START TODAY! | 7 DAY FREE TRIAL
By Megan Hoover, DPT, Balance in Life Physical Therapy
If you are ready to resume exercise after breast cancer, we are glad to support you. Exercise, done smartly, will help you recover quicker from surgery and feel better doing your daily activities, and can even help prevent cancer from recurring.
Please remember to give yourself plenty of grace. You are not going to start where you were before treatment or surgery. Know that you are loved and seen! We are here for you ladies!
The first step is to MAKE SURE YOU ARE CLEARED BY YOUR SURGEON. As you progress in your exercise and wish to take on more, please check in with your doctor or physical therapist at each stage. The information below is a general guideline, but your medical team knows your situation best. Nothing here is to be taken as medical advice.
Our Breast Cancer series is for women like you, bravely fighting breast cancer and overcoming the physical, mental, and emotional challenges that come along with it. Lindsay Brin, CPT, BSE, teamed up with Megan Hoover, DPT, to create more than 25 videos for calming, healing, and restoring your body. Check out Breast Cancer Movement in the Studio. >>
Once you have the OK, start slowly. Watch for increased swelling or pain — clear signs you are doing too much. In general, for the first 6 weeks, you should focus on range of motion, especially in your shoulders. You will need this for daily life activities. You will likely have to continue to work on this mobility for quite some time.
At 4 to 6 six weeks out, if cleared by your surgeon, you can add 1 to 2 pound weights into your exercise routine. Soup cans or water bottles work great if you do not have light weights.
Lumpectomy or partial mastectomy (with or without sentinel node removal) — No activity that jostles the breasts for 2 weeks. Range of motion as tolerated beginning 1 – 2 days post-surgery.
Axillary node dissection — Elevate your arm to decrease swelling for at least 2 weeks. Avoid repetitive lifting for at least 2 weeks. Avoid heavy lifting (>2 – 5 pounds) for at least 4 weeks.
Mastectomy without reconstruction — Range of motion as tolerated even with drains in. Low impact exercise as tolerated. Avoid heavy lifting for 4 – 6 weeks.
Mastectomy with reconstruction — Do not lift shoulders higher than shoulder level or 90 degrees until cleared by your surgeon. Low impact exercise only for at least 4 – 6 weeks. Avoid heavy lifting for at least 4 – 6 weeks. Recommendations vary greatly depending on surgeon and type of reconstruction.
AGAIN, PLEASE GET CLEARED BEFORE STARTING TO EXERCISE!
Somewhere between 30 – 70 percent of women experience lymphedema after breast cancer treatment. Lymphedema is the accumulation of fluid that is typically drained through the body’s lymphatic system. The lymphatic system is like our circulatory system for our immune system, and this fluid needs to move freely.
Our lymph system is greatly affected by surgery for breast cancer. Typically, it affects the same side as surgery or radiation treatment. In this case, the lymph nodes are not able to do their job due to being removed, damaged by radiation, tumor pressing against the node, or cancer cells in the lymph nodes themselves. This can happen immediately or years down the road, and the condition can be temporary or long term. The length of time can be improved depending on how soon you get treatment for the lymphedema.
Our Breast Cancer Movement program includes exercises to help relieve lymphedema. The contraction of your muscles becomes the pump that moves lymph throughout your body. Try it in the Studio.
Axillary web syndrome (AWS), also known as cording, is when a rope-like texture develops under the skin, typically in the armpits and down the arms. The exact cause of the condition is unknown, but there is increased risk with radiation or lymph node dissection. AWS affects mechanics and range of motion of the shoulder. It can sometimes resolve on its own. Don’t be discouraged. A physical therapist can help address the cording, mobility of shoulder and chest, and decrease pain.
You will probably be learning most of these at the hospital and will begin doing them 1 – 2 days after surgery. Be sure you get cleared by your surgeon before performing. Follow along with the video in the Studio.
Work on your upright posture with sternum lifted to ceiling, ears over your shoulders, and knees slightly bent (while standing).
Lean over with an arm supporting yourself on a counter (or not if bilateral mastectomy). Stagger your legs so you can gently shift your weight between your legs and let surgical arm(s) sway side to side and forward/backward. This movement comes from your legs moving, not your arms and should be gentle. Build up to 1 minute for each arm involved.
Start by lying on your back or sitting. Place one hand on your stomach and the other on your chest. Take a deep breath in through your belly. Your hand on your stomach should move but not the one on the chest. Take a deep breath in and push the breath out. Repeat for 1 minute at a nice slow pace (do not hyperventilate).
With your surgical arm on a pillow, lay on the unaffected side. Or prop on pillows if you had a double mastectomy (perform one side at a time). Squeeze your hand into a fist holding a small ball or washcloth for 2 – 3 seconds and then release. Repeat contract/release for 1 minute.
Skip this if you had a double mastectomy until cleared to go above 90 degrees. Do not go above shoulder height or 90 degrees if you had reconstruction and still have drains in. Lying on your back, hold onto a dowel or yard stick (or just hold onto your hand if you don’t have these). Use your non-surgical arm to help raise surgical arm overhead only in pain-free range with your elbow straight. Slowly lower using your NON-surgical arm. You can let your knees go side to side to gently stretch out the sides of your body focusing on lengthening in addition to range of motion. Repeat for 1 minute at a slow gentle pace.
Do not go above shoulder height or 90 degrees if you had reconstruction and still have drains in. Lying on your back, hold onto a broom handle or yard stick with palms UP. Have hands close together initially and raise overhead. Let legs go side to side. Gently stretch for a few seconds and lower. Work your hands gradually apart trying to open your chest. Repeat, building up to 1 – 2 minutes.
Do not go above shoulder height or 90 degrees if you had reconstruction and still have drains in. Lying on your back, place the stick in the palm of your hand, stretching the arm straight. Use the opposite arm to push your hand out alongside, as if you were trying to do half a snow angel. Hold for a few seconds, let legs fall opposite of the arm you are stretching and slowly lower. Repeat for 1 minute.
Hold off on this if you had a reconstruction until cleared by your surgeon. Lying on your back, put both hands behind your head and try to bring your elbows down towards the floor. This is a gentle stretch — you should not feel pain. Hold for a few seconds and release. Repeat for 1 minute.
Sitting or standing, slowly bring your shoulders down and back towards your back pockets, making small circles. The goal is opening up your chest, improving blood flow, and relaxing the arm(s) you just stretched.
These workouts are not meant to replace exercises given to you by a physical therapist. They should be used as a supplement as you work with a physical therapist. A physical therapist can address the entire kinetic chain so your body can work cohesively and effectively. Just 3 – 4 sessions can set your body up for success in the future!
Simply moving your body will go a long way in helping you feel better, physically and mentally. Get up and move even when you do not want to!
You can walk immediately after surgery (and even build up before surgery) to help recovery. The benefits of walking are MANY, including:
Consider using walking sticks or trekking poles (or if you have ski poles in your garage, those will work too!). They encourage a more natural walking pattern with reciprocal arm swing and trunk rotation, increase circulation and lymph flow, and give you better balance. Plus the full body movement burns 25 percent more calories! Be sure you DO NOT use them until your drains are removed after surgery. And know they can take a little getting used to so do not get discouraged if you feel uncoordinated at first! 😊
Check out the 10-minute indoor walking workouts in the Studio.
We always, always recommend some 1-on-1 attention with a physical therapist. Your body will have some imbalances and scar tissue. If you are using insurance, you have more than likely capped your out of pocket expenses and insurance can pay for your physical therapist. A physical therapist’s goal is to get your body functioning properly and get you back to daily movement patterns. Sometimes just 3 or 4 sessions will set you up for success!
Think of exercise as your pump that delivers healing to your muscles and your tissues. Of course exercise will make you stronger, but it has sooo many benefits.
As discussed above, the first 6 weeks post-op focus on range of motion, but it’s never too late. You need your range of motion for daily life! Most likely you will need to continue working on your mobility for the rest of your life (we all need to!).
At this point, as long as you are cleared, you can start adding closed chain exercises. You can add 1 – 2 pound weights into your exercise routine. Soup cans or water bottles work great if you do not have light weights. Again, if you experience increased swelling or pain contact your doctor or physical therapist and ease off!
Are planks okay? Can I do chest exercises? Can I lift my arms overhead? The short answer is yes. But we need to do it in a progressive, safe manner. Our Breast Cancer Movement program is designed with this in mind.
We start by modifying most “traditional” exercises — remember, modifications make you stronger. We mix in a bunch of unique exercises. Our Studio workouts are progressions eg. number 1 is easier than number five. Stay with workout 1 — as long as you need to. Then move into number two, three as you master each workout.
