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Winning case report describes novel approach to post-operative axillary web syndrome

Registered Massage Therapist Paul Lewis has teamed up with Dr. Joan Cunningham to create a case report describing the use of Dynamic Angular Petrissage (DAP) for lymphatic cording in the axillary web after breast cancer surgery. 

January 27, 2015  By Maria DiDanieli

The case report, which placed second in the prestigious annual
Practitioner Case Report Contest held by the Massage Therapy Foundation,
is titled Dynamic Angular Petrissage: A novel approach for axillary web
syndrome (cording/webbing) occurring after surgery for breast cancer.  

who have had breast cancer surgery find themselves dealing with a
number of post-operative issues, not the least of which is pain and
restricted motion in the axillary web. Noting that there is currently no
established treatment for axillary web syndrome (AWS), this case study
describes the use, by the authors, of DAP on a young woman with
post-surgical AWS to gently, quickly and effectively reduce upper
extremity pain, while improving range of motion.

DAP is a
treatment method developed by Lewis. It involves using one hand to
gently knead the soft tissue while using the other hand to passively
lengthen and shorten the muscle via changes in lever length and limb
angle according to the muscle’s line of pull.

In this case
study, the cording/webbing of AWS was restricting range of motion and
causing pain. To relieve these issues, the cording was considered and
treated as part of the arm’s structure rather than an offending tissue
to be torn or broken. The patient received two therapeutic massage
sessions, which included the DAP treatment method, as well as specific
post-treatment home care exercises.


After each 1.5-hour session,
the cording was visibly reduced, pain was significantly attenuated and
the patient’s range of motion was seen to improve. These results suggest
that DAP may be a simple, but effective, method for therapists to apply
in patients with AWS.

Through its annual Student and
Practitioner Case Report Contests, the Massage Therapy Foundation (a
philanthropic, non-profit 501(C)(3) organization based in Evanston,
Ill.) aims to encourage therapists to develop research skills while
thinking critically and enhancing their ability to provide knowledge –
and evidence-based massage therapy to the public. The case reports also
play an important part in massage therapy literature.  

Lewis is a
CPD provider in the UK, Canada and the U.S., who has contributed to a
number of massage therapy publications and has taught extensively across
North America and Europe.  

Cunningham, also a Canadian, is a
cancer epidemiologist familiar with many post-surgical issues faced by
breast cancer patients. She recently retired from the faculty of the
Medical University of South Carolina and is now continuing her work as a
member of the National Coalition of Independent Scholars from San
Antonio, Texas.

Although they are grateful to have achieved the
distinction of second place in the Massage Therapy Foundation
competition, the authors are excited at having tapped into a method that
shows promise for relieving pain and restoring motion in patients with
AWS occurring after breast cancer surgery.   

For more
information on Paul Lewis RMT, please visit For more
information on the Massage Therapy Foundation, please visit

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