Breast Cancer Rehabilitation

Why the shoulder needs attention first

Whether you've had a lumpectomy or a mastectomy, surgery near the armpit and chest wall affects the tissues the shoulder relies on to move. If lymph nodes were removed from the armpit, the area is often tight and sore. Reconstruction adds its own restrictions. Radiotherapy can tighten tissue further, sometimes months after treatment ends.

The result is often an arm that won't go fully overhead, pain reaching behind the back, and a shoulder that starts to round forward to protect the chest. Left alone, some of this becomes permanent stiffness. Treated early, most of it recovers.

Before and just after surgery

If there's time before surgery, one session to measure your shoulder movement and strength gives a baseline to aim for. After surgery, gentle movement usually starts within a day or two. Many surgeons limit how high you lift the arm, often to about shoulder height, until the drains are out, so we follow your surgeon's protocol exactly. Breathing exercises, hand pumping and gentle elbow and shoulder movement come first, progressing to full reach over the following weeks.

Cording, scars and tightness

A few weeks after surgery, some women notice tight, rope-like cords running from the armpit down the inner arm, sometimes as far as the wrist. This is axillary web syndrome. It's uncomfortable and limits reaching, but it responds well to gentle stretching and hands-on treatment.

Once scars have fully healed, scar massage helps them move freely over the tissues underneath. During and after radiotherapy, keeping the shoulder moving every day is the best protection against tissue tightening.

Lymphedema: reducing risk and managing it early

Removing or irradiating lymph nodes raises the risk of lymphedema, swelling in the arm, hand, breast or chest wall caused by fluid that can't drain properly. It can appear months or even years after treatment. The early signs are subtle: a feeling of heaviness or tightness, rings or sleeves feeling tighter, or swelling that goes down overnight.

We take baseline arm measurements so small changes can be picked up early, when they're easiest to control. If swelling develops, treatment combines manual lymphatic drainage, compression, exercise and skin care. For years women were told to avoid using the affected arm. That advice has changed: exercise, including strength training started gently and progressed gradually, is now encouraged.

Strength, fatigue and getting back to life

Cancer-related fatigue is one of the most common and most frustrating after-effects of treatment. Rest alone doesn't fix it. Graded exercise is one of the best-supported ways of improving it. During chemotherapy we adjust sessions around how you feel and your blood counts. After treatment, the aim is full strength for work, household tasks and whatever you enjoy doing.

Some hormone treatments, particularly aromatase inhibitors, can cause joint pain and bone loss. Strength and weight-bearing exercise help with both, and the principles overlap with our menopause physiotherapy program.

How we work

Assessment

Shoulder and neck movement, strength, scar and chest wall tissue, arm measurements for a lymphedema baseline, and your treatment plan and dates.

Treatment

Graded shoulder exercise, hands-on treatment for cording and tight tissue, scar work, and manual lymphatic drainage where swelling is present.

Strength and fitness

Progressive resistance and aerobic exercise, adapted around chemotherapy, radiotherapy and fatigue.

Coordination

We work within the instructions from your surgeon and oncology team, and keep them informed where needed.

Contact your doctor promptly if

• The arm or chest becomes red, hot, swollen and painful, which can be infection
• You develop a fever
• Swelling appears suddenly or worsens quickly
• You have new bone pain that doesn't settle
• You notice calf pain or swelling, or sudden breathlessness

Frequently asked questions