Physical therapy is a bridge from injury or illness to wellness. Rehabilitation programs have specific therapies for different diseases, including metastatic cancer. Special issues can arise with bone metastasis and physical therapy, including pain, deconditioning, falls and fractures. Selecting a skilled physical therapist with knowledge of bone metastasis is important.
Cancer Basics
Bone, breast, lung and prostate cancers are the most likely to metastasize to bone. Bone metastasis can be a sign of extensive cancer; however, treatments have improved dramatically and survival rates have improved. The effects of metastatic cancer are varied. Symptoms include weight loss, weakness, pain and unsteadiness, all of which can hamper successful physical therapy. Furthermore, cancer treatments can cause weakness and fatigue. The correct approach to physical therapy should incorporate these complexities.
Physical Therapy Basics
Physical therapy will improve strength, endurance and balance. Patients with metastatic cancer to bone will need improvement in these areas to continue their medical therapy. Typical physical therapies will include weight bearing and non weight bearing exercises. Since cancer patients with bone involvement are at risk for fractures with load bearing, exercises that avoid excessive load bearing are necessary. Exercises such as swimming, biking and horizontal body movement are generally acceptable. Load bearing may require splinting of the involved limb. If the leg bones are involved, then special medical consultation is required to avoid debilitating leg fractures.
Bone Pain
Patients with metastatic cancer to bone will experience different levels of pain.
Dealing with pain before physical therapy is important to optimize results from a session. Topical pain relief with liniments, ice or heat may be enough. Medications are usually required under the guidance of your physician. Alternative approaches like massage, acupressure and acupuncture are used with varied success. Physical therapy sessions may not be pain free, but should be made as comfortable as possible.
Other Effects
Besides pain and fractures, which limit physical therapy, fatigue and weakness are common with metastatic cancer to the bones. As a result, falls commonly occur; assist devices are readily available to prevent such events. Finally, poor appetite, weight loss and depression are part of the metastatic cancer spectrum and must be addressed by a multidisciplinary team in order to make gains in physical therapy.
References
- "Abeloff''s Clinical Oncology: Problems Common to Cancer and Its Therapy"; Martin Abeloff M.D.; 2008
- "Abeloff''s Clinical Oncology: Bone Metastases"; Martin Abeloff M.D.; 2008
