Range-of-Motion Exercises After Mastectomy or Lumpectomy
Shoulder Range of Motion
I found that most clients, after lumpectomy, mastectomy, or excision of lymph nodes, were too sore to begin range of motion (ROM) exercises for at least three to five days after surgery. I have not found it to have any significant negative impact on clients’ outcomes if structured ROM exercises are not started until seven to fourteen days after surgery, or even longer.
While I think two to four weeks post op is an ideal time to start ROM exercises, movement in a short range is beneficial early after surgery. I prefer to get consults early after surgery to start general education, including gentle movement in a short range. Again, most clients are inclined to do too much, not too little, so early education is important.
Many women regain ROM after surgery with no intervention. Others regain their previous ROM gradually over a period of a few weeks or a couple months. Clients with diabetes or a previous history of frozen shoulder may be at higher risk for persistent ROM deficits. Women who will be undergoing radiation therapy will need to get their arm over their head, so obviously they need full shoulder ROM before beginning radiation.
I start my post-op clients off with shoulder pendulums, cane, pulley, wall walk and table slide exercises. ROM exercises should be done with no more than a one to three of 10 increase in pain above baseline pain. For more on rating pain, see my article on how to rate pain.
In general, clients do not have shoulder joint stiffness. ROM is restricted due to the soft tissue trauma related to the surgery. This discomfort should be respected. Exercises should be done so that you feel a mild to moderate stretch to the incision scar. Stressing the scar too much will cause increased scar tissue as a protective response, but is counter-productive to recovery.
While some clients find it easiest to do two or three exercise sessions per day, I recommend brief sessions with a few repetitions throughout the day. Imagine exercising for 30 minutes, two times a day, versus 10 minutes, six times a day. Which do you think is less likely to cause increased soreness or swelling? I recommend doing the different exercises at different times of day, depending on your routine.
Over time you may find some of the exercises more beneficial than others. If you are not feeling a therapeutic stretch from one of the exercises, you can probably stop that exercise. You may find that you are more drawn to certain exercises because they fit your routine. If this makes you more compliant overall, this is fine, unless the exercises you choose do not give you a therapeutic stretch.