Treatment

Time to get up out of our laziboys? Our bodies love movement to maintain our cardiovascular health and muscular flexibility and strength. After treatment we are often weak and many head and neckers have stiff necks and shoulders after radiotherapy and surgery. Here are some extracts from one of Pauline Tang’s excellent talks in 2014. Pauline is the ORL physiotherapist  at AHBD.

Remember, you don’t need to train for a marathon to be fit or lift 100 kg to be strong. We are looking at optimising fitness and strength for cancer rehabilitation. Pinc and Steel, a rehab organisation, has people with incurable cancer undergoing treatment in their exercise classes.

 (I believe that shoulders are stiff because neck dissections can bruise or even sever the spinal accessory nerve which innervates muscles in the shoulder.)

 

FIGURE-1-The-location-of-the-spinal-accessory-nerve-and-the-suprascapular-nerve-on-the.png

 

Pauline’s Talk

Physiotherapy aims of exercise

  • Obtain optimal positioning of the shoulder
  • Maintain range of motion of the shoulder/neck
  • Reduce the chance of deterioration of function
  • Attempt to reduce pain levels experienced by stiffness of the joint

 Physiotherapy- if you first do not succeed try and try again

 

Shoulder pain disability

"70% of patients following neck dissection have shoulder pain that has considerable impact on activities of daily living" (Dijkstra et al, 2001)

"46% gave up work solely due to shoulder disability and 36% complained of moderately severe to severe shoulder pain" (Shone and Yardley, 1991)

 This is a reality, so what are we/you doing to do about it?

POSTURE

  • Prevent tightening of anterior chest muscles (stretch anterior chest muscles)
  • Keep shoulders pulled back (Rhomboids)
  • One exercise for the shoulders is to put your arms up with thumbs up. Another one is to roll the shoulders.

FATIGUE

Fatigue can be relieved by exercise but there has to be a balance between rest and activity. After three days of inactivity muscle strength can reduce by 50% so it’s important to do some exercise.

FROM PAULINE'S HANDOUT

Exercise to try to manage levels of fatigue. Fatigue is a very common symptom for patients with cancer. Studies have shown that over 70% of the subjects express that with each radio or chemotherapy treatment cycle there is an increase in their level of fatigue.

 The national comprehensive cancer network describe cancer related fatigue as  

" a distressing and persistent subjective sense of physical, emotional and/or cognitive tiredness related to cancer and cancer treatment that is not proportional to the recent activity and that interferes with usual functioning" (Kuchinski et al, 2009)

 Exercise is one method that is recommended to help reduce this symptom. It has been shown that exercise is beneficial for:

● Increasing the efficiency of the heart, blood vessel, lung, and endocrine e systems

● Enhancing muscular endurance

● Improving emotional stresses

● Reducing pain

● Increasing flexibility

● Improving functionality with daily tasks

● Improving quality of life

 Thirty minutes​ of accumulated activity/exercise has been suggested as the ideal amount normally. Studies with cancer patients have shown  that even 10 minutes of activity can make a big difference in a person’s well-being.

 SOME SUGGESTIONS

  • Walking
  • Stationary-cycle
  • Treadmill
  • Gym program
  • Community based exercise/walking groups, tai chi, bowling
  • Swimming , aqua aerobics, water walking
  • Chair/seated exercises ( some suggestion on ACC website)
  • The main purpose is to try and take the activity as you are able and progress as you feel comfortable.

 Start off slowly. You may need to try only 10 minutes twice a week and progress the duration to 30 minutes and frequency to 5 times a week.Keeping an activity diary is a good way to keep track of you won progress.

 

Here is a link to the ACC booklet from Otago University. You have to download it as a PDF and there are diagrams at the end:

http://www.acc.co.nz/publications/index.htm?ssBrowseSubCategory=Older%20adults

 This is a another good link:

http://www.nhs.uk/Livewell/fitness/Pages/sitting-exercises-for-older-people.aspx

HEART RATE​

  • We need a little overpressure to get fit.
  • To figure out your maximum heart rate for exercising, subtract your age from 220.
  • You want to work at a rate of 65% to 70% of that. (I think at 70, my maximum heart rate for exercising should be 105? )

Pauline recruited three volunteers to wear heart rate monitors. One of the volunteers had a resting heart rate of 70. With easy exercise it went up to 78 but after star jumps and/or lunges it was up to 127.

We did squats which involved getting up from a chair, mostly with our arms crossed for one minute. That was too moderate for the volunteers so we did star jumps or lunges which lifted all of them to nearer their maximum.

 What are some other good exercise programmes?

Below is the Modified Borg Scale which is different for everyone because it is your “perceived” breathlessness or exertion. We should be working at about a three or four. Don’t make it too hard or it takes too long to recover.

 Modified BORG Scale of Perceived Breathlessness/Exertion (From the handout). This scale measures your breathlessness/exertion/muscle effort from 0 (nothing at all) to 10 (the worst you have experienced).

 We should be working at about 3 to 4 on the scale

0 Nothing at all

0.5 Very, very slight/light (just noticeable)

1 Very slight/light

2 Slight/light

3 Moderate

4 Somewhat severe/hard

5 Severe

6 7 Very Severe/hard

8 9 Very, very severe/hard (almost maximal)

10 Maximal

There is also the MET score chart which gives a list of activities and their metabolic effects.

 MET score/Activity Level Measure MET is the Metabolic Equivalent of Task

 Physical-activity-MET.png

 

This UK Hospital also has some good exercises for revovering head and neckers.

https://www.guysandstthomas.nhs.uk/resources/patient-information/therapies/physiotherapy/Physiotherapy-recovering-head-neck-surgery.pdf