Abstract
Background and purpose: Cancer is one of the major leading causes of death in the United States and continues to be a prevalent pathology encountered by physical therapists today. Patients diagnosed with breast cancer will undergo multiple combinations of treatment methods that lead to a myriad of side effects involving multiple body systems. This case report describes the use of mat based Pilates exercises as part of the physical therapy management of a patient with breast cancer related shoulder impairments. Case description: The patient was a 76-year-old female treated in an outpatient physical therapy setting following the diagnosis of stage III breast cancer with subsequent bilateral mastectomy, chemotherapy, and radiation therapy. The patient presented with left upper extremity pain, upper extremity mobility impairments, and bilateral chest wall pain. Outcomes: Physical therapy treatment consisted of manual lymph drainage (MLD), manual therapy techniques, modalities for pain relief and promotion of tissue healing, patient education for independent lymphedema management, establishment of a home exercise program, and therapeutic exercises comprising of mat based Pilates. The exercise program was created specifically for the case patient through collaboration by a physical therapist and a Pilates certified instructor. Studies have shown that performing Pilates exercises is beneficial to improving the side effects of secondary lymphedema in addition to improving shoulder range of motion and strength in patients with breast cancer related deficits. Following physical therapy intervention, the patient demonstrated improved pain levels on the visual analog scale (VAS) from 4/10 in the right chest/shoulder to 2/10 and from 7/10 in the left chest/shoulder to 4/10. The patient also improved their overall upper extremity function as noted by a score increase on the Quick DASH from 52 to 36 and active range of motion (AROM) improvements with right shoulder flexion, left shoulder flexion, and left shoulder abduction. Discussion: This case report demonstrates the potential use of mat based Pilates exercises as a viable exercise method in the multi-modal treatment approach for patients affected by breast cancer related shoulder deficits. The exercise method has also shown to be safe and beneficial to a patient who was currently receiving active radiation therapy as part of their cancer treatment.