Effectiveness Of Manual Therapy And Respiratory Muscle Training To Improve Pain, Posture, And Pulmonary Function In Post Mastectomy Patients

Abstract

Background: Breast cancer is the most common cancer among women, by means of mastectomy being one of the major treatments and According to the Global Cancer Observatory, it accounts for nearly a quarter of all female cancer cases and over 15% of cancer deaths. Surgical management chiefly mastectomy, is frequently performed to control the disease, yet this procedure can result in significant postoperative complications, with shoulder pain, restricted mobility, poor posture, and respiratory dysfunction. Post-mastectomy respiratory dysfunction is a common notable concern, decreased thoracic mobility and increased kyphosis have been associated with reduced pulmonary restrictions such as forced vital capacity (FVC),forced expiratory volume in one second (FEV₁). The weakness of respiratory muscles may contribute to fatigue through the metabo-reflex mechanism, where metabolic by-products in fatigued respiratory muscles activate neural pathways that limit blood flow to limb muscles, thereby decreasing exercise tolerance and functional capacity. These impairments can be further compounded by anxiety, fatigue, and reduced quality of life. Given the increasing incidence of breast cancer, especially among younger women, effective rehabilitation strategies are needed to address both musculoskeletal and respiratory complications simultaneously.Current physiotherapy approaches frequently address musculoskeletal and respiratory issues separately, potentially limiting recovery outcomes wheres, Manual therapy techniqueslike Spencer’s Technique, have demonstrated benefits in enhancing glenohumeral joint mobility, reducing adhesions, and facilitating lymphatic drainage. Correspondingly respiratory muscle training (RMT) has shown potential in improving inspiratory and expiratory muscle potency reducing fatigue, and enhancing lung function in cancer survivors. However, research evaluating the combined application of manual therapy and RMT in post-mastectomy rehabilitation is lacking.An integrated approach targeting equally musculoskeletal and respiratory components may offer aadditional comprehensive solution, potentially reducing pain, improving posture &enhancing pulmonary function. This study aims to explore the effectiveness of combining manual therapy with respiratory muscle training for post-mastectomy women, thereby addressing a critical gap in current rehabilitation strategies.

Objective: This study aimed to evaluate the effectiveness of a combined rehabilitation intervention involving manual therapy (Spencer’s Technique) and respiratory muscle training (RMT) in improving pain, postural alignment, and pulmonary function in post-mastectomy patients.

Methods: A randomized controlled experimental study was conducted with 60 female participants who underwent mastectomy within the past 12 weeks. Participants were randomly assigned to two groups: Group A (experimental) received combined treatment – (Respiratory muscle training + Spencer’s Technique + TENS), while Group B (control) received only conventional physiotherapy interventions which includes TENS – For pain management, Postural correction exercise (Chin tuck, Scaption exercise, Codman’s exercise),Passive stretching of pectoralis major & breathing exercise (Pursed lip breathing , Diaphragmatic breathing & Buteyko Breathing).The intervention lasted for 12 weeks. Pulmonary function was assessed by Maximum Inspiratory Pressure (MIP) and Maximum Expiratory Pressure (MEP) and peak flow meter score. Kyphosis was measured using occiput to wall distance (OWD) test and pain was quantified using the Numeric Pain Rating Scale (NPRS). The primary outcomes were improvements in respiratory muscle strength, shoulder mobility, pain reduction, and postural correction.

Results: It was found that the combined intervention of Respiratory muscle training and manual therapy yield significant improvements in pulmonary function, decreased kyphosis, and pain reduction compared to conventional physiotherapy with enhanced shoulder range of motion, reduced pain, better respiratory muscle strength, improved thoracic expansion and reduced kyphosis resulting in overall improved functional capacity and quality of life.

Conclusion: The study presents a novel approach to post-mastectomy rehabilitation by integrating manual therapy with respiratory muscle training. This comprehensive approach may provide better rehabilitation outcomes for breast cancer survivors, addressing both musculoskeletal and pulmonary issues. The results could have significant implications for enhancing rehabilitation protocols and improving the long-term recovery and quality of life for post-mastectomy patients.