Jen Carter is a speech pathologist who has been treating adults with dysphagia for more than 20 years, including work at the University of Colorado Hospital and at the nationally renowned Craig Hospital in Denver.
A game changer for head and neck cancer patients
The more I use myofascial release and manual therapy (MFR) at my clinic, the more I am convinced that it may be the “secret sauce” that helps my patients who have dysphagia after head and neck (H&N) cancer get better. You can check out my previous blog about myofascial release for a little more information about what MFR is. Today’s post is an update on what I’ve learned after many years of providing this treatment.
What I have found to be true:
Stiffness makes structures not move, and not moving creates weakness
The fibrotic tissue (scar tissue) that can form after radiation treatment results in decreased movement of the swallowing structures. When we swallow, there is A LOT of movement that happens to protect our airway and propel the food/liquid through our pharynx (throat). The scar tissue reduces that movement which is sort of like putting the swallowing muscles in a cast. Muscles in a cast can’t move to do their job and not moving then creates weakness due to disuse atrophy (if you’ve seen an arm or leg when a cast is removed, you know what I mean). The primary principle I use in planning all my swallowing therapy is to go to the source of the problem and fix that to improve functioning. MFR allows me to go after the source of the swallowing difficulty (stiffness and tightness) for patients after head and neck cancer.
Loosen it up, then make it stronger
If we go back to thinking about stiffness like a cast, trying to exercise a muscle that is stiff or restricted in movement is like trying to exercise a body part that is in a cast. If it can’t move, it just can’t be done. I’ve found that if I loosen up the swallowing mechanism first that the exercises and therapy that follow are much more effective. And when the swallow system can move better AND gets stronger from exercise, it is better able to do its job of protecting the windpipe and squeezing food and liquids through the pharynx.
Swallowing exercises for patients with dysphagia after H&N cancer may not be effective alone:
A recent study was published in the journal Head & Neck that evaluated the efficacy of electrical stimulation during swallowing therapy with this population. Not only was the electrical stimulation found to not be effective, but the authors found that basic swallowing therapy didn’t improve swallowing much either. They state “For patients with head and neck cancer with moderate to severe dysphagia caused by radiation therapy, current behavioral therapies are of limited help in reversing long-term dysphagia” (Langmore 2015). That conclusion is a real bummer for us clinicians because we’re in the business of trying to help people, and to hear that standard treatment doesn’t work is discouraging. But since I started using myofascial release with my patients, I have found swallowing therapy with this population IS effective. So, I’m wondering, if the patients in that study had myofascial release as part of their therapy would the outcomes have been different? Hmmmm. Sounds like a good future research project.
Many patients get better…but not everybody
I find the single biggest predictor of success with this therapy is a patient’s motivation and willingness to complete a home program every day. For this treatment to be effective and stay effective, MFR must be completed on the throat for a few minutes every day. As part of my treatment program, I spend an entire session instructing my patients on how to do self-MFR and what they should be feeling for when they do it. I’ve also trained family member how to do it if self-MFR is not an option. In return, my patients have come back and shown me many creative ways to assist with effective self-massage. One patient with arthritis used the bottom of a pill bottle instead of a knuckle to do the massage, and another patient constructed a massage tool out of small PVC pipe. And yet another patient used the flat end of a hairbrush to take the place of fingers doing the work. Whatever it takes to get the job done!
To me, adding myofascial release to my therapy with patients who have stiffness in their swallowing system after head and neck cancer treatment just makes sense. And I have seen the positive outcomes that have followed that line of thinking. While no medical treatment works for every patient, I have found MFR to be a real game changer in my swallowing therapy with these patients.