After breast cancer surgery you might develop a stiff shoulder or arm. Your nurse or a physiotherapist will ask you to do regular exercises after surgery to help you recover. They should give you a leaflet which explains the exercises.
Simple arm exercises can help to:
- keep your movement full in your arm and shoulder
- relieve pain and stiffness
- reduce swelling
Exercise after a breast reconstruction
If you have had breast reconstruction, the exercises you need to do are different and depend on the type of reconstruction you have had.
When to start
You start the exercises the day after surgery if possible. You should aim to do the exercises 2 or 3 times a day. The goal is to get your arm and shoulder moving as well as it did before the surgery.
What exercises to do
Begin each session by circling your shoulders to get the muscles moving.
Other early exercises are:
- brushing or combing your hair
- slowly reaching up behind your back to touch just under the shoulder blades
Once your drains and stitches are out, and as you get stronger and more confident you can do more of the exercises and increase the range of movements.
These exercises shouldn’t be painful, but you may feel a stretching sensation in your armpit or along your arm. It can help to take painkillers before you start. It will become easier and more comfortable the more you do the exercises.
Below is a short video showing you how to do exercises after breast cancer surgery.
Physiotherapist: These exercises should help you regain your arm and shoulder movement following breast cancer surgery. They may not be suitable if you have had a reconstruction. If you are unable to do these exercises please contact your health carers.
Knock at the door
Woman: Come in.
Physiotherapist: Hello there.
Physiotherapist: Hello, hi, my name is Nicola. I am one of the physiotherapists. Do you mind if I come round and go through your exercises with you?
Woman: Oh no, of course not.
Physiotherapist: Thank you very much.
Woman: I have been expecting you.
Physiotherapist: Have you, oh okay. Well what we would like to do now is just try and get this arm moving, okay. I am going to go through some exercises for your arm and for your shoulder, okay. Unfortunately it can be a little bit uncomfortable in the armpit and across the chest when you have this type of surgery. So some people are quite reluctant to get that arm moving but obviously it is really important that we get you to have full range of movement as soon as possible and also get you back to all the activities that you were doing before.
Physiotherapist: Okay, and back to your housework as well.
Woman: Oh well, I am not so keen.
Physiotherapist: Not so keen, okay. Um, it is also really important that we get your arm moving well so you can have your radiotherapy. Sometimes for having radiotherapy you need to have your arm up over your head. So that’s quite a stretch that you may need to build on.
Physiotherapist: Okay, and it is also really important that you do these exercises for the next couple of months especially after your radiotherapy, because problems can sometimes occur a little bit further down the line.
Physiotherapist: Okay, what we going to do now is we’re going to go through the exercises. So if I just take this pillow away, okay. It’s really important that you try and use this arm as normally as you possibly can over the next couple of weeks. These exercises are perfectly safe to do in the first couple of weeks after your surgery. And obviously at the moment you’ve got your drain in, be aware of it but you can still do these basic exercises. What we don’t want you to do is lift your arm above shoulder level if you can help it.
Physiotherapist: Okay, when I say shoulder level, it is where your elbow is in relation to your shoulder. So you can think about having your arm up, only until your arm is level with your shoulder. Okay, and you can do that out to the side. So you should still be able to do your hair, or put a hat on or anything like that. Okay, but we don’t want you taking your arm up higher than that at the moment. Okay, can you do that in both directions, for me?
Physiotherapist: That’s it. Good.
Physiotherapist: Yep, and then come back down. And then come out to the side. This can be the one that pulls a little bit in the armpit, don’t be afraid of it. That’s it, good, well done, and then come back down again. Okay, that just shows you what you can do with that arm. And now the exercises. The first exercise – the shoulder shrugs. So just relax the shoulders first ,to begin with.
Physiotherapist: These exercises can be done either in the bed, or sat in the chair or standing it doesn’t matter. I want you to bring your shoulders up towards your ears, and then relax them down, okay. Come up again, and then relax down. Good once more, and relax. Okay, you going to that 10 times and maybe try and do it 3 to 5 times during the day, okay.
Physiotherapist: Okay, the next exercise is very similar, it’s shoulder circles. So now with the shoulders relaxed, take your shoulders up and then roll them back and down, good and again. That’s it, once more. Good and now can you change direction so you are coming forwards first so you are rolling them up and forwards. Once more and then relax. Okay, if you can do that 10 times in each direction and again try and do it 3 to 5 times a day, okay.
Voiceover: Try to repeat these shoulder shrugs and circles throughout the day. Think about doing them whilst you are doing other things such as watching the television or when you are waiting for the kettle to boil.
Phsyiotherapist: At the start of the second week following your surgery you should try and push that arm a little bit further. You should try to continue with the shoulder shrugs and the shoulder circles that you were doing in the first week but now also try this next set of exercises to lift your arm above your shoulder.
Voiceover: Lean with your back up against a wall. Gently lift your arms up over your head. You should be aware of a gentle stretching sensation in your armpit and across your chest wall. Now bring your arm back down to your side. And repeat this 10 times.
Stay in the same position, but now take your arm up and out to the side. It is normal to feel a stretching sensation. Again repeat this 10 times and do both sets of exercises 3 to 5 times a day.
Now lie on your back on a firm surface. You may have a folded towel or cushion underneath your head. Place both hand behind your head so that your elbows are pointing up towards the ceiling. Slowly let your elbows fall gently out to the side. Repeat this movement 10 times and on the last movement hold for a slow, deep breath in and out. Try to repeat this exercise 3 to 5 times a day. You can carry doing these exercises during your course of radiotherapy.
Talk to your surgeon or breast care nurse if you have ongoing problems with arm or shoulder pain, stiffness or swelling.
Sometimes fluid collects near the wound, this is called a seroma. Sometimes the fluid needs to be drained and it may affect the movement in your arm. Speak with your doctor if this happens to you.
You must also contact your nurse or doctor if your wound looks red or inflamed or is painful. In any of these situations, they may need to see you in the clinic. They may also suggest that you stop the exercises for a short time.
If you haven’t seen a physiotherapist already and you are struggling with pain or lack of movement speak to your doctor or breast nurse. They can arrange for you to see one. The physiotherapist can give you more exercises to do and offer advice on physical activity.
Scar tissue in the armpit (cording)
Some women develop scar tissue in the armpit after lymph node removal. The connective tissues in the armpit get inflamed, which forms one or more tight bands. This usually happens within the first few weeks or months after the operation.
The scar tissue is called cording or banding or axillary web syndrome. It can feel something like a guitar string. It can extend down the arm past the elbow, possibly as far as the wrist or thumb.
Cording is harmless but can be painful and can limit your arm movement. Massaging the area regularly can help. Tell your breast care nurse if you develop cording. They can refer you to a physiotherapist. They can show you how to massage the area and teach you stretching exercises. It usually gets better within a few months. Taking anti inflammatory painkillers may also help. Speak to your nurse or doctor about taking these.
It is important to massage the scar area to keep the skin as supple as possible. This can be done with a gentle moisturiser. If you are having radiotherapy, check with your specialist which moisturiser is suitable.
How long should I exercise for?
You should continue your arm exercises until you get back to the range of arm movements before you had surgery, and without any discomfort. This can take a few weeks or months.
You should carry on with these exercises during radiotherapy treatment. This helps to stop your arm and shoulder from becoming stiff during your treatment.
Speak to your nurse or physiotherapist if you have any concerns about the exercises.
Davina had a lumpectomy and lymph nodes removed. This is her story about her treatment, challenges and how she coped.
“I’m getting stronger every day by doing the exercises I was shown at the hospital.”