment.

5. Emission of increased heat radiating from the region.

6. Sense of repelling force perceived by the therapist’s hand.

7. Crescendo and decrescendo of the ‘therapeutic pulse’  (this must be experienced to be comprehended). 

Research

To date there have been few research studies on the effectiveness of myofascial release.  At the present time Alexandra is clinician in a research project taking place by the Department of Nursing and Health care, University of Glasgow entitled ‘Myofascial release to improve upper limb mobility for women undergoing radiotherapy’ and is based at The Beatson West of Scotland Cancer Centre within NHS Greater Glasgow and Clyde.  The study should be completed by the end of 2010.