Effects of myofascial reorganization associated with kinesiotherapy on chronic pain and functionality of breast cancer survivors: development of a study protocol

Cunha, Natália de Souza; Sinhorim, Larissa; Schleip, Robert; Zomkowski, Kamilla; Santos, Gilmar Moraes; Sperandio, Fabiana Flores

doi:10.1590/fm.2022.35609

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Original Article • Fisioter. mov. 35 (spe) • 2022 • https://doi.org/10.1590/fm.2022.35609 copy

Effects of myofascial reorganization associated with kinesiotherapy on chronic pain and functionality of breast cancer survivors: development of a study protocol

Efeitos da reorganização miofascial associada à cinesioterapia na dor crônica e funcionalidade de sobreviventes de câncer de mama: desenvolvimento de um protocolo de estudo

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Breast cancer is the most common type of cancer among women. Treatments can lead to complications modifying upper limbs movement patterns and generating pain and functionality loss. Kinesiotherapy and myofascial reorganization (MR) have shown positive effects reducing chronic pain and improving upper limbs function. We hypothesize that these techniques can maximize results and reduce treatment time in clinical practice.

Objective:

To develop a study protocol to verify whether MR associated with kinesiotherapy is more effective than isolated kinesiotherapy to treat chronic pain and upper limb dysfunction in breast cancer survivors.

Methods:

Participants will be divided into two groups: intervention group (myofascial reorganization + kinesiotherapy) and sham group (traditional massage + kinesiotherapy). Six treatment sessions (once a week) and three-time assessment will occur. Instruments for assessing pain and functionality will be Visual Analogue Scale, Body Pain Diagram, Disabilities of the Arm, Shoulder and Hand Questionnaire, and goniometry. Statistical analysis will be conducted based on intention-to-treat analysis. To analyze the difference of means between groups, we will use T-Student or U Mann-Whitney test. Repeated measures ANOVA will be used to check treatments effects. Significance level for all tests will be 5%.

Conclusion:

We believe that the developed study protocol will show that MR associated with kinesiotherapy improve chronic pain and upper limbs functionality of breast cancer survivors.

Keywords:
Breast cancer; Chronic pain; Functionality; Manual therapy; Physiotherapy modalities

Techniques sequence	Techniques description
A. Sternal region	Participant: supine position with knees bent. Therapist: standing in front of the participant's head. Technique: the therapist fixes one hand in the region of the nuchal ligament and the other hand over the sternum, making a smooth and progressive caudal pressure towards the stretcher (1 minute).
B. Anterior ribcage region	Participant: supine position with knees bent. Therapist: standing in front of the participant's head. Technique: the therapist performs pressure and sliding from the xiphoid process, passing through the sternum, the infra clavicular region and ending at the acromion (6 times).
C. Diaphragm reorganization	Participant: supine position with knees bent. Therapist: standing beside the stretcher, in front of the participant's pelvis. Technique: the therapist performs pressure and sliding from the xiphoid process to the lower borders of the last ribs (6 times).
D. Pectoralis major	Participant: supine position with knees bent. Therapist: standing beside the stretcher, in front of the participant's chest. Technique: the therapist fixes one hand on the humerus and applies pressure towards the sternum with the other hand (1 minute).
E. Scapular region 1	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's abdomen. Technique: therapist performs pressure and sliding on the medial and upper border of the scapula (6 times).
F. Scapular region 2	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's abdomen. Technique: therapist departs the scapula from the ribcage and performs scapular mobilization in eight (1 minute).
G. Scapular region 3	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's abdomen. Technique: the therapist places the thumb in the region of teres minor muscle and applies sustained pressure (1 minute).
H. 45° Lateral trunk	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's posterior thorax. Technique: therapist with hands overlapped at 45 ° with the lateral region of the participant's thorax, performs pressure between the 6th and 8th ribs towards the stretcher and shoulder of the participant (1 minute).
I. Lateral trunk region	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's posterior thorax. Technique: therapist positions one hand on the upper thorax and the other on the lower thorax, the upper hand remains fixed and the lower one moves in a caudal direction (1 minute).
J. Thorax reorganization	Participant: lateral position, without pillow and with 90º of knee and hip flexion. Therapist: standing beside the stretcher, in front of the participant's posterior thorax. Technique: therapist places one hand on the anterior region of the last ribs and the other hand in the region of the inferior angle of the scapula, applying twisting pressure in a cranial direction (1 minute).

Exercises sequence	Exercises description
1. Stretches	Seating, participants will stretch pectoral, levator scapulae, trapezius and latissimus dorsi. Each position will be held for 1 minute and 30 seconds.
2. Codman's pendulum exercise	Participants will stand with torso flexed over hips at 90º and one arm hanging in a 60º to 90º flexion or abduction position in the scapular plane. Participants will perform circling movements for 1 minute and 30 seconds. Dumbbells up to 1 kg will be used.
3. Scapular mobilization	Participants will stand, face the mirror and perform scapular adduction, abduction, elevation and depression movements. 1 set of 10 repetitions for each movement.
4. Shoulder flexion and abduction	Participants will stand, close to the wall, performs flexion and abduction movements in the scapular plane, sliding her hands along the wall. 1 set of 10 repetitions for each movement.
5. Shoulder elevation with dumbbells	Participants will stand, performs scapular elevation and depression with arms parallel to the body holding dumbbells. 2 sets of 10 repetitions. Dumbbells up to 1 kg will be used.
6. Seated chest press with dumbbells	Participants will be seated with upper limbs in 90º of shoulder flexion and full elbow extension, with pronated forearms, will bring the dumbbells towards the chest performing elbow flexion. 2 sets of 10 repetitions. Dumbbells up to 1 kg will be used.
7. Diagonal patterns exercises	Diagonal D1 flexion: participants will sit, start with shoulder extended, abducted, and internally rotated and end with shoulder flexed, adducted, and externally rotated. Diagonal D2 flexion: participants will sit, start the exercise with shoulder extended, adducted, and internally rotated and end with shoulder flexed, abducted, and externally rotated. 2 sets of 10 repetitions for each diagonal. Dumbbells up to 1 kg will be used.
8. Full can exercise	Participants will stand up, perform shoulder abduction with the elbows extended in the scapular plane, the humerus in external rotation and the thumbs pointing upwards, holding dumbbells. 2 sets of 10 repetitions. Dumbbells up to 1 kg will be used.
9. Scapular stabilization exercise	Participants will stand with shoulders flexed at 90º and hands on the wall, and will perform scapular abduction and adduction keeping hand contact with the wall and elbows extended. 2 sets of 10 repetitions.

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[1] *Correspondence: ndscunha@gmail.com