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Superhero Support

ALL SUPERHEROES NEED TUNEUPS, ESPECIALLY BREAST CANCER SURVIVORS! IT'S A GREAT IDEA TO FIND A CERTIFIED BCRL THERAPIST NEAR YOU AND CHECK IN WITH THEM TO TRACK YOUR AFTERCARE PROGRESS.

BCRL Therapy

Before you begin breast cancer treatment, ask your medical provider about therapy to support your healing process. Best practice is to meet with a certified BCRL therapist prior to surgery. They help manage and reduce the common side effects of breast cancer treatment, including pain, stiffness, limited range of motion and BCRL. 

Types of Treatment that BCRL TherapY ProvideS

  • BCRL Education - Before & After Breast Cancer Treatment

    A certified BCRL therapist will provide you with the knowledge and self-care tools to learn about minimizing the risk of BCRL. Your BCRL therapist is an essential member of your breast cancer aftercare team and can track potential BCRL development.

     

    Think of your BCRL therapist as your superhero coach!

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    BCRL is complicated and scary, and most medical care providers currently don't take a deep dive into it ahead of time when planning your breast cancer treatment. That's why securing a great BCRL therapist, before breast cancer treatment, as an essential member of your medical care team is essential. They will provide you with as much knowledge as possible to equip you to make the most informed breast cancer treatment choices you can to minimize your risk of BCRL.

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    Already have BCRL?

    Yes, BCRL is overwhelming and what you need to do to manage it for the best quality of life possible is demanding. So having a great BCRL therapist/ superhero coach makes ALL the difference.

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    The facts speak for themselves: approximately half of breast cancer survivors with BCRL do not follow their prescribed self-care regimen. The primary barriers to consistent adherence include feelings of helplessness, a desire to feel "normal," frustration from a lack of noticeable results, and inadequate support from social circles and healthcare professionals.

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    If this describes your situation, then an amazing BCRL therapist along with the  Athena Aftercare community is the jolt of energy you need to recalibrate your BCRL management program. We got this!

    Information Sources

  • Stretching Exercises

    Stretching exercises can be a beneficial component of managing BCRL. While not a standalone treatment, stretching can improve lymphatic drainage, reduce swelling, and enhance overall function and quality of life for those with or at risk of BCRL. Some of the benefits of stretching for BCRL  include:

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    • Improved Lymphatic Drainage: Stretching can help encourage lymphatic fluid to move towards the torso and away from the affected limb, reducing swelling. 

    • Reduced Pain and Stiffness: Stretching can alleviate pain and stiffness in the affected area, improving range of motion and flexibility. 

    • Enhanced Muscle Function: Stretching can improve muscle strength and endurance, which can be compromised in BCRL. 

    • Improved Quality of Life: By reducing symptoms and improving function, stretching can contribute to a better quality of life for individuals with BCRL. 

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    Important Considerations

     

    Consult with a Healthcare Professional

    It's crucial to consult with your doctor or your BCRL therapist before starting any exercise program, including stretching, to ensure it's appropriate for your specific situation and to receive guidance on proper form and precautions.

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    Listen to Your Body

    Pay attention to your body's signals and avoid pushing yourself too hard, especially when first starting. If you experience pain or increased swelling, stop the exercise and consult with your healthcare provider.

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    • Gentle stretching: Stretch slowly and only until you feel a gentle pulling sensation. Avoid bouncing or jerky movements, and never stretch to the point of pain.

    • Consistency: Regular stretching, even for short periods, is more beneficial than infrequent, intense sessions.

    • Listen to your body: Your flexibility may vary from day to day, so adjust your stretches accordingly.

    • Deep breathing: Incorporate deep breathing into your stretching routine to enhance relaxation and help with lymphatic drainage.

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    Combine with Other Therapies

    Stretching is often most effective when combined with other BCRL management strategies, such as manual lymph drainage, compression therapy, and appropriate exercise. 

     

    Consider wearing a compression garment

    Some individuals with BCRL may benefit from wearing a compression sleeve or glove during exercise, including stretching. Check with your medical care provider or BCRL therapist about prescribing compression garments and purchase garments from a certified fitter.

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    Seek professional guidance

    A certified BCRL therapist can provide personalized guidance and ensure you are performing the exercises correctly and safely.

    Information Sources

  • Complete Decongestive Therapy

    Complete Decongestive Therapy (CDT) is the gold standard treatment for BCRL. It's a non-invasive approach that combines multiple therapeutic techniques to reduce swelling, improve lymphatic drainage, and enhance quality of life. CDT is typically divided into two phases: an intensive phase and a maintenance phase. 

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    Phase 1: Intensive Phase

    • Manual Lymphatic Drainage (MLD): This is a gentle, skin-stretching technique applied by a trained lymphedema therapist to stimulate the flow of lymphatic fluid and reroute it to functioning lymphatic pathways.

    • Compression Therapy: This involves applying compression bandages, wraps, or garments (sleeves, gloves, stockings, etc.) to the affected limb. This provides external pressure to help reduce swelling, prevent fluid re-accumulation, and support the lymphatic system. 

    • Exercise: Targeted exercises, performed with compression, help stimulate the muscle pump action, which aids in moving lymphatic fluid out of the swollen area. Exercises can include stretching, strengthening, and aerobic activities, tailored to the individual's needs and limitations.

    • Skin Care: Maintaining good skin and nail hygiene is crucial to prevent infections, such as cellulitis, which are more common with lymphedema. This involves regular cleaning, moisturizing, and protection from injuries.

     

    Phase 2: Maintenance Phase

    • Self-Care: Patients learn to perform MLD, bandaging, and exercises at home to manage their lymphedema long-term. 

    • Compression Garments: Continued use of compression garments is essential to maintain the reduced swelling and support lymphatic function. 

    • Regular Monitoring: Regular check-ups with a BCRL therapist are needed to assess progress, adjust treatment as needed, and address any complications. 

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    Effectiveness and Importance

    • CDT is effective in reducing limb volume, improving range of motion, and enhancing quality of life for individuals with BCRL. 

    • Early intervention with CDT is crucial for optimal outcomes, as the earlier treatment begins, the greater the success of therapy. 

    • Adherence to CDT is vital for long-term management of BCRL, and patients should be encouraged to actively participate in their treatment plan.

     

    Information Sources

  • Manual Lymphatic Drainage

    Manual Lymphatic Drainage (MLD) is a specialized, gentle massage technique used to manage BCRL. It involves applying light pressure to the skin to stimulate lymphatic drainage, reduce swelling and soften scar tissue. The aim of MLD is to move fluid from the swollen area into a place where the lymphatic system is working normally. It's performed by therapists trained in this specific technique.

     

    How does it work for BCRL?

    • Stimulates Lymphatic System: MLD encourages the lymphatic system to drain excess fluid and proteins from the affected area, reducing swelling.

    • Reduces Swelling: By promoting lymph flow, MLD helps to decrease the volume of the affected limb and improve comfort.

    • Often part of Complete Decongestive Therapy (CDT): MLD is often used in conjunction with other therapies like compression therapy, skin care, and exercises to manage BCRL. 

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    What happens during MLD treatment?

    During an MLD session, you will lie down in a comfortable position. You will feel gentle pressure as the therapist uses light, slow, and rhythmic motions on your skin to encourage natural lymphatic flow and drainage.

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    The number of MLD treatments required differs for each person. Your specialist will create a tailored plan for you based on the type of MLD and the severity and extent of your swelling.

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    After having manual lymphatic drainage

    To manage swelling, your BCRL therapist might use a specialized technique known as multi-layered lymphedema bandaging. In cases where this type of bandaging is not necessary or practical, a compression garment is usually worn as an alternative.

     

    Your BCRL therapist will regularly check how well your treatment is working. They’ll look at whether the tissues are softening and how much the swelling is decreasing.

    Newer MLD techniques

    In the UK, fluoroscopy-guided manual lymphatic drainage (FG-MLD), also known as the "Fill and Flush" method, is a specialized massage technique for treating lymphedema. It is based on research that maps the lymphatic system to see how fluid moves and where it accumulates, allowing BCRL therapists certified in the technique to identify both functioning and non-functioning drainage pathways.

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    To enhance the treatment, a lymphofluoroscopy mapping test may be used. This involves injecting a fluorescent dye (ICG) under the skin and using an infrared camera to visualize the lymph channels and any blockages. This mapping allows for a more targeted massage and can also help in the early detection of lymphedema.

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    During an FG-MLD session, a specially trained therapist uses firm, slow, and rhythmic hand movements to encourage lymph fluid to drain away from swollen areas. The number of treatments needed varies depending on the individual's specific condition. While the mapping test is not available on the NHS, it can be accessed through private clinics in the UK.

    Information Sources

    • Cancer Research UK

    • Dr. Vodder School™

    • Lin, Yan et al. Manual Lymphatic Drainage for Breast Cancer-related Lymphedema: A Systematic Review and Meta-analysis of Randomized Controlled Trials Lin, Clinical Breast Cancer, Volume 22, Issue 5, e664 - e673, July 2022.

  • Compression Bandaging

    Compression therapy is a key component of managing BCRL. It's typically used as part of Complete Decongestive Therapy (CDT), which also includes manual lymphatic drainage (MLD), stretching, exercise and skin care. Multi-layer inelastic compression bandaging helps to reduce swelling, support lymphatic drainage, and maintain the reduced limb volume achieved through MLD. Compression bandaging should be applied by a certified BCRL therapist, or under their guidance, to ensure correct technique and avoid complications. 

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    How it works

    • Provides pressure: Compression bandaging applies pressure to the affected limb, helping to move lymph fluid out of the tissues and back into the lymphatic system. 

    • Supports muscle pumping: By increasing pressure during muscle contraction, it enhances the natural pumping action of the lymphatic vessels. 

    • Reduces swelling: The pressure helps minimize swelling and prevents the buildup of excess fluid in the affected area. 

    • Supports skin and soft tissue: Compression can help stabilize and support the skin and soft tissues of the limb, which can be beneficial in managing BCRL. 

    • Maintains limb volume: After MLD, compression bandaging helps maintain the reduced limb volume by preventing fluid from reaccumulating. 

    • Inelastic and short-stretch bandages are preferred: These types of bandages are often recommended because they offer more consistent pressure and support than elastic bandages. 

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    Types of bandages used

    • Short-stretch bandages: These bandages have a low resting pressure and a high working pressure, meaning they provide more support when the muscles are active. 

    • Inelastic bandages: These bandages maintain consistent pressure and are often preferred for lymphedema management. 

    • Foam padding and stockinettes: These are used underneath the compression bandages to provide padding, protect the skin, and help distribute pressure evenly.

     

    Important considerations

    • Bandaging technique: Compression bandaging should be applied by trained professionals or individuals who have received proper instruction to ensure correct pressure and prevent complications. 

    • Skin care: Regular skin care is essential when using compression bandages to prevent skin irritation and infections. 

    • Individualized treatment: The specific type of compression bandaging and the pressure applied should be tailored to the individual's needs and the severity of their lymphedema. 

    • Monitoring and adjustments: Compression bandaging should be monitored regularly for effectiveness and adjusted as needed. 

    Information Sources

  • Kinesio® Taping

    Kinesio® taping is a therapeutic technique that may help with BCRL by:

    • Lifting the skin: The tape is applied to the skin and gently lifts it. This creates a small amount of space between the skin and the underlying tissues.

    • Improving fluid flow: This lifting action is thought to decompress the area, reducing pressure and creating a channel for lymphatic fluid and blood to flow more freely. This can help to drain the excess fluid that causes swelling in lymphedema.

    • Providing continuous stimulation: Because the tape can be worn for several days, it provides a constant, gentle pull on the skin that may continue to promote lymphatic drainage.

    In essence, Kinesio taping is thought to work in a way that is similar to manual lymphatic drainage.  While not a replacement for comprehensive lymphedema treatment, it can be a beneficial addition alongside manual lymphatic drainage, compression, and exercise​.

    Information Sources

  • Pneumatic Compression Therapy

    Pneumatic compression therapy utilizes a mechanical pump with inflatable sleeves, vests, or stockings to apply intermittent pressure to the affected area, reducing swelling and stimulating lymph flow. This therapy is a component of Complete Decongestive Therapy (CDT).

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    Here's how pneumatic compression therapy works

    • Mechanism: The intermittent pressure from the pump mimics the natural pumping action of muscles, helping to move stagnant lymph fluid from the affected limb or torso towards areas with better lymphatic drainage.

    • Benefits: Pneumatic compression devices, particularly Advanced Pneumatic Compression Devices (APCDs), have been shown to be an effective intervention for lymphedema, leading to reduced limb edema volume, improved quality of life scores, and decreased rates of infections like cellulitis. One study noted that APCD use was associated with steep reductions in healthcare costs and cellulitis rates in CRL patients.

    • Integration with CDT: Pneumatic compression therapy is most effective when used in conjunction with other components of CDT, including manual lymphatic drainage (MLD), compression bandages or garments, skin care, and exercise.

    • Types of Devices: Both simple and advanced pneumatic compression devices are available. Advanced devices offer more adjustability and the ability to target specific areas of the body.

    • Application: While pneumatic compression can be used in the clinic, it is also a valuable tool for home-based self-care and maintenance of lymphedema symptoms.

    • Importance of Education: Individuals using pneumatic compression therapy, especially at home, must be properly trained in its use by a qualified lymphedema specialist to ensure safety and effectiveness. 

    • It's important to consult with a healthcare professional to determine if pneumatic compression therapy is appropriate for your specific BCRL case and to receive proper guidance on its application.

    Information Sources

  • Scar Tissue

    BCRL can occur due to scarring associated with wound healing, cancers causing tumor compression on lymphatic channels, surgical trauma to the lymphatic channels, fibrosis or scarring of the channels caused by radiation therapy, and infection. Trauma to the lymphatic channels inhibits the ability for the lymphatic fluid to travel back to the blood circulatory system resulting in protein-rich lymphatic fluid accumulation in the extracellular spaces and swelling of the soft tissues, leading to BCRL.

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    Impact of scar tissue in BCRL

    • Lymphatic flow obstruction: Scar tissue can directly obstruct lymphatic flow, exacerbating lymphedema symptoms.

    • Reduced lymphatic regeneration: Scarring may hinder the regeneration of lymphatic channels, potentially worsening lymphedema.

    • Contracture and stiffness: Scar tissue, especially in areas like the axilla, can lead to contracture, limiting movement and potentially interfering with lymphatic drainage.

    • Fibrosis and hardness: As BCRL progresses, the accumulation of fluid can lead to fibrotic changes, causing the tissue to become harder and less pliable. 

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    BCRL therapists and scar tissue treatment

    BCRL therapists play a crucial role in addressing scar tissue, particularly following breast cancer surgery and treatment. They utilize various techniques to help manage and minimize the effects of scarring, including:

    • Manual Therapy Techniques: These involve hands-on approaches such as massage, myofascial release, and skin rolling to mobilize and manipulate the scar tissue and surrounding areas. This can help break down adhesions, improve tissue pliability, reduce pain, and increase the range of motion of nearby joints.

    • Instrument-Assisted Soft Tissue Mobilization: Therapists may use specialized tools to help release restrictions and break down adhesions within the scar tissue and surrounding fascia.

    • Stretching and Exercise: BCRL therapists guide patients through specific stretching exercises to promote proper scar tissue remodeling and improve flexibility. Targeted exercises can also increase blood flow and encourage a greater range of motion.

    • Taping: Kinesio® tape can be applied to provide a sustained, low-intensity stretch to the tissues around the scar, aiding in the remodeling process and improving scar characteristics.

    • Education and Self-Care: A key aspect of BCRL therapy involves educating patients on self-massage techniques, stretching exercises, and proper scar care practices they can perform at home to continue managing the scar tissue and supporting long-term healing.

    • Addressing Lymphedema: BCRL therapists are also skilled in managing lymphedema, which can be a consequence of breast cancer treatment and potentially impact scar tissue. Treatment for lymphedema may include manual lymphatic drainage and compression bandaging and garments. 

     

    Overall, the goal of BCRL therapy for scar tissue is to:

    • Reduce pain and discomfort associated with scarring.

    • Improve the pliability and elasticity of the scar tissue.

    • Increase the range of motion of affected joints and muscles.

    • Decrease adhesions and restrictions caused by scar tissue.

    • Enhance the overall appearance of the scar. 

     

    It's important to remember that every patient's needs and every scar are unique, and BCRL therapists will develop an individualized treatment plan based on the specific type, age, and characteristics of the scar, along with the patient's goals and overall health. 

    Information Sources

  • Cupping

    Cupping therapy, when combined with other treatments, may offer benefits for BCRL, particularly in improving range of motion, reducing swelling, and potentially enhancing the effectiveness of complete decongestive therapy (CDT). While research is ongoing, some studies suggest that cupping can help mobilize the lymphatic system, improve skin mobility, and potentially reduce pain associated with BCRL. Cupping should be done by a trained BCRL therapist.

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    How cupping may help BCRL

    • Improved lymphatic flow: Cupping creates suction, lifting the skin and surrounding tissues, which is believed to stimulate lymphatic fluid movement and help drain accumulated fluid. 

    • Increased blood flow: The suction can increase blood circulation to the treated area, delivering oxygen and nutrients that may promote healing.

    • Reduced inflammation and pain: Cupping may help alleviate inflammation and pain associated with BCRL by releasing muscle tension and improving circulation.

    • Improved tissue flexibility: Cupping can also help separate tissue layers, potentially improving the mobility of scar tissue and reducing the tightness in the affected area.

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    Cupping techniques for lymphatic drainage

    • Lighter pressure: When using cupping for lymphatic drainage, the pressure should be lighter than with typical cupping applications to effectively address the surface anatomy where lymph travels.

    • Moving cupping: Instead of stationary cups, dynamic or moving cupping techniques can be used to move fluid and prevent superficial stagnation, similar to manual lymph drainage therapies.

    • Targeted areas: Cups can be applied along specific lymphatic pathways, such as the arms, armpits, and abdomen, to help reduce fluid retention and swelling in targeted areas.

    • Potential side effects of cupping include temporary bruising or circular marks, skin irritation, and mild soreness.

    Information Sources

  • Dry Needling

    Dry needling is a technique used by some BCRL therapists to treat muscle pain and dysfunction. BCRL can be a consequence of breast cancer surgery, reconstruction, or radiation, leading to tension and pain in the chest wall, underarm, shoulder, and rib cage. Dry needling may potentially help address these issues by releasing tightness, improving circulation, reducing nerve irritation, improving range of motion, addressing myofascial restrictions, promoting lymphatic flow, and calming the nervous system. 

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    Dry needling involves the insertion of thin, flexible needles to stimulate the muscle and surrounding connective tissue. This carries a risk of infection or injury to lymph nodes, which could worsen lymphedema. ​Given the potential risks, it is crucial to approach dry needling with caution in cases of BCRL. A thorough evaluation by a healthcare professional is necessary to determine if dry needling is appropriate and to minimize potential risks.

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    Here's how dry needling may help with BCRL

    1. Relieving Muscle Tension and Pain: BCRL can cause muscle tightness and pain, often exacerbated by trigger points, which are sensitive areas within the muscle. Dry needling involves inserting thin needles into these trigger points, triggering a local twitch response and releasing tension in the muscle fibers. This can lead to pain reduction and increased comfort.

    2. Improving Range of Motion and Flexibility: Tight muscles and trigger points associated with BCRL can limit the range of motion in the affected limb. By releasing these tight areas, dry needling helps restore flexibility and improves the range of motion. This can be particularly beneficial for individuals struggling with movement limitations due to BCRL.

    3. Enhancing Blood Flow: Dry needling can stimulate increased blood flow to the targeted area. Increased circulation delivers oxygen and essential nutrients to the muscles and aids in the removal of metabolic waste products, promoting healing and reducing inflammation. This improved blood flow can help with muscle recovery and overall limb health in patients with BCRL.

    4. Addressing Trigger Points and Referred Pain: BCRL can involve the development of trigger points not only in the affected limb but also potentially in surrounding areas. These trigger points can cause referred pain, which radiates to other parts of the body. Dry needling targets these trigger points to deactivate them and reduce both local and referred pain. This can help manage the diverse pain patterns experienced by individuals with BCRL.

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    It's important to note

    • Dry needling is a technique rooted in Western medicine and primarily focuses on musculoskeletal pain and dysfunction, differentiating it from acupuncture, which is based on traditional Chinese medicine principles.

    • The effectiveness of dry needling for BCRL is likely optimized when combined with other BCRL management strategies, such as physical therapy, compression therapy, and manual lymphatic drainage.

    • Consult with a trained and certified healthcare professional, like a physical therapist, to determine if dry needling is appropriate for your specific BCRL symptoms and to ensure safe and effective treatment. 

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    Precautions

    While dry needling shows promise in managing BCRL symptoms when accompanied by CDT, it is important to be aware of potential risks. There is an increased risk of infection or cellulitis when dry needling is performed near or in an area affected by lymphedema. Dry needling may not be suitable for individuals with compromised immune systems, abnormal bleeding tendencies, those on blood-thinning medications, or those with needle phobia. 

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    Information Sources

  • Exercise Therapy

    Exercise therapy plays a vital role in managing, and reducing the risk of, BCRL. Recent research indicates that exercise is not only safe but also beneficial for individuals with or at risk of BCRL. The activation of the "muscle pump" through physical activity is crucial for promoting lymph flow, which in turn can decrease the volume of the affected limb. 

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    How exercise helps

    • Improved lymphatic function: Exercise helps stimulate the flow of lymph fluid, reducing the accumulation of fluid and swelling in the affected area.

    • Reduced limb swelling: Studies have shown that exercise can lead to a reduction in the volume and circumference of the affected limb.

    • Improved muscle strength and endurance: Exercise can help strengthen muscles, which is important for supporting lymphatic flow and overall functional ability.

    • Improved quality of life: Regular exercise can reduce pain, increase range of motion, improve physical function, and enhance overall well-being and quality of life for individuals with BCRL.

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    Recommended exercises

    Exercise recommendations should be individualized and tailored to a person's needs and fitness level, preferably with guidance from a healthcare professional or BCRL therapist. Here are a few suggestions to ask your doctor or BCRL therapist to see if these are right for you:

    • Gentle stretches and range of motion exercises: These can help maintain flexibility and encourage lymph flow.

    • Aerobic exercises: Brisk walking, swimming, cycling, and other activities that use the upper body can improve circulation and lymphatic drainage.

    • Light resistance training: Using light weights or resistance bands can help build muscle strength without exacerbating lymphedema.

    • Deep breathing exercises: Diaphragmatic breathing can help stimulate lymphatic flow by changing pressure in the abdomen and chest.

    • Other exercises: Yoga, Tai Chi, Pilates, and water-based exercises are also beneficial.

    Information Sources

  • Kidding but not kidding...

    Your BCRL therapist is your shoulder to cry on. They have seen many cases of BCRL and the best of the best will provide you with tools to help you manage your condition. Think of seeing them as a tuneup. They'll get you back on track when things start to go sideways. Consistency is key!

    Information Source

    • Dr. Katherine Bunker, PT, DPT, CLT at Renown Health

BCRL THERAPISTS

Below is a map of BCRL specific care providers as identified by supporters of Athena Aftercare.

Know of other champions to add to this roster? Send your intel to hello@athenaaftercare.com.

PORi-Certified Therapists 

The Physiological Oncology Rehabilitation Institute (PORi) is a leader in oncology rehabilitation, with more than 2,500 therapists completing coursework, many with a focus on breast cancer aftercare, including lymphedema treatment. 

 

Below is a listing and map of PORi therapists that are specialized in breast cancer aftercare.

LANA-Certified SPECIALISts 

The Lymphedema Association of North America certifies specialists who successfully complete a 135-hour course in Complete Decongestive Therapy and possess a current, unrestricted US state or international license or registration as a Registered Nurse, Occupational Therapist, Certified Occupational Therapy Assistant, Physical Therapist, Physical Therapist Assistant, Medical Doctor, Doctor of Osteopathic Medicine, Doctor of Chiropractic, Massage Therapist, or Certified Athletic Trainer.

 

Click on this link to access a listing and map of LANA Certified Specialists.

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