Physical therapy plays critical role in breast cancer treatment and rehab

Researchers from the Netherlands in 2015 found that a combination of supervised strength and aerobic training during the early stages of breast cancer treatment reduces fatigue while helping patients increase muscle fitness.

More recently, a study published in the Canadian Medical Association Journal (CMAJ) concluded that exercise and weight management are the most important lifestyle changes a breast cancer survivor can make to help prevent the reoccurrence of cancer.

As breast cancer awareness is often in the forefront of many women’s minds, Lynnwood physical therapist and certified lymphedema specialist Becky Miller points out these and other studies in a growing collection of research that touts the important role physical therapists can play in breast cancer treatment — from general rehabilitation and prevention to the early diagnosis of potential complications following treatment.

“Physical therapy can play a critical role in improving the quality of life for breast cancer patients during and after treatment through hands-on interventions as well as therapeutic exercise,” Miller, a physical therapist with Impact Physical Therapy in Lynnwood. “The goal is to reduce pain while helping patients improve flexibility, strength and range of motion following treatment.”

For women battling with or who have survived breast cancer, physical therapy exists to alleviate the impact of surgery related to breast cancer treatment. Working closely with surgeons and oncologists, Miller says the ultimate goal of a PT is to help clients attain the highest level of function, getting them back on track toward the life they lived before diagnosis.

“Physical therapists are trained to help restore motion in patients following a mastectomy or axillary lymph node dissection, while at the same time guiding them toward return to their daily activities and lifestyles,” she said.

Miller points to a few of the ways physical therapy can help those affected by breast cancer:

Combat Fatigue: The Netherlands study mentioned above, which appeared in a recent issue of BMC Medicine, found that a supervised strength and conditioning regimen during the first 18 weeks of treatment helped breast cancer patients offset the deconditioning effects of chemotherapy. It also built muscle strength while increasing a feeling of “general self-efficacy and mastery” among patients.

Early Diagnosis of Lymphedema: Physical therapists have taken on a greater role in the early detection of lymphedema, abnormal swelling of the arm and hand that may result when lymph nodes are removed or treated with radiation as a part of cancer treatment. Once detected, a PT can treat the early stages of the condition through massage, range-of-motion and strength exercise, and the use of compression sleeves.

Exercise for Prevention: Studies have shown that regular exercise and physical activity may actually lower the risk of the onset and reoccurrence of cancer (including breast cancer) when compared with living a sedentary lifestyle. Following cancer treatment, physical therapists like those on the Impact Physical Therapy team can work with breast cancer survivors to establish an exercise program that maintains long-term strength, cardio fitness and overall functionality.

Create Heart-Healthy Habits During Heart Month

February is American Heart Month, a time when health professionals like physical therapists strive to raise awareness about maintaining and improving cardiovascular health. 

The month also serves as a sobering reminder that, as a society, we must do a better job of preventing heart disease, which continues to be the leading cause of death in the U.S. 

Stats confirmed by the Centers for Disease Control & Prevention (CDC) show about one in every four American deaths is due to heart disease. 

On the flip side, the CDC also reports that about 200,000 cardiovascular-related deaths each year could have been prevented. If achieved, that would be a nearly 30 percent reduction. 

In a lot of cases, heart disease can be traced back to factors that are preventable – things like the lack of physical activity, obesity, high blood pressure and/or cholesterol, an unhealthy diet, smoking and so onThese are factors related to lifestyle, and they’re all things that can be improved by changing habits. 

For example, according to the U.S. Department of Health and Human Services (HHS), fewer than 5 percent of adults participate in 30 minutes of physical activity every day. Yet, daily exercise remains one of the best tools we have in the prevention and control of heart disease. 

Getting your recommended 150-plus minutes of exercise each week is key to controlling your weight, lowing your blood pressure and strengthening your heart, all important aspects in the prevention of heart disease. 

It also helps improve the way your body reacts to stress, which is another key element. 

While regular exercise is critical, the American Heart Association notes that its combination with other preventative measures can pack a mighty punch when it comes to preventing cardiovascular disease. These include: 

Heart-Healthy Eating 

Nutrition also plays a crucial role in preventing heart disease. One’s risk can be lowered by eating fruits, vegetables, whole grains and lean meats, while cutting back on sodium, saturated fats, processed sugars and alcohol. 

Keeping a Healthy Weight 

The more body fat you have and the more you weigh, the more likely your chances of developing a number of issues including heart diseaseAccording to the National Heart, Lung and Blood Institute, a body mass index between 18.5 and 24.9 represents a healthy weight. 

Managing Stress 

Chronic stress can contribute to high blood pressure and other cardiovascular risks. Exercise is a great way to help manage stress, but see your physician for other treatment options. 

Quitting Smoking 

This is a no-brainer. If you smoke, you simply must quit. 

These are all key in keeping a healthy weight, managing stress and warding off potential disease. 

If there’s something keeping you from regular activity – something like pain, disability or other movement limitations – consider visiting a physical therapist for a solution to living a healthy, active life. 

Take Steps to Prevent, Manage Ankle Sprains

With basketball season in full swing and winter weather affecting large areas of the country, it’s peak season for ankle sprains, one of the most common musculoskeletal injuries in the U.S. And yet Lynnwood physical therapist Nancy Mitrano says incidents of ankle sprains can be minimized through simple strength, balance and flexibility exercises. 

“Ankle sprains happen when your foot turns or twists beyond its normal range of motion due to a slip, trip or roll on an uneven surface, injuring the ligaments in your ankle,” said Mitranoowner of Impact Physical Therapy in Lynnwood. “A sprained ankle is one of the most common injuries we see, so if you’ve experienced it before, you’re in good company.” 

According to the American College of Sports Medicine (ACSM), 25,000 people suffer ankle sprains every day in the U.S. That’s around 9 million ankle sprains each year, accounting for nearly half of all sports injuries. One study  found that ankle sprains account for nearly one-third of all reported sports injuries, with 41 percent of these injuries related to basketball – from awkward landings, oftentimes on a player’s foot. 

About three out of four ankle sprains are the classic rolled ankles, or inward “inversion sprains.” Such injuries vary in grade, based on the extent of injury to the ligament, leading to pain, swelling, weakness and instability. 

“Sprained ankles happen, there’s no denying that. But there are ways to minimize the odds of a sprain or a re-sprain,” said Mitrano. “Depending on your functional or performance goals, as well as the levels of strength and stability you have, individualized programs can be created based on improving three areas: strength, balance and flexibility.” 


Weak muscles around the ankle joint, specifically those on the outside of the ankle, can make you more susceptible to an ankle sprain, Mitrano said. While a physical therapist can provide a customized strength program specifically for your ankle, a simple exercise you can perform at home is this: While sitting, wrap a towel around your foot for resistance as you move your foot up and down, left and right. 


Proprioception is your body’s ability to sense itself relative to neighboring body parts. Low proprioception in your ankle can affect your balance and, hence, your ability to prevent ankle sprains. To get a sense of this, stand one leg for several seconds. Close your eyes (within reach of a wall, chair or countertop for balance) for a greater challenge. Do this once for a sense of balance; do it daily on each leg (and hold) to improve your balance over time. 


Tightness and movement limitations up your legs and into your hips and torso can affect the stability of your ankles. It’s true! So, remaining flexible and mobile not just in your ankle, but throughout your body, can dramatically improve functional and athletic performance, Mitrano said, while decreasing the chance of ankle sprains. 

“If you have experienced an ankle sprain, rest is important, but studies show that individualized treatment by a physical therapist can get you back to your normal lifestyle and performance goals quicker than you can do on your own,” Mitrano said. “Seeing a physical therapist first can save you time, money and put you on track toward injury prevention in the future.”  

Exercise to Ease Chronic Anxiety This Year 

A new year offers the potential for new opportunities and experiences. 

For those who struggle with general and consistent anxiety, however, the prospect of the new year and the expectations that come with it can be tricky to maneuver. 

It’s with this in mind that our physical therapy team reminds you of one of the most natural and effective ways to ease anxiety symptoms any time of year is through regular exercise. 

Going for a walk, taking a bike ride, hitting the gym or signing up for an exercise class … they all can be powerfully effective tools for easing anxiety and its effects on your life and health. 

Anxiety Disorders 

According to the Anxiety and Depression Association of America (ADAA), an estimated one in five adults and one in three teens experience chronic anxiety disorder each year. This disorder is defined as anxiety that’s persistent, excessive and routinely triggered by situations that aren’t actually threats. 

Though it’s a psychological condition, anxiety can take a toll on one’s physical health. 

High stress and anxiety have been linked to higher blood pressure and a greater risk of heart disease and stroke. 

Also, those who have high levels of anxiety tend to be more sedentary and avoid challenging situations, which can also have long-term health consequences. 

So, how does exercise help ease anxiety? Here are four ways this happens: 

Your brain chemistry changes. 

When you exercise, your body releases chemicals, like dopamine and endorphins in the brain, which contribute toward making you feel calmer and happier. 

General tension diminishes. 

Whether working out, competing, playing or dancing, moving your body reduces general muscle tension in the body, decreasing your general feeling of anxiety. 

You get distracted. 

Exercising can have a distracting effect, diverting your mind from the things about which you are or have been anxious. It’s also been shown that exercising outdoors, in nature, can calm your mind. 

You give your brain a boost. 

Several studies have shown that regular exercise can maintain, and even improve, cognitive function in the brain. That means exercise can actually help you strengthen your ability to weather high-stress situations. 

On its own, exercise may not completely solve your anxiety issues. Those suffering from chronic anxiety should discuss options with their personal physician. 

When possible, though, studies show that regular exercise should be part of any natural, long-term treatment for anxiety. 

Sticking with an Exercise Program 

And, if you struggle to stick with a consistent exercise regimen? 

Don’t just join a gym. Experts agree you should find an activity or activities you enjoy. 

Recruit a friend or friends for some social support, and set a SMART goal – an acronym that describes a goal that’s Specific, Measurable, Attainable, Relevant and Time-based.” 

Also, visit a physical therapist if pain, discomfort, weaknesses or chronic conditions are keeping you from exercising safely and consistently. 

Following an initial assessment, a physical therapist can develop a personalized exercise program that best aligns with your individual circumstances and goals. 

Use Fitness Apps in 2020…but Use with Caution, says Lynnwood PT

As more people continue to turn to health apps on their smartphones to help achieve goals related to exercise and weight loss, it’s important to use such tools with an element of personal caution, says Lynnwood physical therapist Nancy Mitrano. 

Tens of thousands of health and fitness apps available to consumers, with estimates between 97,000 to 325,000 in existence. These include popular apps like Strava, Lose It!, Couch to 5K, FitStar Personal Trainer, etc. – apps available to help people achieve goals related to weight loss, healthy eating, and improved fitness. 

“The emergence of health and fitness apps has definitely been a positive development in the health care world as many have been successful in engaging people and empowering them to take on a greater personal role in their health care journeys,” said Mitranoowner of Impact Physical Therapy in Lynnwood. “That said, even the best fitness apps can’t address everything that’s important when it comes to safely and effectively achieving personal goals.” 

The missing ingredient is obvious, Mitrano added. 

“Fitness apps don’t know you – your medical history, your current strengths and weaknesses … how to get you to your goals in a way that’s safe and which takes into consideration the limits of your body and current fitness levels,” Mitrano said. “Many of these apps are great for helping people track their fitness goals, holding them accountable through reminders and tips, and often providing them with an online support system. But the app’s user is the key to the entire equation.” 

With this in mind, Mitrano provides the following Do’s and Don’ts for safely and effectively using health apps: 

DO use apps to track your goals. Whether it’s tracking distance, calories consumed/burned, workout times, etc., this is one of the most effective uses of health apps and smartphones. And, tracking progress only helps in the achievement of goals. 

DON’T use apps to set your goals. Running a 5K, for instance, may seem like a great goal. But based on current fitness levels, injury history, movement limitations, etc., perhaps it’d be better and safer to start more slowly (perhaps first running a mile) or trying a different exercise (i.e., cycling, hiking or swimming). 

DO use apps for motivation. Being we’re attached to our smartphones throughout the day, apps serve as great motivational tools when trying to stick to a workout regimen. Apps can even connect the user with others for added encouragement. 

DON’T let apps push you too far. Listen to your body over your app. If something’s not feeling right, it’s OK to skip today’s Couch to 5K workout. Through pain or discomfort, your body may be telling you to rest, or perhaps get checked out by a physical therapist or physician. 

DO use apps to help you explore new activities. Apps can certainly make you feel empowered, serving as motivation to try new things – new yoga poses, new core exercises, new activities like running or cycling, etc. But… 

DON’T forget to seek professional medical advice before starting something new. As with any new physical activity, it’s important to get assessed by a medical professional, such as a physical therapist, to ensure your body’s equipped to handle the rigors of said activity.  Be safe and injury-free when pursuing your goals.

Exercise Therapy Proven to Ease Pain in Expecting Mothers

For the majority of future mothers who experience mild to debilitating back pain during and after pregnancy, Lynnwood physical therapist Nancy Mitrano offers some encouraging news: 

Education and exercise therapy have proven effective in reducing back pain for most expecting mothers. 

According to a study published in the Journal of Orthopaedic and Sports Physical Therapy, a physical therapist-directed exercise regimen that focuses on the muscles around the spine and pelvic floor – a program that includes strength training, aerobic exercise and balance training – can greatly benefit the approximately 2.5 million women who experience lower-back pain related to pregnancy each year. 

“While some back discomfort is normal during pregnancy, the pain shouldn’t keep you from your usual daily activities,” said Mitranoowner of Impact Physical Therapy in Lynnwood. “If the pain or discomfort is such that it’s impeding your ability to live your life, a physical therapist can guide you toward exercises, advice and a personalize treatment program that offers relief.” 

According to Mitrano, the added weight of pregnancy, coupled with the release of hormones that relax the ligaments in the pelvis, lead to strain in the hips, pelvis and lower-back. Diagnosing the exact cause of pain, however, is essential in determining the safest and most effective treatment paths for pregnant and postpartum moms. 

Following a thorough examination, a physical therapist may offer the following treatment options: 

Stabilization Exercises: As hormones relax the ligaments, stronger muscles can help stabilize the pelvis and lower-back. A physical therapist can teach women safe and effective exercises that specifically target the muscles in this region of the body – exercises that can often be performed at home. 

Stretching: Along with strength exercises, stretching the muscles around the hips, pelvic floor and back can also help relieve pain and discomfort. 

Aerobic Exercise: The American College of Obstetricians and Gynecologists (ACOG) suggests expecting moms exercise for 15 minutes three to four times per week, at a heart rate of 140 beats per minute. A physical therapist will help identify aerobic exercises, like walking, swimming, yoga, etc., that are both safe and effective. 

Other Options: A physical therapist may decide that other treatment options, such as manual therapy or braces, might be effective based on one’s specific diagnosis. 

“Movement is often key to relief, and as physical therapists, we not only treat expecting mothers, but we help them alter the way they perform everyday tasks in order to reduce pain,” Mitrano said. “We show patients how to improve posture and better manage their average daily activities, and we educate them on why such changes are effective.” 

Volunteering Benefits Seniors Physically & Mentally

For some older adults who live alone, life can become filled with instances of social isolation and loneliness.

Research shows social isolation can have adverse effects such as depression, reduced cognitive function, decreased activity, and many physical conditions.

For instance, we tend to see more instances of issues like high blood pressure, heart disease and obesity in people who perhaps aren’t as social as they used to be.

Why Be Social?

While it’s completely fine to be comfortable by yourself, it’s often beneficial both mentally and physically to make time for social interactions.

One great way to do this – especially this time of year – is to take advantage of community volunteer opportunities.

Studies have shown that volunteering is a great way for seniors to counter many of the effects of isolation and aging. Just getting out in a useful way to support a cause you believe in can benefit the mind and the body – from combatting loneliness to increasing levels of health and activity.

And, volunteering can take on many forms, regardless of age, health or physical limitations.

Some proven health benefits of volunteering include:

Improving Self-Esteem, Lowering Depression

Giving time to others can create a personal sense of accomplishment. When assisting others, the body releases dopamine in the brain, which has a positive effect on how people feel.

It is documented that volunteers also experience lower levels of depression.

Expanding Connections

Volunteers are surrounded by a community that’s attuned to helping – people willing to lend a hand when times get tough. And, they realize that safety nets go both ways: helping when asked and asking for help.

Combating Stress

According to a study by a Carnegie Mellon University doctoral student, volunteering reduces stress. In her study, 200 hours of volunteering per year correlated to lower blood pressure, and lower blood pressure correlated to better health outcomes.

Keeping the Mind Active

The same study speculated that mentally stimulating activities, like tutoring or helping with reading, contribute to maintaining memory and thinking skills that, in turn, reduces cognitive impairments.

Physical therapy services often work to complement these effects by working with seniors and others to keep their bodies volunteer ready.

And, in the end, once a person starts to realize all the physical, mental and social benefits of giving back to people and their communities, this can help motivate them to live healthier, more active lives. Physical therapists, then, are there to offer support that allows these efforts to extend into the long term.