Physiotherapy for Cancer-Related Pain: Approaches and Benefits

Physiotherapy for Cancer-Related Pain: Approaches and Benefits

Living with a cancer diagnosis often comes with pain that affects every aspect of your daily life: fatigue that prevents you from doing your usual activities, muscle tension that sets in, and discomfort related to treatments. If this is what you're experiencing, you're not alone. Between 50% and 70% of cancer patients experience pain at some point during their journey.¹

It's normal to seek solutions to improve your quality of life.

Here's the good news: Oncological physiotherapy offers proven approaches to relieve pain, combat fatigue, and maintain your independence during and after treatments. Research shows that patients who incorporate physiotherapy into their care journey report a significant improvement in their well-being.² What the science shows:

• Adapted Exercise Reduces Fatigue: Contrary to what one might think, moving helps regain energy. Studies show a 25% to 30% reduction in fatigue with a personalized exercise program.³
• Movement is Safe During Treatment: International guidelines confirm that exercise is not only safe but recommended during chemotherapy and radiation therapy.⁴
• Physiotherapy Can Reduce Pain: Certain techniques can reduce pain by 30% to 50% in oncology patients.⁵

This guide presents the most effective physiotherapy approaches for cancer patients. For an overview of cancer-related pain, please consult our dedicated page.

What is Oncological Physiotherapy?

Oncological physiotherapy is a specialty that helps cancer patients manage pain, fatigue, and physical limitations caused by the disease or its treatments. It uses adapted exercises and safe manual techniques to improve your quality of life at every stage of your journey.

This complementary approach integrates with your oncological care and is for anyone affected by cancer. Regardless of the type of cancer, the stage of the disease, or the phase of treatment, physiotherapy can help you. Whether you are undergoing chemotherapy, recovering after surgery, or several years after your treatments, the benefits are well-documented.

The main difference from general physiotherapy lies in the specific expertise of the professional. A physiotherapist trained in oncology understands the necessary precautions, treatment side effects, and adaptations required for each situation. They adjust their interventions accordingly to ensure your safety and comfort.

What are the Goals of Physiotherapy in Oncology?

The goals are personalized according to your needs but generally include:

• Pain Management: Manual techniques, therapeutic exercises, and education to reduce your daily discomforts.
• Maintaining or Improving Mobility: Keeping your body moving despite treatments to preserve your independence.
• Fatigue Reduction: Adapted exercise programs that, paradoxically, increase your energy levels.
• Prevention of Complications: Avoiding lymphedema, physical deconditioning, and joint stiffness.
• Support for Independence: Enabling you to continue your daily activities, whether it's grocery shopping, caring for your family, or working.

What types of pain can be treated in cancer patients?

Cancer patients can experience pain caused by the tumor itself, pain related to treatments like chemotherapy (iatrogenic pain), post-surgical pain, and secondary musculoskeletal pain. Each type requires a specific approach in oncology physiotherapy.

Tumor pain occurs when the tumor compresses or invades surrounding structures like nerves, bones, or organs. This type of pain is usually managed in close collaboration with your oncology team. Physiotherapy can help maintain mobility and reduce the compensatory muscle tension that often develops. Treatment-related pain is caused by the treatments themselves. Chemotherapy-induced peripheral neuropathy is a common example, causing numbness, tingling, or pain in the hands and feet that can persist. The after-effects of radiotherapy can also include stiffness and localized pain. Physiotherapy offers specific exercises to manage these symptoms and improve your function. Post-surgical pain can persist after a mastectomy, lung resection, or other surgeries. Tissue adhesions, muscle tension, and limitations in movement respond well to physiotherapy techniques. Early intervention leads to better results. Secondary musculoskeletal pain often results from deconditioning, changes in posture, or decreased activity. Your muscles and joints can become stiff and painful simply because you're moving less. This type of pain often responds best to physiotherapy, with significant improvements seen within a few weeks.

How is pain assessed in oncology physiotherapy?

Pain assessment in an oncology setting goes beyond a standard evaluation. Your physiotherapist will use validated pain scales and will look at:

• How pain affects your daily activities and sleep
• Your fatigue level and how it interacts with pain
• Your current cancer treatments and their potential side effects
• Your personal goals and what matters most to you in your daily life

This comprehensive assessment forms the basis for creating a realistic treatment plan and measuring your progress over time.

How does physiotherapy help manage cancer-related fatigue?

While it might seem counterintuitive, adapted exercise is the most effective intervention for cancer-related fatigue. Gradual physical activity programs can reduce fatigue by 25 to 30%, improving energy and quality of life during and after treatments.³ This is one of the strongest findings in oncology rehabilitation research.

Cancer-related fatigue affects between 70 and 100% of patients at some point in their journey.⁶ It's different from ordinary tiredness: rest alone doesn't relieve it. This profound fatigue impacts your ability to work, care for yourself, and enjoy your activities. It's frustrating, and we understand how disheartening it can be.

The exercise paradox might seem counterintuitive: you're exhausted, and you're told to move more? Yet, dozens of meta-analyses confirm that adapted exercise is more effective than rest in combating this fatigue.⁷ Your body needs movement to regain its energy and vitality.

Your exercise program is always personalized based on your condition each day. On days you feel better, you can do a bit more. On difficult days, you reduce the intensity. This flexibility is essential to keep you engaged without over-exhausting yourself.

What exercises help combat fatigue?

The ideal approach follows the principle of "start gently, increase gradually." Your physiotherapist will guide you to find the right balance between effort and recovery based on your specific condition.

What is lymphedema and how is it treated?

Lymphedema is swelling caused by the buildup of lymph fluid, often after breast cancer surgery or lymph node removal. Manual lymphatic drainage, specific exercises, and multi-layer bandaging are the first-line physiotherapy treatments.⁸ Early management helps to better control this condition.

This swelling occurs when the lymphatic system, damaged by surgery or radiation therapy, can no longer effectively drain fluids. The affected arm or leg can become heavy, uncomfortable, and more prone to infections. The risk of developing lymphedema after breast cancer surgery is between 20 and 30%.⁹

Risk factors include:

• Mastectomy with axillary lymph node dissection
• Radiation therapy in the lymph node area
• Repeated infections in the affected limb
• Overweight or obesity
• Prolonged inactivity

Rest assured: lymphedema can be managed effectively with the right interventions. Early detection and prompt treatment are key to controlling this condition and maintaining your quality of life.

How to prevent lymphedema?

Prevention starts right after surgery:

• Early Post-Surgery Exercises: Gentle arm movements in the days following surgery promote natural lymph drainage
• Skin Care: Keeping skin hydrated and avoiding cuts or burns reduces the risk of infection
• Avoid Trauma to the Limb: No blood draws or blood pressure readings on the operated side when possible
• Active Monitoring: Regularly measuring the limb's circumference helps detect changes early

What is Manual Lymphatic Drainage?

Manual Lymphatic Drainage (MLD) is a very gentle and specific massage technique that stimulates lymph circulation towards functional drainage pathways. Unlike a regular massage, the movements are slow, light, and follow a precise path determined by the anatomy of the lymphatic system.

A typical MLD session lasts between 30 and 60 minutes. The frequency depends on the severity of the lymphedema, ranging from daily during the intensive phase to weekly during the maintenance phase.

Complete lymphedema treatment also includes:

• Compression: Compression sleeve or multi-layer bandage depending on the treatment phase
• Specific Exercises: Movements that promote natural lymphatic pumping
• Skin Care: Strict hygiene and hydration to prevent infections
• Education: Understanding how to manage your condition daily to maintain results

What Exercises Are Safe During Cancer Treatment?

Exercise is generally safe and recommended during cancer treatment, with adaptations based on your condition. The American College of Sports Medicine guidelines recommend 150 minutes of moderate aerobic activity and 2 strength training sessions per week, adjusted individually.⁴

This recommendation might seem daunting if you feel tired or weak. The important thing is to start where you are and progress at your own pace. Even 5 minutes of walking can be beneficial. Every step counts.

Generally safe types of exercises include:

• Walking: The most accessible and well-studied exercise in oncology
• Stationary Cycling: An excellent option for days when balance is compromised
• Swimming or Aqua Fitness: Ideal if you have joint pain, as the water supports your weight
• Light Strength Training: Resistance bands, light weights, bodyweight exercises
• Gentle Yoga or Tai Chi: Combines movement, breathing, and relaxation for overall benefit

When Should You Adapt or Avoid Exercise?

Certain situations require modifying or temporarily postponing exercise:

• Fever or Signs of Infection: Wait until you've recovered before resuming
• Severe Neutropenia: When your white blood cell count is very low, avoid environments with a high risk of infection, such as public swimming pools.
• Significant Anemia: Reduce intensity and listen carefully to your body.
• Significant Nausea: Prioritize gentle exercises like slow walking.
• Unassessed Acute Pain: Consult a professional before continuing to ensure there are no contraindications.

These situations are usually temporary. Your physiotherapist will help you safely resume exercise as soon as your condition allows.

How can manual therapy relieve pain?

Adapted manual therapy can relieve muscle tension, improve mobility, and reduce certain types of pain in cancer patients. Techniques are modified to ensure safety, avoiding at-risk areas and respecting oncological precautions specific to your situation.

Manual techniques used in oncology include:

• Gentle Joint Mobilizations: For joints that have become stiff after a period of immobilization.
• Myofascial Release: For muscle tension and tissue adhesions.
• Oncological Massage: Adapted in terms of pressure and treated areas according to your specific precautions.
• Drainage Techniques: To promote lymphatic circulation and reduce swelling.

The difference between oncological massage and traditional massage is significant. Oncological massage uses lighter pressure and avoids recently irradiated areas, known bone metastasis sites, and regions where catheters or venous access ports are located.

Beyond physical relief, manual therapy can also reduce anxiety and improve sleep quality. Therapeutic touch has a calming effect that benefits your overall well-being during this difficult period.

Why is physical activity beneficial in oncology?

Research shows that regular physical activity reduces fatigue, improves quality of life, maintains muscle mass, and can even improve survival in some patients.¹⁰ The benefits extend to both the body and mood, as well as overall well-being. It is a powerful tool you can actively use in your care journey.

Documented Physical Benefits:

• Maintaining strength and muscle mass despite treatments
• Improved daily endurance and energy
• Better body composition
• Reduction of treatment side effects
• Preservation of physical function and independence

Psychological Benefits:

• Reduction of anxiety and depressive symptoms
• Improved sleep and recovery
• Better sense of control over your health
• Increased self-confidence and self-esteem

Impact on Cancer Outcomes:

Observational studies suggest that exercise could reduce the risk of recurrence by 30 to 50% for certain cancers, such as breast and colon cancer.¹¹ While these results require further research for confirmation, they provide additional motivation to stay active during and after your treatments.

When should you consult a physiotherapist?

Consult a physiotherapist as soon as you are diagnosed with cancer to establish a preventive plan, when pain or limitations appear, before and after cancer surgery, or if you experience fatigue that limits your daily activities. The sooner you start, the better the results.

Ideally, consult as soon as you are diagnosed: A baseline assessment helps determine your initial condition and allows you to start a preventive program. This is especially important before surgery or the start of systemic treatments. Consult a professional quickly if you have:

• Pain that limits your daily activities
• Fatigue that doesn't improve with rest
• Swelling in the arm or leg
• Stiffness or limited movement
• Balance or coordination difficulties
• Persistent numbness or tingling

Don't wait for symptoms to become severe. Physiotherapy is more effective when started early. To learn how to manage your pain at home while waiting for an appointment, consult our practical guide.

What happens during an oncology physiotherapy session?

An oncology physiotherapy session begins with a comprehensive assessment, considering your cancer and treatments. The physiotherapist then develops a personalized plan, including exercises, manual techniques, and education, to help you achieve your specific goals.

The initial assessment generally lasts 60 minutes and includes:

• Discussion about your diagnosis, current treatments, and personal goals
• Assessment of your mobility, strength, and balance
• Assessment of your pain and fatigue using validated tools
• Discussion of your current functional abilities and what you would like to improve

The treatment plan is then established based on your priority needs. It may include:

• Supervised therapeutic exercises in the clinic
• Home exercise program tailored to your level
• Manual techniques if appropriate for your condition
• Education on daily symptom management
• Energy management strategies to optimize your days

Follow-up Sessions usually last 45 to 60 minutes and allow you to progress with your program, adjust exercises according to your condition, and answer your questions.

Communication with your oncology team is essential. Your physiotherapist can communicate with your oncologist to ensure that interventions are appropriate for your situation. To learn more about a physiotherapy assessment at Physioactif, consult our detailed guide.

What are the frequently asked questions about physiotherapy and cancer?

Can physiotherapy cure cancer?

No, physiotherapy does not cure cancer. It is a complementary treatment that helps you manage symptoms, maintain your physical function, and improve your quality of life during and after your cancer treatments. It is part of a comprehensive care approach, alongside medical treatments.

Does my insurance cover oncology physiotherapy?

Most private insurance plans in Quebec cover physiotherapy. The amounts and number of sessions vary depending on your plan. Check with your insurer to find out your specific coverage. Some cancer clinics also offer physiotherapy services covered by the public system in certain contexts.

How many sessions will be necessary?

This depends on your goals and condition. Some people benefit from a few sessions to learn independent exercises they can do at home, while others require more regular follow-up for conditions like lymphedema. Your physiotherapist will discuss a realistic plan with you from the first meeting.

Can I exercise even if I'm very tired?

Yes, generally. Light exercise can actually improve your energy rather than decrease it, even if it seems counterintuitive. The key is to start very gently and listen to your body. On days of high fatigue, even a short 5-minute walk can be beneficial. Talk to your physiotherapist to establish a program adapted to your energy level.

Is physiotherapy painful?

Oncological physiotherapy is tailored to your comfort level. The techniques used are generally gentle and considerate of your condition. You might experience slight discomfort during some exercises or movements, but it should never be severe pain. Always communicate with your physiotherapist about how you're feeling so they can adjust the treatment.

How can I find a physiotherapist specializing in oncology?

Look for a physiotherapist with training or experience in cancer rehabilitation. At Physioactif, our physiotherapists are trained to adapt their treatments for cancer patients and understand the necessary precautions. Don't hesitate to mention this when booking your appointment so you can be directed to the right professional.

Conclusion

Oncological physiotherapy is a valuable ally in your cancer journey. Whether it's managing pain, combating fatigue, treating lymphedema, or simply maintaining your physical fitness, evidence-based approaches can significantly improve your quality of life.

You don't have to go through this challenge alone. Specialized physiotherapists understand your unique challenges and can support you every step of the way, during and after your treatments. At Physioactif, we are here to help you regain your independence and well-being.

Book an appointment now for an assessment and discover how physiotherapy can help with your specific situation.

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