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I’ve been working as the Clinical Lead of Physiotherapy Outpatients at The Royal Marsden in Chelsea for just over a year. I have more than 15 years’ experience as a musculoskeletal specialist, so I’m really happy to be able to bring my expertise to cancer patients. The physiotherapy teams across Chelsea and Sutton work together – each physiotherapist has a different area of expertise and we value each other’s knowledge. The team also supports junior physiotherapists and students through their journey of development.

I arrive at work at 8.30am and go through my emails, process referrals, book appointments and write reports before my clinic starts at 9am. I book an hour for new referrals, and follow-up appointments tend to be 30 minutes long.

A holistic approach

On busy days, I could see as many as 12 patients, but I normally see about eight on average. Trying to prioritise our patients is crucial, as early intervention often means better outcomes. I would never compromise on quality, regardless of the volume of referrals. I believe in a holistic approach to therapy based on the latest evidence, and my aim is to improve patients’ quality of life – both physically and psychologically.

One of the most common problems I treat is when a breast cancer patient’s radiotherapy has been delayed because they can’t lift their arm into the required position. This is a result of axillary web syndrome – also known as cording – which sometimes develops as a side effect of sentinel lymph node biopsy or lymph node removal in surgery.

By manually stretching out soft tissue and gently ‘breaking down’ the cording, I can increase the patient’s range of movement, allowing them to continue treatment. I’ve known patients to cry with relief after a session has helped them regain movement.

I’ve known patients to cry with relief after I’ve helped them regain movement

Thyone A Pana, Clinical Lead of Physiotherapy Outpatients

Aiding recovery

My aim is to reduce the severity of musculoskeletal problems by facilitating movement and managing pain. It is important that I listen to my patients and tailor my treatments for a more personalised outcome. This includes getting to know them and their families, listening to what they  want to achieve and helping them reach their goals. I use techniques such as myofascial release – which is a hands-on technique working on connective tissue – scar tissue release, joint and spinal mobilisation, postural correction, and exercises to help increase range of motion and muscle strength. To complement treatment, I can also provide acupuncture for pain and symptom management.

Working with colleagues across the Trust is essential. I work closely with occupational therapists, thelymphoedema team, speech and language therapists, the pain management team, consultants, and our Exercise Specialist Adrian Fautly. Having Adrian on our team means we can provide our patients with both pre- and post-operative rehabilitation.

My clinic usually finishes around 5pm, after which I complete that day’s notes and start prepping for the next day. I love working at The Royal Marsden – helping my patients and their families is incredibly rewarding.