Impact of pre-radiation manual therapy on neck and shoulder dysfunction and quality of life in head and neck cancer survivors: A randomized control trial.

Surgical procedures in head and neck cancer, while necessary for tumour removal and reconstruction, can cause musculoskeletal impairments, including pain, restricted range of motion (ROM), and functional disability due to muscle dissection and altered biomechanics. A regimen of exercises and patient education is an effective tool to reduce shoulder disability and improve shoulder function. The study suggests that manual therapy techniques can alleviate neck pain and improve quality of life, and recommends their use in clinical settings, but caution should be exercised when selecting these techniques for head and neck cancer survivors. MWM is associated with improved pain, mobility, and function in patients with a range of shoulder musculoskeletal disorders, and the effects are clinically meaningful. Radiation to the neck can cause a woody texture and limited mobility of the neck, enhance lymphedema, significant tightness of the neck and shoulder muscles, including the scalenes, trapezius, and sternocleidomastoid muscles. Fibrosis may cause both cosmetic and functional impairment, leading to deterioration in the quality of life. Research suggests Pain reduction, Improvement in Cervical, TMJ, and shoulder range of motion, Improved Quality of life, and reduction in disability following a combined manual therapy approach in head and neck cancer patients post radiation. Although manual therapy is often used after surgery and radiation, its benefits when applied before radiation therapy have not been well studied, particularly for HNC patients with reconstructive flap surgeries. Applying manual therapy before radiation could be an effective way to manage dysfunction early in the recovery process, potentially preventing long-term problems caused by radiation. Given the lack of research on this approach, a randomized controlled trial (RCT) is needed to determine the effectiveness of pre-radiation manual therapy in reducing neck and shoulder dysfunction in HNC patients. Such a study could provide valuable evidence to develop evidence-based rehabilitation protocols that improve patient outcomes and reduce the need for intensive post-radiation interventions.