Regardless of where your head’s at right now, after surgery the goal is to get back full range of motion in your shoulder – that means the ability to move your arm and shoulder the same way you did before surgery. Do you know what to do to make that happen?
Close your eyes and say (out loud) the word EXERCISE.
Are your thoughts positive or negative?
Keep your eyes closed and scan your body. Do you feel excitement, dread, overwhelm, fear, apathy?
What you feel may depend on where you’re at in your breast cancer experience. If you’ve just had surgery it’s not at all unusual to feel negative emotions at the thought of doing any type of activity – strenuous or not.
Even before your breast surgery, I would imagine that you had very strong opinions about exercise. Every person has a unique “relationship” with the act of moving their body for health – some people love being active, some hate being active, some could go either way.
For many people, activity, exercise and fitness appear completely interchangeable, even though there are fairly significant differences between them. Perhaps you think they all mean running, jumping, pounding hearts, breathlessness and sweat; buckets of sweat. (1)
Bleh. Who likes THAT, especially after breast cancer surgery? This confusion, in my opinion, is where much of the fear and apprehension regarding exercise stems from.
Regardless of where your head’s at right now, after surgery the goal is to get back full range of motion in your shoulder (that means the ability to move your arm and shoulder the same way you did before surgery). Do you know what to do to make that happen?
I created this post to offer inspiration, information and guidelines to help you SAFELY get your movement back after surgery, but first, have a look at what activity is and isn’t.
Defining Activity, Exercise and Fitness
Physical Activity: Bodily movement produced by muscles that results in calorie burning. Physical activity in daily life can be occupational (standing/walking at your job), sports (bowling, volleyball), physical conditioning (swimming, walking), household (cleaning, washing windows), other activities (gardening, mowing the lawn).
Exercise: Exercise is a subset of physical activity that’s planned, structured, and repetitive and has an objective of the improvement or maintenance of physical fitness. Examples are: weight lifting to get stronger and more toned, walk-to-run training, or a regular exercise program that keeps you strong, flexible and aerobically fit.
Physical Fitness: A set of attributes that are either health- or skill-related. The degree to which people have these attributes can be measured with specific tests. Examples are cardiovascular endurance, muscle strength and endurance, flexibility, and/or body composition (i.e. body fat to muscle ratio).
What you’ll be doing after surgery is definitely not physical fitness, nor is it considered physical conditioning. Rather, you’ll be executing planned, structured, repetitive exercises designed to help you regain full range of motion. Even though right now it may seem daunting, I encourage you to try them; these exercises are designed to be done gently, while keeping you on a rehabilitation schedule that’s safely within your individual ability.
I’m not gonna lie; these aren’t body-punishing exercises, but they are tough! Actively DOING the exercises requires effort and commitment that will remind you to never take for granted again the ability to effortlessly raise your arm over your head! It’s normal to experience a certain degree of discomfort as you work to regain the ability to scratch your own back and hold a blow dryer – but it’s definitely an effort worth making.
What’s Your Relationship with Exercise?
Trust me when I say, one of the most helpful things you can do to support continued improvement in regaining full range of motion and the use of your arm is to get your mindset in the right place, right off the bat.
Before breast cancer, where did you fall on the physical activity spectrum; avid, occasional or only-if-your-life depended on it participant?
If you weren’t big on moving before your diagnosis, it’s unlikely this life-altering situation has converted you to an avid fan. But because job #1 is getting your mobility and full range of motion back, and physical activity is the way to make that happen, we need a plan to get you moving – breathlessness, pounding heart and buckets of sweat not included, unless of course, you want that (but please, not until after your drains are removed and your doc has cleared you for activity!).
If you didn’t receive information from your healthcare team on how to (physically) recover from surgery, you may not even realize there’s a timeline for getting started and progressing, and targeted exercises designed to help.
I know that I certainly didn’t receive anything.
Given my background and experience as a personal fitness trainer, you’d think I’d have a sense of what to do, or at least some idea of what exercises were safe and recommended. Even though I got moving the very next day (I had no drains and I did nothing intense), because I don’t work with the cancer population, I honestly had no idea that a specific protocol existed.
I was simply moving on instinct.
It’s critical that all breast cancer patients be provided with rehabilitation information, as well as given the option (and referral) to work with a physical therapist specializing in post-breast cancer surgery rehabilitation.
Whether surgery means lumpectomy or partial/full mastectomy, a qualified physical therapist can address weight restrictions, issues around scar tissue, and satisfy potential lymphedema and cording concerns with trustworthy information, resources and exercises.
If you haven’t received any guidance from your healthcare team, ASK FOR IT (and take them a copy of this blog!).
These Exercises Help Improve Range of Motion
I’ve had quite a few women ask me what exercises are safe and appropriate to do at the time of diagnosis, as well as following surgery (sometimes even well beyond surgery), so I did some research and offer you the following.
First of all, please know that it’s perfectly normal to feel hesitant about moving the part of your body affected by surgery.
It will feel weird. It may feel tight or stretchy. Or tingly. It may hurt a bit, or feel completely numb at or near the area where you had surgery.
All of this is normal.
While everyone has a different experience with recovery, over time most women will experience improvement in range of motion, a decrease in pain and tingling (it most likely will completely disappear), and elimination of or reduction in the feeling of numbness (fyi, sometimes numbness lingers).
The way to maintain the “gains” you make in your recovery is to NEVER STOP doing the stretching and exercises. Even three and a half years after my own surgery, I still do work to open (and keep open) the tightness in my chest every, single, day; it’s what keeps me mobile.
There are three phases to post-surgery exercise:
- First week after surgery
- Second week after surgery or after drains are removed
- Six weeks and beyond
Post-surgery exercises also vary depending on whether or not you’ve had breast reconstruction, with range of motion guidelines, restrictions and the number of repetitions recommended accordingly.
CAUTION!!! *** BEFORE You Begin ***
- Get your doctor’s okay first, and don’t start any exercise before your doctor approves activity. If you have drains placed, there are very clear guidelines for activity BEFORE and AFTER their removal. If you don’t have drains, you may have a bit more leeway regarding timeline for starting and what you can/can’t do, but bottom line, follow your doctor’s recommendations for WHEN to begin.
- Be sure to use guidelines for your individual surgical situation regarding the type of surgery you had, and whether you did or didn’t have reconstruction.
- Guidelines also vary based on whether you had surgery on one or both sides. The side(s) where surgery occurred is called the “affected side”. This is important to be aware of as you hear or read exercise cues indicating how to involve each side in the recommended exercise.
- Perform all exercises slowly and gently while taking deep, calming breaths.
- It’s important to keep moving, even if you feel some (slight) pain or numbness; these should both lessen with time. However, if you feel that the pain and/or numbness prevents you from performing your activities of daily living (ADL’s), or doesn’t seem to improve with time, contact your doctor, nurse navigator or physical therapist.
- Some swelling or puffiness on the affected side is normal; ask your doctor or physical therapist for guidance on what to do to help reduce the swelling.
- It’s never too late to begin. If you didn’t do any exercises following your surgery and are living with physical limitations, you too can use these guidelines.
Ok, are you inspired and ready to begin?
Because breast cancer surgery rehab isn’t my area of expertise when it comes to recommending EXACTLY what to do, I’m simply acting as the messenger.
To get you started, I’ve included a link to a wonderful piece from Memorial Sloan Kettering Cancer Center. Be sure to click on the VIDEO LINKS embedded in the article. We all have different learning styles, and some of us do better when we can watch what to do vs looking only at a diagram. Luckily, this link includes BOTH: Exercises After Breast Surgery
Once you’ve hit the “6 weeks and beyond” stage, and your doctor has cleared you to ramp up your routine, have a look at my “DAM. MAD. About Breast Cancer” Youtube Channel where I demonstrate fun, unique ways to build and maintain strength!
And going forward, here’s a friendly reminder that EXERCISE is a critical tool for strong survivorship and reducing risk of recurrence. Here’s a link to Part 1 of my 6-part blog series on how to Reduce Your Risk of Breast Cancer with Physical Activity
If you found this blog helpful, please share it with friends, family and colleagues who would benefit.
By the way, leave a comment below and let me know if you had formal rehab after your breast cancer surgery; I’m curious to learn what YOU learned from your experience!
- Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.
- The Ohio State University Wexner Medical Center. Exercises After a Mastectomy or Lymph Node Removal
- Mount Sinai Hospital. Functional Rehab After Breast Cancer Surgery
- University of Wisconsin Health. Exercises After Breast and Axillary Surgery