Introduction

A woman who has breast cancer may undergo a variety of treatments. You may have had a:

• breast biopsy
• lymph node biopsy or removal
• breast conservation surgery (lumpectomy)
• mastectomy
• breast reconstruction

Any of these procedures can affect your ability to move your shoulder and arm, to take a deep breath, or to perform daily activities (such as dressing, bathing, and combing your hair).

Regardless of the type of surgery you had, it is important to do exercises so that any side effects of your surgery can be lessened and you can manage your daily activities again. If you have radiation therapy, exercises are important to help your arm stay flexible, since this type of therapy may continue to affect your arm and shoulder for 6 to 9 months after it is completed.

It is very important to talk with your doctor before starting any exercises so that you can decide on a program that is right for you. Your doctor may suggest that you talk with a physical therapist or occupational therapist who can help design an exercise program just for you, particularly if you do not have full arm motion within three to four weeks of surgery.

Some exercises should not be done until drains and sutures (stitches) are removed. However, some exercises can be done soon after surgery. The exercises that increase shoulder and arm motion can usually be started in a few days and the strengthening exercises are later added to the program as part of the healing process.

The Week After Surgery

These exercises should be done for the first 3 to 7 days after surgery, but only with your doctor’s permission.

• Use your affected arm (on the side where your surgery was) as you normally would when combing your hair, bathing, dressing, and eating.

• Raise your affected arm above the level of your heart for 45 minutes, two or three times a day, while lying down. Put your arm on pillows so that your hand is higher than your wrist and your elbow is a little higher than your shoulder. This will help decrease the swelling that may happen after surgery.

• Exercise your affected arm while it is elevated above the level of your heart by opening and closing your hand 15 to 25 times, then bend and straighten your elbow. Repeat this 3 to 4 times a day. This exercise helps reduce swelling by pumping lymph fluid out of your arm.

• Practice deep breathing exercises (using your diaphragm) at least 6 times each day. While lying on your back, take a slow, deep breath. Breathe in as much air as you can while trying to expand your chest and abdomen (push your belly button away from your spine). Relax and breathe out. Repeat this 4 or 5 times. This exercise will help maintain normal movement of your chest, making it easier for your lungs to expand. Continue to do deep breathing exercises indefinitely.

• Avoid sleeping on your affected arm or on that side.

Getting Started -- General Guidelines

The exercises described here can be done as soon as your doctor gives you permission. Be sure to talk to your doctor before trying any of them.

• You will feel some tightness in your chest and armpit after surgery. This is normal and the tightness will decrease as you continue your exercise program.

• Many women have a burning, tingling, numbness, or soreness on the back of the arm and/or chest wall. This is because the surgery irritated some of your nerve endings. Although the sensations may increase a few weeks after surgery, continue to do the exercises unless you notice unusual swelling or tenderness. (Notify your doctor if this occurs.) Sometimes rubbing or stroking the area with your hand or a soft cloth can help "desensitize" the area.

• It may be helpful to do exercises after a warm shower when muscles are warm and relaxed.

• Wear comfortable, loose clothing when doing the exercises.

• Do the exercises until you feel a slow stretch. Hold each stretch at the end of the motion for a count of five. It is normal to feel some pulling as you stretch the skin and muscles that have been shortened because of the surgery. Do not do bouncing or jerky-type movements when doing any of the exercises. You should not feel pain as you do the exercises, only gentle stretching.

• Do 5 to 7 repetitions of each exercise. Try to do each exercise correctly. If you have difficulty with the exercises, contact your doctor. You may need to be referred to a physical or occupational therapist.

• Exercises should be done twice a day until you regain normal flexibility and strength.

• Be sure to take deep breaths, in and out, as you perform each exercise.

• The exercises are designed so that you begin them lying down, move to sitting, and then finish standing.

These exercises should be performed on a bed or the floor while lying on your back with your knees and hips bent, feet flat.

	Figure 1

This exercise helps increase the forward motion of the shoulders. You will need a broom handle, yardstick, or other similar object to perform this exercise.

• Hold the wand in both hands with palms facing up.
• Lift the wand up over your head (as far as you can) using your unaffected arm to help lift the wand, until you feel a stretch in your affected arm.
• Hold for five seconds.
• Lower arms and repeat 5 to 7 times.

	Figure 2

This exercise helps increase the mobility of the front of your chest and shoulder. It may take several weeks of regular exercise before your elbows will get close to the bed (or floor).

• Clasp your hands behind your neck with your elbows pointing toward the ceiling.
• Move your elbows apart and down toward the bed (or floor).
• Repeat 5 to 7 times.

This exercise helps increase the mobility of the shoulder blades.

	Figure 3

• Sit in a chair very close to a table with your back against the chair back.
• Place the unaffected arm on the table with your elbow bent and palm down. Do not move this arm during the exercise.
• Place the affected arm on the table, palm down with your elbow straight.
• Without moving your trunk, slide the affected arm toward the opposite side of the table. You should feel your shoulder blade move as you do this.
• Relax your arm and repeat 5 to 7 times.

	Figure 4

This exercise also helps increase the mobility of the shoulder blade.

• Facing straight ahead, sit in a chair in front of a mirror without resting on the back of the chair.
• Arms should be at your sides with elbows bent.
• Squeeze shoulder blades together, bringing your elbows behind you. Keep your shoulders level as you do this exercise. Do not lift your shoulders up toward your ears.
• Return to the starting position and repeat 5 to 7 times.

This exercise helps increase the mobility of the trunk/body.

	Figure 5

• Clasp your hands together in front of you and lift your arms slowly over your head, straightening your arms.
• When your arms are over your head, bend your trunk to the right while bending at the waist and keeping your arms overhead.
• Return to the starting position and bend to the left.
• Repeat 5 to 7 times.

This exercise helps stretch the chest wall.

	Figure 6

• Stand facing a corner with toes approximately 8 to 10 inches from the corner.
• Bend your elbows and place forearms on the wall, one on each side of the corner. Your elbows should be as close to shoulder height as possible.
• Keep your arms and feet in position and move your chest toward the corner. You will feel a stretch across your chest and shoulders.
• Return to starting position and repeat 5 to 7 times.

This exercise helps increase the mobility in the shoulder.

• Stand facing the wall with your toes approximately 8 to 10 inches from the wall.
• Place your hands on the wall. Use your fingers to "climb the wall," reaching as high as you can until you feel a stretch.
• Return to starting position and repeat 5 to 7 times.

Figure 7

Things to Keep in Mind

Begin exercising slowly and progress as you are able. Stop exercising and notify your doctor if you:

• get weaker, start losing your balance, or start falling
• have pain that gets worse
• have new heaviness in your arm
• have unusual swelling, or swelling gets worse
• have headaches, dizziness, blurred vision, new numbness, or tingling in arms or chest

It is important to exercise to keep muscles working as well as possible, but it is also important to be safe. Talk with your doctor about realistic exercises for your condition, and then set goals for increasing your physical activity level.

This information was developed with assistance from the Oncology Section of the American Physical Therapy Association.

Revised: 08/06/2007