Myofascial versus conventional physiotherapy in post-mastectomy patients: a randomized controlled trial

INTRODUCTION: Mastectomy can be debilitating due to the effects of radical surgery on the musculoskeletal system. Improved therapeutic approaches that include scar tissue are needed. This research aimed to compare manual myofascial therapy to conventional physiotherapy to improve the functional status of post-mastectomy patients. METHODS: A total of 61 patients who underwent total mastectomy for breast cancer with shoulder and/or upper torso functional impairment were enrolled in this trial, with 56 randomized to treatment; of these, 48 met all study protocol requirements, and underwent a final assessment. Patients received either four weeks of conventional physiotherapy consisting of exercise and massage (n ¼ 21) or myofascial therapy (n ¼ 27). The following variables were assessed: muscle length; pain intensity; ROM (range of motion); scar mobility. Measurements were made using a centimeter measure, calculating difference of distance from the bone point to the most limited place in the scar. This study was approved by the Institutional Review Board #42/13 at The Poznan University of Medical Sciences in Poznan, Poland. RESULTS: Myofascial therapy was superior to conventional physiotherapy in reducing the percentage of patients with shorter-than-normal muscle length at several sites. In the treatment group, significant decreases from baseline were observed for the pars clavicularis (67% with shortened muscles at baseline vs. 22% post-treatment; p ¼ 0.002), descending trapezius (81% vs. 26% p < 0.001), pars sternocostalis (37%e7%; p ¼ 0.02), latissimus dorsi (52%e 15%; p ¼ 0.008), and levator scapulae muscle (41%e7%; p ¼ 0.009). Before treatment there were no differences between groups in scar mobility (pretreatment p ¼ 0.809 measured in relation to xiphoid process and p ¼ 0.829 to coracoid. After treatment there was significantly improved significantly improved mobility in the scar area between groups CG and TG, with increases relative to the xiphoid process (p ¼ 0.02) and to the coracoid (p ¼ 0.001). CONCLUSION: Thefindings presented here show thatmyofascialinterventions can significantly improve the elasticity of certain muscles, and ROM in the upper limb girdle musculature. In the treatment group, scar therapy could be an important factor in restoring normal tissue and joint mobility and in reducing pain. These findings suggest that manual myofascial therapy is superior to conventional physiotherapy in post-mastectomy patients.