Author's note: this is part two of a two part story on rehab in cancer survivors. Click here for part one.


Cancer treatment can be taxing enough. Surgery, chemotherapy, radiation, port management – they’re all possibilities.

But your treatment plan could also send you to physical, occupational or speech therapy. OSF HealthCare physical therapists Kelly Bogowith and Susan Young are shedding some light on what to expect.

Conditions associated with cancer that could require therapy include lymphedema, pelvic floor dysfunction, neuropathy and fatigue. Bogowith and Young outline some symptoms and which symptoms warrant a call to which therapist.

Physical therapy

Cancer survivors should talk to a physical therapist if they’re experiencing:

·         Joint pain, especially in the neck, shoulders and back

·         Difficulty getting around due to being out of shape

·         Swelling in the arms, legs, breasts or torso, a sign of lymphedema

·         Constipation or incontinence, signs of pelvic floor dysfunction

·         Tingling, numbness, weakness or pain in your hands or feet, signs of neuropathy

·         Tiredness that is more frequent, intense or lasts longer than normal, signs of cancer-related fatigue

Occupational therapy

·         Vision issues

·         Dizziness or lack of balance

·         Problems completing everyday tasks, such as using your hand and arm to grab an object in the kitchen. Bogowith says a health care provider could recommend equipment, like a shower seat, or suggest modifying your home, like moving items from high shelves to low shelves.

Speech therapy

·         Difficulty speaking, including your pitch

·         Difficulty swallowing

·         Memory problems, such as forgetting the order you need to perform tasks in

Tips and tricks

Bogowith and Young have treated plenty of cancer survivors, so they know how exhausting recovery can be. Aside from the usual advice (listen to your care team, and take advantage of community resources, they say), the two always try to keep spirits up.

“I think trying to keep a positive outlook as best you can is important. That’s not always easy, but I think mindset is important,” Bogowith says. “Also, good nutrition and proper rest.” 

Says Young: “A lot of times when people have cancer, they tend to isolate themselves. Or they get isolated by their circle of friends because the friends don’t know what to do for them. Just reach out to make connections. Don’t isolate yourself.”

Learn more

Read more about how OSF supports rehabilitation and cancer patients. Cancer care at OSF includes the OSF HealthCare Cancer Institute in Peoria, Illinois.

Interview clips - Kelly Bogowith

Interview clips - Susan Young

Author's note: this is part one of a two part story on rehab's role in cancer care. Click here for part two.


Cancer treatment can be taxing enough. Surgery, chemotherapy, radiation, port management – they’re all possibilities.

But your treatment plan could also send you to physical, occupational or speech therapy. OSF HealthCare physical therapists Kelly Bogowith and Susan Young are shedding some light on what to expect.

Conditions and treatments

Conditions associated with cancer that could require therapy include:

• Lymphedema: This is when fluid buildup leads to swelling in the arms or legs.
  
  “Cancer tends to spread through lymph nodes,” Young says. “So when doctors do surgery and they’re taking out a tumor, they take out a couple lymph nodes to make sure [the cancer] hasn’t spread. One side effect that’s possible is lymphedema.
  
  “When women have breast cancer, [doctors] will remove lymph nodes from the armpit, and the arm can swell up. Same thing for prostate cancer. The legs sometime swell up. Head and neck cancer can cause swelling in the head and neck,” she adds.
  
  In physical therapy, people with lymphedema learn massage techniques and other lifestyle changes to reduce swelling. The person could also wear compression socks or bandages.
   
• Pelvic floor issues: This is when someone can’t control, contract or relax the pelvic floor muscles, leading to chronic constipation, urinary or fecal incontinence or pain. Bogowith says this can happen to men or women, young or old.
  
  “Physical therapists who specialize in pelvic floor therapy are well versed in how to identify and manage those conditions,” Bogowith says. “These are things that should not be ignored because they’re such an important part of quality of life.”
  
  A therapist could teach you exercises, like Kegels, that support the pelvic floor. Or, you could learn bladder control techniques, like timed voiding. This is when you pee at certain times, like once an hour, not just when you feel the urge. When you get comfortable with one hour, you can increase the time.
   
• Neuropathy: This can be a side effect of chemotherapy where you experience tingling, numbness, weakness or pain in your hands or feet.
  
  “There’s no quick fix for neuropathy. Medicines can be given by a physician to help manage symptoms,” Bogowith says. “But in physical therapy, we tend to work on balance since they might have difficulty feeling ground underneath them. That can lead to falls.”
   
• Cancer-related fatigue: Bogowith says fatigue – physical and mental – from cancer treatment is different from everyday fatigue in that it occurs when you wouldn’t expect it. It lasts longer and it doesn’t respond to rest. Her advice to cancer survivors is to not underdo or overdo daily activities. Stay active, but listen to your body and know when to rest. Try for 30 minutes of exercise for five days a week to help maintain a healthy weight. See a mental health provider if the mental fatigue becomes unmanageable.
   
• Joint pain: Young says this is one you might not realize. She says cancer survivors tend to hunch over due to fatigue, stomach pain or just generally feeling down in the dumps. That poor posture can lead to neck, shoulder or back pain.

Tips and tricks

Bogowith and Young have treated plenty of cancer survivors, so they know how exhausting recovery can be. Aside from the usual advice (listen to your care team, and take advantage of community resources, they say), the two always try to keep spirits up.

“I think trying to keep a positive outlook as best you can is important. That’s not always easy, but I think mindset is important,” Bogowith says. “Also, good nutrition and proper rest.”

Says Young: “A lot of times when people have cancer, they tend to isolate themselves. Or they get isolated by their circle of friends because the friends don’t know what to do for them. Just reach out to make connections. Don’t isolate yourself.”

Learn more

Read more about how OSF supports rehabilitation and cancer patients. Cancer care at OSF includes the OSF HealthCare Cancer Institute in Peoria, Illinois.

Interview clips - Susan Young

Interview clips - Kelly Bogowith

Related stories

Kickin' cancer
A breast cancer survivor's toolkit

A growing social media trend is putting vibration plates in the spotlight as a potential tool to shake off lymphedema symptoms, though specialists caution that the devices should complement, not replace, established therapies.

Whole-body vibration plates, which create rapid muscle contractions while users stand, sit or exercise on the device, have attracted attention online for claims that they can improve circulation, reduce swelling and support lymphatic health.

Many people discover the devices through social media platforms such as TikTok, where wellness trends often spread quickly. Rachel Rohman, PT, DPT, CLT, an OSF HealthCare physical therapist specializing in lymphedema treatment, stresses that while vibration plates may provide an additional tool for symptom management, they should not replace compression therapy, manual lymphatic drainage or other evidence-based treatments.

She also warns against believing claims circulating online that portray vibration plates as a standalone solution for lymphedema. While early research is encouraging, Rohman says evidence specific to lymphedema remains limited.

More research is needed

“There has been a lot of positive research regarding, especially improvements in circulation, improved venous vasodilation and getting the blood moving,” Rohman says. “While the circulatory system and the lymph system go hand in hand, there's not as much research looking directly at people with lymphedema and use of vibration plates.”

Lymphedema is a chronic condition caused by a disruption in the lymphatic system that leads to swelling, most commonly in the arms or legs. While the condition cannot be cured, it can often be effectively managed through treatments such as compression garments, manual lymphatic drainage therapy and compression pumps.

Rohman points out studies examining vibration plates in healthy individuals, and patients with other medical conditions, have demonstrated benefits related to circulation and mobility. A smaller number of studies have explored their use among people with lymphedema or related conditions, with some positive results.

In the past few years, there have been a handful of published studies including one that looked at women with a related condition called lipedema, which results in an abnormal fat buildup on both sides of the body.

Rohman explains, “Those women do get some swelling and that study did show some positive improvements in swelling over time with use of vibration plates in addition to manual lymphatic drainage massage. So, the new studies are showing some promise. I think there will be a lot more promising research that comes out, even potentially in the next few years.”

Because research remains limited, vibration plates are not considered part of the standard of care for lymphedema management. Instead, Rohman says she discusses the devices primarily with patients who are already following established treatment recommendations and are looking for additional ways to manage symptoms.

Vibration plates can be a good supplement to care

“They are already potentially doing their other treatment options that are more standard of care, but they're just looking to take their treatment to the next level and so I’m telling them that is an additional option they can try that does have some promising research,” Rohman shares.

Users of vibration plates often report feeling less swollen, more energized or generally better after use. For most healthy people, the devices are frequently incorporated into fitness routines, allowing people to perform body-weight exercises while standing on the vibrating platform.

Still, Rohman cautions that the devices are not appropriate for everyone.

“I am looking for a patient that does not have any medical contraindications,” Rohman says. “They don't have any uncontrolled medical conditions that would warrant being seen by a specialist. Someone with an implanted device like a pacemaker, that can cause some harm to the device, which could be life-threatening.”

Patients with poor balance, untreated blood clots or uncontrolled heart and respiratory conditions could face increased risks. Anyone trying a vibration plate should begin with a low setting and short sessions before gradually increasing intensity.

For people experiencing swelling and considering vibration therapy, Rohman recommends consulting a lymphedema specialist first to determine whether the treatment is appropriate and to rule out other underlying causes.

As interest in vibration plates continues to grow, Rohman emphasizes that potential users should approach the therapy with realistic expectations and view it as one potential component of a broader treatment plan rather than a miracle cure.

Rachel Rohman is a physical therapist specializing in lymphedema treatment at OSF HealthCare in Bloomington.

Video clips with Rachel Rhoman

B-roll-Vibration plates

If you break a leg or sprain an ankle during a basketball game, health care providers have a good idea what happened and how to treat it.

But if you have daily aches, pains and swelling in your legs, it will require some investigation.

Causes

Aman Khurana, MD, a vascular medicine physician who sees patients at OSF HealthCare, outlines common causes of leg pain. 

• Arterial disease
  
  “The arterial cause of leg pain is when people walk, and they get leg, calf, hip or thigh pain. That can be from less arterial flow down in the legs,” Dr. Khurana says. “When we walk, the muscles are demanding more blood. But because of blockages, blood doesn’t come.” 
   
• Venous disease
  
  “Venous pain brings heaviness, tiredness and fatigue. Varicose veins and leg discoloration are signs of venous disease,” Dr. Khurana explains. “That pain seems to get better when you lay flat or with your legs up.” 
   
• Arthritis, or inflammation of a joint
   
• Nerve issues
  
  “We have large nerves that go down from the back,” Dr. Khurana explains. When those nerves are irritated, it can cause a condition called sciatica. “Then there’s small vessel nerve pain that causes tingling and numbness in the feet.”

Wounds, such as those associated with diabetes, and lymphedema, a condition where fluid builds up causing swelling, can also contribute to these problems.

Diagnosis and treatment

Dr. Khurana recommends seeing a provider at the first sign of leg pain. He says it’s hard for people to pinpoint the problem, and waiting can make it worse.

A provider, he says, could check the blood pressure in your arms and legs to gauge blood flow and run a test to check for vein leakage.

“Veins have valves. When blood goes up, the valve should close. Some valves don’t close right. Blood goes up, and it keeps coming down. That’s how you have the heaviness, tiredness and swelling in the legs,” associated with venous disease, Dr. Khurana says. You could be given compression stockings for this problem.

Other treatments include medication, a device (such as a lymphedema pump that massages the legs and aids blood flow to the heart) or an ablation procedure to stop the blood flow in the problematic vein.

Prevention

How do I keep my legs moving? Dr. Khurana repeats advice many doctors have given. Daily healthy habits that prevent cardiovascular disease will help prevent leg issues.

• Keep your blood pressure, cholesterol and chronic conditions like diabetes in check.
   
• Don’t smoke. 
   
• Exercise and eat a healthy diet to avoid obesity. When your weight impacts your ability to get around, Dr. Khurana says, it’s definitely time to see a provider.
   
• Know your family history of health issues, and bring these up to your provider at your regular checkups.

Interview clips

Related stories

Beating blood clots
All ages should keep cholesterol in mind
How to stay active in chilly weather
Smart eats, healthy streets

One in 1,000 Americans are affected by secondary lymphedema. It’s a chronic disease when there’s an increased collection of lymphatic fluid in the body that causes swelling. Those with cancer are known to develop lymphedema, which can lead to skin and tissue changes, according to the National Institutes of Health.

Sometimes those with lymphedema can inherit the disease, known as primary lymphedema, which is much rarer. You can be born with lymphedema, develop it during puberty, or later.

There’s no cure for lymphedema. It’s a disease, and one like diabetes that you have to manage through treatment. Treva Haney, a supervisor in Rehabilitation Services at OSF HealthCare, says her team works through different treatment plans with patients to meet their specific needs.

“Usually the plan of attack for treating lymphedema is complete congestive therapy,” Treva says. “This involves compression bandaging and a special, lymphatic massage.”

Along with the massage and bandaging, the plan can include manual lymph drainage, which – like it sounds – is a specialized form of manual therapy used to stimulate the lymph system and promote drainage.

Haney says exercise is a great way to get lymph fluid moving from the part of the body where it has collected.

“We have therapists who will use some of the equipment to get people moving and exercising. We teach the patients how to do the self-massage and how to do the bandages. As we get that limb better under control, we can recommend compression garments that they can wear,” Treva says.

Haney says some patients her clinic works with are former cancer patients.

“Our lymph system just builds up and you can get a big arm. We see that a lot with ladies who get breast cancer treatments,” Haney says. “They have axillary nodes or armpit nodes removed as part of their treatment and then their arm will swell. We occasionally see it in the legs from other pelvic cancers.”

“Stay active, stay mobile!” Is the advice Haney has for those looking to prevent lymphedema.

“If you can maintain a healthy and active lifestyle, that can decrease your risk for lymphedema,” Haney says.

People should see an occupational therapist or physical therapist if they’ve been diagnosed with lymphedema or have swelling due to a post-surgery or post-traumatic injury. You’ll need a referral from your physician to set up an initial evaluation.

Video Interview Clips