Many women with breast cancer will have surgery, such as breast biopsy, lymph node biopsy/removal, breast conserving surgery (lumpectomy), mastectomy or breast reconstruction.
As vital as these surgeries are in the fight against breast cancer, they can have negative consequences of their own for which physical therapy can provide a significant benefit.
Because of surgery, for instance, many women will experience shoulder, arm, neck, chest and upper back pain, stiffness, numbness/tingling, weakness and loss of function. Functional deficits can include limitations in activities of daily living, such as bathing, dressing, lifting/carrying, home chores, functional reach overhead, work function and recreational activities.
Radiation therapy can cause physical and functional impairments. Breast surgery can result in swelling (lymphedema), scar tissue formation, soft tissue restriction, skin changes and achiness and heaviness in the limb.
Role of Physical Therapy
Early intervention (one week after surgery with physician’s clearance )
Exercises to restore normal movement, such as range of motion/flexibility exercises
Postural correction exercises
Physical Therapy manual treatment: joint mobilization, range of motion/stretching, massage techniques, soft tissue mobilization
Lymphedema treatment: designed to reduce and control swelling
Home exercise program
A physical therapist will design a patient-specific treatment program based on a thorough evaluation. The patient must have a referral from her physician/surgeon that should include any precautions and/or reasons to withhold a certain medical treatment because of the harm that it could cause the patient (contraindications).
TMJ stands for the temporomandibular joint, which connects one side of your mandible (lower jaw) to your skull. Temporomandibular dysfunction (TMD) is the umbrella term used to describe what happens when the joint and/or muscles used for chewing become inflamed, stuck or painful.
TMD affects more females than males and generally affects people between the ages of 20 and 40 who have a history of clenching and grinding their teeth (bruxism), dental work, trauma to the jaw or face, increased anxiety or stress, or poor posture.
Symptoms include pain in the jaw, ears, face, neck and upper back. Some patients may have difficulty opening or closing their mouths, deviations in jaw movement, or popping, clicking or grinding sounds in the joint when yawning, talking, or eating.
A symptomatic TMJ may limit daily, social, or work-related activities. Lifestyle behaviors that could contribute to TMJ discomfort or TMD include:
1. Increased stress and anxiety. Increased stress is one of the main contributors to TMD pain, often causing clinching of the jaw or grinding of the teeth. To relieve stress, you may want to consider getting more sleep; taking 5 to 10 minutes throughout your day to practice diaphragmatic breathing; exercising; participating in a yoga class; or simply walking around the office for a few minutes and recording your stress triggers in a journal or diary.
2. Slouched posture. The neck and jaw are intimately connected; thus, a slouched posture associated with desk work and the use of cellular devices can place undue stresses on the cervical spine (neck) and musculature and affect the position of the mandible. Rounded shoulders commonly accompanied by a forward head position can place the condyles of the jaw bone deeper into their joint sockets. Poor posture may alter the length tension relationship of the masticatory muscles that help open and close the mouth. Joint malalignment and muscle imbalances may lead to increased joint compression, which may be the source of pain. One way to correct posture is to place a rolled-up hand or beach towel in the small of your back while you sit at a desk or drive. This should cue you to sit up tall and correct your neck and shoulder positioning.
3. Oral habits. Chewing on gum or writing utensils, nail and lip biting, and clinching and grinding teeth are among the habits that may lead to overuse of the TMJ muscles and result in microtrauma of the joint or the soft tissues (such as the ligaments, tendons, and muscles) that surround and support the joint. If you grind your teeth at night, try wearing a mouth guard to bed or sucking on candy mints instead of chewing gum.
4. Diet. Healthy eating habits are not just for weight management and proper nutrition but also for optimal TMJ function. Some foods, although healthy, may cause undue compression forces or fatigue of the TMJ: steak, nuts, stringy vegetables (such as celery), and certain breads. Large bites that require excess mouth opening also may add stresses. Eating softer foods or taking smaller bites may reduce overuse of the TMJ and possibly discomfort.
5. Excessive mouth opening. Your mouth should be able to open at least three finger widths or 40 centimeters. However, excess mouth opening can occur with yawning, singing, or even laughing. To help reduce excessive mouth movement, use the width of three of your fingers or place your fist between your chin and breast bone before opening your mouth.
If you have other questions regarding the TMJ or need help determining specific lifestyle triggers of TMJ pain, contact a physical therapist with your concerns. You can learn more about how we treat TMJ discomfort by visiting our TMJ Rehab page.
Chang, C. L., Wang, D. H., Yang, M. C., Hsu, W. E., & Hsu, M. L. (2018). Functional disorders of the temporomandibular joints: Internal derangement of the temporomandibular joint. The Kaohsiung Journal of Medical Sciences.
Glaros, A. G., Marszalek, J. M., & Williams, K. B. (2016). Longitudinal multilevel modeling of facial pain, muscle tension, and stress. Journal of dental research, 95(4), 416-422.
Jaeger, J. O., Oakley, P. A., Moore, R. R., Ruggeroli, E. P., & Harrison, D. E. (2018). Resolution of temporomandibular joint dysfunction (TMJD) by correcting a lateral head translation posture following previous failed traditional chiropractic therapy: a CBP® case report. Journal of physical therapy science, 30(1), 103-107.
Klasser, G., & Greene, C. (2017). Screening orthodontic patients for temporomandibular disorders. Clinical Dentistry Reviewed, 1(1), 8.
Lampa, E., Wänman, A., Nordh, E., & Häggman‐Henrikson, B. (2017). Effects on jaw function shortly after whiplash trauma. Journal of oral rehabilitation, 44(12), 941-947.
Lobbezoo, F., List, T., Michelotti, A., Nixdorf, D. R., Peck, C. C., Raphael, K., … & Breckons, M. (2017). Self-management programmes in TMD: results from an international Delphi process.
What manifests as a headache actually could be coming from your neck. It’s what is known as a cervicogenic headache.
Luckily, cervicogenic headaches can be reduced, eliminated, or prevented with physical therapy exercises at home.
A cervicogenic headache is specifically when your upper cervical spine – your neck –sends pain into your head via the local nervous system.1,2 These headaches can begin rapidly with an injury or can develop over time from prolonged poor posture, degenerative arthritis, or decreased cervical muscle strength or length.
The workplace is a major culprit, specifically with jobs that require repetitive head movements, frequent heavy lifting, or prolonged sitting postures at a desk or computer screen. Many of these factors can be seen at home, as well, with the heavy lifting of yardwork, bending and reaching into cabinets, or simply sitting with poor posture while watching television. Even sleeping can put your neck into a poor position and create a headache.
How to address your cervicogenic headache
First, it is important to identify whether your headache truly is coming from your neck. If you do not have neck pain, have never had a neck injury, or do not participate in any of the previously mentioned activities, then you may have a different type of headache and the following exercises may not be appropriate. If you are not sure, your doctor or physical therapist can help you differentiate.
Patients who experience cervicogenic headaches often demonstrate similar underlying factors that could include, but are not limited to forward head posture, limited neck range of motion, poor flexibility surrounding the cervical spine, and poor deep neck flexor strength.3 It is important to note that these factors vary for everybody.
Please see the below video for demonstrations of the following exercises that can help address the underlying causes of your cervicogenic headache.
1. Sitting cervical retraction with forward head nodding overpressure
2. Supine deep neck flexor facilitation
3. Corrected posture holds
4. Doorway pectoralis major stretch
5. Thoracic spine extensions over a small ball
6. Scapular Squeezes
7. Supine snow angels
How to prevent future headaches
Work demands and activities at home can predispose you to developing poor habits and posture. These tips will help you avoid injury, improve your posture, and reduce your risk of developing a cervicogenic headache:
1. If you must repetitively turn your head in each direction during the workday, incorporate full body rotation rather than just neck rotation. The use of a rotating office chair or stool can help.
3. If you have to lift repetitively or lift heavy objects such as boxes, bend at your knees and squat to the floor versus bending at your back. Bending at your knees will help to keep your spine in a more neutral and safer position with improved posture.
4. If you are required to lift objects at home or work, keep the object you are lifting close to your body as this will reduce strain on your spine.
5. When sitting for prolonged periods at home, avoid soft couches or chairs that you sink into will encourage poor posture. Instead, sit on a firmer surface with a lumbar roll for better spinal alignment.
6. When sleeping on your back or side, only use enough pillows (often one) to keep your neck neutral and not bent to either side. Sleeping with too many pillows can shift your head forward or to the side and place strain on the neck throughout the night.
Cervicogenic headaches are manageable if properly identified and addressed. A physical therapist can help with this process.Please contact your local Drayer Physical Therapy Institute center if you suspect you have a cervicogenic headache and would like more specific physical therapy intervention on your way to reduced or abolished headaches!
Bogduk N, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol 2009; 8:959.
“Cervicogenic headache: the basics,” American Migraine Foundation website, accessed March 2018
Page P. CERVICOGENIC HEADACHES: AN EVIDENCE-LED APPROACH TO CLINICAL MANAGEMENT. International Journal of Sports Physical Therapy. 2011;6(3):254-266.