Patients who have had treatment for head and neck cancer are one of the most challenging populations that we dysphagia clinicians work with in therapy. One of the obstacles to helping this population is getting beyond the significant fibrotic tissue that can develop after the radiation treatment. But there is new hope for treating this condition. Before I dive into the good news (and there is good news, so keep reading), here’s some background about the challenge.
All the muscles in our body are covered with a substance called fascia. This fascia provides protection, allows effective circulation and lymphatic flow, and helps support cellular metabolic activity. That’s good stuff. However, when the fascia becomes stiff and dense in response to some sort of trauma, it can restrict movement and cause weakness. And that’s downright bad.
So following radiation treatment for head and neck cancer, the fascia in the throat can develop significant stiffness and fibrotic tissue (a form of scar tissue) which can make successful swallowing nearly impossible. And here’s the thing about this fibrotic tissue. It starts to develop slowly after the radiation treatment and may not impact the movement needed in the throat for swallowing right away. So years after the treatment for head and neck cancer is “finished”, the fascia restrictions may continue to build up until one day the movement in the neck is so limited that the patient can no longer swallow effectively. I’ve seen patients that developed swallowing difficulty as much as 10 years after the radiation treatment. That’s a long slow progression!
In the past when these patients would come to swallowing therapy, we dysphagia clinicians would try to do exercise to strengthen the muscles, but all the fibrotic tissue on the throat made it a lot like trying to exercise an arm in a cast. If the muscles can’t move, you can’t exercise them.
But, like I said earlier, there is now some hopeful good news about treating this condition. Myofascial release, a treatment that has been used for years by physical therapists and massage therapists, is a soft tissue therapy technique to correct restrictions in muscle and connective tissue. Over the past few years, the speech pathology profession is slowly starting to use this technique in our therapy as well. Personally, when I have used myofascial release with patients in swallowing therapy, I’ve seen great results in breaking up the fibrotic tissue to allow better range of motion of the muscles for swallowing.
In addition to using myofascial release for swallowing therapy, there is a new form of VitalStim that is now available to treat patients after head and neck cancer treatment. This FDA cleared e-stim called High Volt (what a name, huh?) has more “push” behind the current so that it can better reach the muscles under all the fibrotic tissue. When I’ve used High Volt with patients, they are often surprised at how much better they can feel a muscle contraction than when they’ve had VitalStim. And a better muscle contraction can mean better exercise, and better exercise can mean better outcomes.
More and more attention is being given to these new treatments for head and neck cancer. I just heard today that a physician in CA has finished collecting data on using myofascial release to treat swallowing difficulty, so hopefully that will be submitted for publication soon. Given the limited results of traditional therapy with this population and the increasing number of success stories about using myofascial release and High Volt, I think the dysphagia field is ripe for research studies measuring the effects of these treatments. In the meantime, I am excited about being able to give my head and neck cancer patients new options and new hope for treating their dysphagia.