Multiple myeloma treatment approach depends on the stage of the disease as well as the patient’s overall health. Advances in treatment and early detection have led to those impacted by multiple myeloma to live longer with improved quality of life.  In fact, the disease has had one of the largest increases in survival rates compared to other cancers since the early 1990s.[i]

It is estimated that 4000 individuals were diagnosed with this type of blood cancer in 2022 in Canada alone. In this article, we will look at how multiple myeloma affects the body, types of treatment and their physical side effects, as well as the role that physiotherapy plays in the management of this disease.

Table of Contents

What is Multiple Myeloma?

Multiple myeloma is a type of cancer that affects plasma cells, which are white blood cells that produce antibodies that help the body fight off infections. In multiple myeloma, the abnormal plasma cells produce an excess amount of abnormal antibodies, which can damage the kidneys and weaken the immune system.

Comparison of healthy bone marrow vs bone marrow with multiple myeloma. Physiotherapy for multiple myeloma treatment Propel Physiotherapy.

This type of cancer typically develops in the bone marrow, the spongy tissue inside the bones where blood cells are produced. As the abnormal plasma cells grow and multiply, they can crowd out normal blood cells, leading to anemia and a weakened immune system.

Diagnosis often involves blood and urine tests, as well as imaging tests such as X-rays and MRI scans. As with all types of cancer, early detection and treatment are crucial for improving outcomes and reducing the risk of complications.

Symptoms of Multiple Myeloma

In multiple myeloma cancerous plasma cells accumulate in the bone marrow causing bone diseases such as osteolytic lesions, osteoporosis/osteopenia and fractures.[ii] The resulting bone pain is often one of the first signs of the disease, as well as fatigue, weakness and recurrent infections.

Bone pain is often seen in the spine, ribs and hip joints. This breaking down of bone causes an increase in calcium in the blood (hypercalcemia) leading to symptoms such as muscle weakness, loss of appetite, unexplained weight loss, difficulty thinking, constipation and increased urine production.[iii]

Multiple Myeloma Treatment

Treatment will depend on the stage of the disease as well as the patient’s overall health.  In this section we highlight treatment options for multiple myeloma as well as some of the physical manifestations of these treatments that are important for physiotherapy management.

Treatment can include the following:

TreatmentDescriptionSide Effects
ChemotherapyDrugs given orally or intravenously to kill cancer cellsPeripheral neuropathy in hands and feet that can affect walking and balance, fatigue
ImmunotherapyHelps use your body’s own immune system to target cancer cellsFatigue, dizziness, muscle or joint pain and changes in blood pressure
CorticosteroidsHelp to reduce inflammationTrouble sleeping, high blood pressure and muscle weakness
Radiation TherapyUse of high energy radiation to kill cancer cells and shrink tumorsVary depending on the area but general symptoms include fatigue and skin issues
Stem Cell TransplanttAfter high dose chemotherapy to kill cancer cells, stem cells are then reintroduced to the body to hopefully stimulate healing and growth of healthy cellsIncreased risk of infection and bleeding, digestive issues

As vertebral compression fractures occur in 55 to 70 percent of patients, spinal surgery may be a necessary treatment while also preventing deformity and neural compression.[iv] These surgeries may involve metal plates or rods to stabilize the fracture, and/or vertebroplasty (bone cement injected into the fractured vertebral body) and kyphoplasty (a balloon inserted into the collapsed area to raise it up).

Physiotherapy Management of Multiple Myeloma

Physiotherapy can play an important role in the management of disease symptoms and enhancing quality of life.  Physiotherapy interventions will vary depending on the stage of treatment of the disease.  Treatment can include:

  • Referral/Recognition of Symptoms – As it is estimated that 70% of the initial manifestation of this disease is low back pain often described as a dull persistent ache that worsens with movement and at nighttime. It is crucial that physiotherapists perform thorough history taking and assessment of clients to rule out other pathologies and refer to primary care providers.[v]
  • Education – Education is key to helping clients understand the importance of movement, proper movement techniques, and the progression of therapy.
  • Aerobic Exercise – Improving and maintaining endurance is key to managing fatigue and other symptoms.
  • Postural Exercises – Strengthening and stretching of postural muscles helps to optimize stability, limit fatigue and help with pain, particularly in patients with vertebral bone involvement and those who have had surgery
  • Strengthening – Progressing strengthening exercises during various treatment stages help to maintain strength and prevent deconditioning
  • Pain Management – Acupuncture and other modalities to help with pain management

Special Considerations in Oncology Rehab

With oncology rehab it is important not only to provide a comprehensive treatment approach but for providers to also be aware of restrictions and contraindications.  This includes being aware of hemoglobin levels, platelet counts, cardiac considerations, and bony lesion restrictions to provide appropriate and therapeutic treatment.

Research indicates that exercise is beneficial before, during and after treatment in patients with multiple myeloma.[vi]  Our experienced and knowledgeable therapists can help design a tailored therapeutic program that is right for you.

Let us help and guide you at each stage of your journey and get back to living fully.

Written by

Kathy Mileski
Kathy MileskiRegistered Physiotherapist and Mindfulness Trainer
Kathy Mileski loves the idea of helping others be as mobile and active as they possibly can. She believes that every person has the potential to do amazing things. That belief bolstered by her training and experience has helped her clients to achieve success in their rehab goals no matter where they are in terms of their recovery.



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