Physical Therapy Techniques for Breast Pain

Physical Therapy Techniques for Breast Pain

Nicole Mogensen, SPT

 

Background:

Throughout physical therapy school, I have been interested in women’s health physical therapy. Until this project, that was limited to learning and treating pelvic health issues. My second year I was lucky enough to meet Dr. Alison Stuebe, an OBGYN that created the 4th Trimester Project, which focuses on providing care for postpartum women. When I reached out to Dr. Stuebe in hopes of collaboration for my capstone project, she connected me with Dr. Katrina Mitchell, a breast surgeon in New Mexico that works with many breastfeeding patients and often refers them to physical therapy to address breast pain.  Dr. Mitchell had been working with Ada Portman, a physical therapist, and had the idea to create a manuscript to submit about physical therapy techniques for breast pain in breastfeeding patients. For my capstone project, I created an evidence table and wrote a literature review to prepare for creating the manuscript.

Although I originally thought my capstone project would be focused on pelvic floor physical therapy, through networking with close and far away physicians and physical therapists, it ended up being centered around breast pain. I learned about different breast pain diagnoses, appropriate treatments, and when physical therapy is indicated. It was exciting to see physical therapy literature on this topic, as it is woefully underrepresented and under researched in our field. Throughout this process, I connected with quite a few physical therapists currently treating breast pain, and I am excited to take this knowledge forward and educate other women’s health physical therapists on how we can be effective at providing relief for breast pain.

 

Project Overview and Purpose:

Breast pain is a common phenomenon amongst women; however, there is a lack of research investigating conservative efforts for treatment. Symptoms of breast pain are common in the breast cancer population and breastfeeding population. Breast cancer treatments of radiation and surgery often cause acute pain that leads to chronic breast pain. As many as 24% to 47% of patients report symptoms of chronic pain following treatment for breast cancer.¹ Symptoms of anxiety and depression are higher in the population of individuals with cancer, which contributes to this high rate of chronic pain.²

Breastfeeding pain is common amongst new mothers in the first weeks postpartum, and as many as 1 in 5 women may develop chronic breastfeeding pain lasting beyond 2 months. Pain with breastfeeding is often cited as the reason for early cessation of breastfeeding, with one study reporting 29.3% of mothers stopping breastfeeding within the first month due to severe pain.³

The purpose of this project was to review the literature related to physical therapy techniques related to breast pain, as many women prefer conservative treatment following breast cancer or during breastfeeding.

 

Statement of Need:

There is currently no literature review or clinical practice guidelines about physical therapy techniques for breast pain.  The literature review served as a basis for a clinical practice guideline manuscript that is being submitted to the Clinical Lactation journal.

Clinical Lactation has an audience of physicians, lactation consultants, physical therapists, nurses and other health care professionals offering breastfeeding support. Submitting to this journal will help disseminate current evidence and support the use of physical therapy techniques in the breastfeeding population.

 

Product:

For my capstone product, I created an evidence table and literature review investigating physical therapy techniques for breast pain.

Breast Pain Evidence Table

Breast Pain Literature Review

 

Health Literacy Evaluation:

To evaluate the health literacy of my literature review, I held a focus group for feedback from my classmates since they represent the education level of the target audience of physical therapists. A few of us met together, read the paper and discussed what terms were unfamiliar and should be described in more depth. I was able to apply this feedback to the final draft of my literature review to improve readability for physical therapists that are not trained in breast health physical therapy. I further described the idea of the biopsychosocial model and defined the term “milk let down.” Since physical therapy for breast pain is not currently taught in our curriculum, I found this exercise to be valuable in sharing the information as well as evaluating the health literacy of the paper. Overall, my paper was at an appropriate health literacy level for physical therapists and physical therapy students.

 

Self-Assessment:

I am proud of my final capstone product and the work that I put into it. When it comes to school work, I much prefer a detailed rubric with each step explicitly stated, so producing this evidence table and literature review was definitely out of my comfort zone. I had never written a full literature review before, and I was very anxious about my ability to end up with an excellent product.

My strengths throughout this project were quick and effective communication, sticking to my timeline, and my strong desire to learn. Communication has always been one of my strengths, and I was able to efficiently ask and answer questions with my committee members and advisors throughout this project. Because I am also writing a manuscript based on the information from the literature review, I had to complete the review fairly early. I did a good job of sticking to the specific tasks and associated dates on my original timeline, which set me up for success in getting my final product done on time and working on the manuscript without added stress. Although I was intimidated by performing a literature review on a part of physical therapy in which I had no experience, my desire to investigate this topic and learn more about it kept me motivated to do a thorough search.

Although I am happy with my journey and the final product of my capstone, there are areas which I could have improved upon. I did not use a reference manager until the very end, so I ended up having to work on references alone for a few hours. If I had been more organized and utilized a reference manager the whole time, I could have been much more efficient. I also wanted to shadow a physical therapist who treated breast pain and never ended up being able to fit that into my schedule. I think this would have been helpful for further understanding what I was reading and learning different search terms, although my committee was helpful in providing these. I look forward to working in the women’s health setting for my final rotation and am hopeful to see some breast health physical therapy.

Overall, I gained confidence in my academic writing ability, improved my efficiency and effectiveness when searching for literature, and learned a lot about breast health physical therapy. I learned from many different breast health physical therapists that I contacted during my project, and am looking forward to using both the evidence I found in my search and clinical anecdotes from therapists to improve and expand my clinical practice.

 

Acknowledgements:

I am thankful for all the help and support I received to complete this project. Thank you to Dr. Deborah Thorpe, my advisor, who provided guidance and direction throughout this process.

I am thankful to my committee members Dr. Dana McCarty and Ada Portman. Thank you Dr. Dana McCarty for helping me navigate the waters of writing a literature review and manuscript and providing extremely valuable feedback on my project. Thank you Ada Portman for sharing your knowledge and expertise in the subject, which helped guide my search.

Thank you Dr. Alison Stuebe for connecting me to this project and Dr. Katrina Mitchell.

Dr. Katrina Mitchell, thank you for sharing your breastfeeding expertise with me and entrusting me to produce a manuscript based on this material. I am continuing to learn from both you and Ada through this process and am very appreciative.

Thank you to my classmates for providing feedback on my project as well as supporting me throughout this endeavor that is physical therapy school. Lastly, thank you to my partner Kai, who has, while pursuing a PhD himself, continually encouraged me to grow and chase my passions.

 

References:

Image: https://familydoctor.org/condition/breast-pain-in-women/

1. Juhl AA, Christiansen P, Damsgaard TE. Persistent Pain after Breast Cancer Treatment: A Questionnaire-Based Study on the Prevalence, Associated Treatment Variables, and Pain Type. J. Breast Cancer 2016;19(4):447-454. doi:10.4048/jbc.2016.19.4.447.
2. Jackson T, Wang Y, Wang Y, Fan H. Self-efficacy and chronic pain outcomes: a meta-analytic review. J. Pain 2014;15(8):800-814. doi:10.1016/j.jpain.2014.05.002.
3. Berens P, Eglash A, Malloy M, Steube AM. ABM Clinical Protocol #26: Persistent Pain with Breastfeeding. Breastfeed. Med. 2016;11(2):46-53. doi:10.1089/bfm.2016.29002.pjb.