Are you a multiple myeloma patient that experiences a number of symptoms like numbness, tingling, burning pain, weakness, or muscle spasms? You aren't alone. 

Thanks to physical medicine and rehabilitation, patients like you can restore physical function in order to get back to doing what you enjoy. While some modifications are needed, the same quality of life you had before is achievable. 

On April 6th, 2022, Dr. Sonal Oza gave a talk about rehabilitation exercises that can be helpful for myeloma patients who exhibit the aforementioned side effects to our HealthTree Moves for Myeloma Chapter. You can watch her presentation or read the highlights from the talk below. 

Rehab Exercises for Pain Related to Myeloma

Generalized weakness can occur in muscles and be due to either steroid use or long periods of reduced physical activity. 

The proximal muscle groups, the muscles closest to our spine, are often affected when it comes to weakness in the muscles. This causes us not to be able to function normally due to the fact that these muscles are so important in our overall mobility and day-to-day function. More information about these muscle groups, their functions, and exercises to help stimulate them can be found below: 

Shoulder Muscles

When these muscles are affected, patients tend to have difficulty with overhead movements.

Exercises:

• Shoulder external rotation:  Helps re-strengthening the rotator cuff muscles to improve the ability to perform overhead movements.
• Low row: Helps to stabilize your shoulders and arms for pulling, lifting, and carrying items.
• Lateral pull down: Helps make movements easier by strengthening upper back muscles and shoulder blades.

Core Muscles and Hip Muscles 

Since these are the muscles attached to our pelvis, they are really important for day-to-day function and for recreational outside activities.

Exercises:

• Bridge: Strengthens deep core and buttock muscles that you need to walk and perform daily activities.
• Bridge with hip abduction: To further the challenge,  you can add a resistance band. to improve core and girdle muscles' strength. 
• Sit to Stand: This exercise improves core and hip girdle muscle strength and endurance to prevent fatigue.

There are some adaptive devices available to facilitate movements like a cushion to facilitate sit-to-stand motions, buckling braces to help stabilize the knees, or walkers for patients who become easily fatigued.

Shoes with curved soles are more supportive and can help alleviate some of the pain and make you feel more balanced. You can add insoles in the shoes, in addition to what already comes with the sneaker, especially carbon fiber insoles, to provide support.

For patients with more severe symptoms like foot drops, an ankle-foot orthotic can be really supportive.

Recommendations

• Resistance exercises with dumbbells or resistance bands help to maintain the muscles.
• There are medications to help strengthen bone density
• Keep in mind that if you have spinal fractures or shoulder fractures you need to find modifications for the exercises
• Aerobic exercises or cardio are recommended because they can improve a number of symptoms in patients with cancer
• Exercising improves fatigue, mood swings, and sleep

Common Pains Related to Cancer

It's hard to return to exercise or even start an exercise program if you're limited by pain or weakness, so how can you get your pain well managed? 

Neuropathy

As we know, some treatments can cause peripheral neuropathy that targets the nerves that are the furthest away from our spine, causing numbness, tingling, burning pain, etc.

Topical medications like lidocaine can be helpful to help relieve some of the symptoms as well as complementary therapies like acupuncture which are known to help relieve nerve pain and reduce numbness.

Compressed Fractures

Multiple myeloma patients are at a higher risk of developing fractures of the spine. This can be a source of pain transitioning from one position to the other, so over time patients develop a curvature of the alignment of the spine that can cause more back pain.

To help ease this pain, target deeper core muscles and low back muscles, diaphragm, and pelvic floor as they form a barrel that supports our spine. Some exercises to strengthen the core muscles and support the spine are:

• Thoracic Extension
• Bicycle and Marches
• Scapula Retractors
• Stretching Hamstrings

You can use a semi-rigid spine brace to provide support at the shoulders, in the front of the abdomen, along the hip and pelvis area, and to promote an upright posture, this helps to relieve some of the pain from the back.

Exercises to Avoid

• High Impact Activities: Jumping, hopping, running, oscillating motions
• Weight-bearing exercises through the arm: Push-ups, planks, bench press/chest machines, triceps or. bench dips

Summary

Physical therapy is an excellent tool to help control the pain and improve muscle strength. This is important for your myeloma journey in order to have a better quality of life. Find this support within your medical team or your closest exercise program, remember it doesn't matter if you are just starting, you can find modifications to the exercises to meet your needs and keep getting better. 

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