Dynamic Angular Petrissage (DAP); A Novel Therapeutic Approach for Axillary Web Syndrome
Posted:Monday, August 4, 2014
Silver Award Winner
Paul Lewis, NCBTMB, RMT, CDT
Background and objectives: Axillary web syndrome (AWS), also called lymphatic cording, typically presents in the weeks after axillary surgery for breast cancer. This painful condition is likely angiolymphatic in origin. It restricts use of the upper extremity, and has no established treatment although physical therapy and other approaches have been used to variable effect. We applied therapeutic massage techniques using Dynamic Angular Petrissage (DAP) with the aim of quickly but gently reducing upper extremity pain and improving range of motion in the case of a young woman with AWS.
Methods: Patient assessment included self-report of pain (5 on a scale of 0-10), extent of flexion of the glenohumeral (GH) joint (140 degrees by goniometer), and visual and physical determination of extent of cording (taut, from axilla to wrist). She received two therapeutic massage sessions including the DAP approach: passive manipulations of the involved joint through all possible angles of movement, lengthening and shortening the target muscle(s) while simultaneously adapting petrissage techniques to the condition of the underlying soft tissue. The cord was considered part of the arm structure restricting motion, rather than a tissue to be torn or broken. Specified home care exercises were also used by the patient.
Results: After a 1.5 hour session using DAP, pain was reduced to 0/10 and flexion was improved to 170 degrees. The cord was visibly reduced. Following a second 0.5 hour DAP treatment the cord was only residually apparent, with no restrictions 4 even during hyperextension. Long-term outcome was complete resolution with no recurrence.
Conclusion: The techniques of DAP are simple for the trained therapist to apply. We propose that DAP may be an efficient, comfortable and effective approach to treating axillary web syndrome.