Human Gait Changes following mastectomy.
We first wrote about this a year ago after the news of Angelina Jolie’s double mastectomy decision.
Research has confirmed that following a mastectomy there are limitations in the efficiency of the upper limb and even changes in the posture of the torso. (1,2,3)
Following mastectomy, whether unilateral or bilateral, restorative measures are necessary, and not just for cosmetic effects either. From a biomechanical perspective, obviously depending on breast size, removing a considerable mass of tissue is going to change the symmetry of the torso particularly if we are dealing with a unilateral mastectomy. Not only is it going to change symmetry from a static postural perspective (bulk, weight, fascial plane changes, strength etc) but it will change dynamic postural control, mobility and stability as well as dynamic spinal kinematics. The literature has even shown that post-mastectomy clients display changes in spatiotemporal gait parameter such as step length and gait velocity.
Breast tissue moves. It oscillates a various cycles depending on speed of walking or running. There is a rhythmic cycle that eventually sets up during walking and running and the cycle is intimately and ultimately tied to arm swing. Thus, it would make sense that removing a sizable mass of tissue, particularly when done unilaterally, will change the tissue and joint rhythmicity. And if you have been here with The Gait Guys for more than a year you will know that impairing an arm swing will show altered biomechanics in the opposite lower limb (and furthermore, if you alter one lower limb, you begin a process of altering the biomechanical function and rhythmicity of the opposite leg as well.) Here are 2 links for more on these topics,Arm Swing: Part 1 and Arm Swing: Part 2, When Phase is Lost. Plus here from our blog search archives, everything we have talked about on Arm Swing.
Arm swing impairment is a real issue and it is one that is typically far overlooked and misrepresented. The intrinsic effects of altering the body through subtraction of tissue are not all that dissimilar to extrinsic changes into the system from things like walking with a handbag/briefcase, walking with a shoulder bag, walking and running with an ipod or water bottle in one hand. And do not forget other intrinsic problems that affect spinal symmetry, for example consider the changes on the system from scoliosis that can either consciously or unconsciously alter arm swing and thus global body kinematics. (Also, do not forget any changes in opposite leg function secondary to a frozen shoulder (adhesive capsulitis) and the like which can impair arm swing.
The bottom line is that because of the neurologically embedded reflexes and reflexive motions and motor patterns, which are things that permeate all human locomotion, anything that changes one of the limbs directly or indirectly can impair and change locomotion, motor pattern choices and programming.
Obviously the degree to which intervention is taken depends on the amount and location of breast tissue removed and intervention will be determined by physical placement of the prosthesis (whether it be external or internal) as well as the prosthesis weight, shape and possibly several other independent factors such as comparative support to the chest wall in comparison to the opposite breast. (There is a plethora of research out that addresses other methods of intervention such as latissimus dorsi relocation to reform the breast mass. This deserves a blog article all on its own because modifying a major shoulder, scapular and spinal stabilizer and prime mover has never made sense to us clinically or biomechanically.)
In Hojan’s study (below) they found significant differences in the gait parameters in the younger age groups with and without breast prosthesis however there appeared to be no significant differences in the women of the older study group. However, it appeared that their study did not take into account all of the intimate issues we talk about in gait here on The Gait Guys blog. None the less, in the younger and likely more active study group, the use of a breast prosthesis brought the gait parameters closer to the healthy control group, as we suspected.
Bottom line, every external and internal parameter that changes affects the human organism and thus affects their gait.
Again, here are those links to our other blog writings on arm swing that are paramount to understanding what we are discussing here today.
Arm Swing Part 1: The Basics http://thegaitguys.tumblr.com/post/13869907052/arm-swing-in-gait-and-running-part-1-there-is
Arm Swing Part 2: When Phase is Lost http://thegaitguys.tumblr.com/post/13920283712/arm-swing-part-2-when-phase-is-lost
From our blog search http://thegaitguys.tumblr.com/search/arm+swing
Shawn and Ivo, The Gait Guys
References:
1.Blomqvist L, Stark B, Engler N, et al. Evaluation of arm and shoulder mobility and strength after modified radical mastectomy and radiother- apy. Acta Oncol. 2004;43(3):280Y283.
2. Rostkowska E, Bak M, Samborski W. Body posture in women after mastectomy and its changes as a result of rehabilitation. Adv Med Sci. 2006;51:287Y297.
3. Crosbie J, Kilbreath SL, Dylke E, et al. Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement. Phys Ther. 2010;90(5):679Y692.
4. Hojan K, Manikowska F, Molinska-Glura M, Chen PJ, Jozwiak M. Cancer Nurs. 2013 Apr 29. [Epub ahead of print] The Impact of an External Breast Prosthesis on the Gait Parameters of Women After Mastectomy.
