My name is Karen Robin, I’m the consultant physiotherapist for cancer at Barts and the London NHS trust

and I’m also part of a Macmillan group, which is called the Consequences of Cancer Treatment Collaborative.

And my name is Kate Jones, I’m a clinical specialist physiotherapist working at the Royal Marsden.

Surgery for breast cancer affects everybody differently

but we know that most people will feel a little bit sore and a little bit tender after their operation, and that’s really quite common.

And as a result of that they can sometimes get a little bit of stiffness in their arm and in the shoulder

and they’re not keen to move their arm or shoulder following the surgery.

They can also develop a little bit of swelling in and around the wound site

and sometimes that can concern people as well.

There are other things to consider following treatment for breast cancer.

For example, radiotherapy can cause some localised skin redness and some soft tissue tightness

and this can also affect the movement of the arm.

If patients have had surgery underneath their arms, so they’ve had axillary node surgery

they may also develop something called ‘cording’ and that can affect the movement of the arm as well.

Related to the axillary node surgery is also lymphoedema.

Now lymphoedema basically just means swelling of a limb

and some patients will have a risk of lymphoedema following their surgery

and that risk is related to the amount of lymph nodes that they’ve had removed and the extent of radiotherapy they’ve had as well.

Physiotherapy has a very important role following treatment for breast cancer

and can actually help patients regain their full movement back in the arm

and it normally comprises of things like exercises and soft tissue work

and advice and education for patients on how they can move their arm safely and in a functional way.

The exercises that we use following surgery for breast cancer are divided into three different sections:

The post-operative section, the maintenance section and then the advanced exercises.

In the first seven days following surgery for breast cancer it’s very important that you don’t lift your arm up above your head

because this can put too much of a stretch on your wound and can actually cause some problems.

The maintenance exercises are about gaining full range of movement in your arm

and you start now to take your arm up above your head.

And then the advanced exercises give you a little bit more of a stretch

and actually take your arm even further and hold the position to try to get full range of movement back.

We’re now going to start talking about exercises

but before we do so we just want to mention about posture.

It’s easy after surgery to adopt bad postures and wanting to protect the area.

So just be aware, take your shoulders back, keep your head up tall, lift your breastbone and keep your chin tucked in.

Before you start any exercises ensure that you and try and keep relaxed

and make sure that you don’t push into pain.

The first set of exercises we’re going to discuss are the ones to do immediately after

your operation for the first week.

The first exercise is the shoulder shrug and all it means is you’re going to raise your shoulders up towards your ears

hold it there and then relax down.

Repeat this exercise around about five times.

The second exercise is the shoulder girdle stretch.

In this exercise, you want to shrug your shoulders as far forward as can

and then stretch back with your shoulders as far as you can

and again repeat about five times.

The third exercise starts taking your shoulder gently forwards.

Place your hand on the tip of your shoulder

and then lift your elbow forwards, so at about 90 degrees or the height of your shoulder level

and then slowly bring it back down to your side.

And again, repeat this exercise about five times.

The next exercise is gentle shoulder going out to the side.

Again, put your hand on the tip of your shoulder

and this time take your elbow out to the side, again to about shoulder height

and slowly lower back down.

The next exercise, place your hand in the small of your back

and reach upwards as far towards your shoulder blades with your hand as you can

and then slowly lower back down to the side.

The final exercise in this section, place your hand behind your head

ensuring that your head doesn’t come forward

and then take your arm gently out to the side

side until you feel a stretch along your chest wall

and then slowly bring it back down.

If you’ve had surgery affecting both sides

you need to repeat these exercises on each side.

From day 7, once you’ve found the first set of exercises are getting easier

then you can progress to further exercises.

The first exercise, keep your arm down by your side

and then slowly raise it forward as far above your head as you comfortably can

you can do this either sitting or standing. Repeat this about five times.

The arm sideways.

Start with your arm down by your side

and then take your arm slowly sideways above your head as far as you comfortably can

and then slowly lower and bring it back down to the side.

We’re now going to cover the stretching and strengthening section.

The first thing we’re going to do is discuss a couple of stretching exercises you can do.

Shoulder forward in lying.

Lying down with your arm down by your side with your palm facing upwards.

Take your arm up as far as you can comfortably above your head

you may need to bend your elbow a little bit

and hold it there for as long as you comfortably can for about 10 seconds and then relax slowly down by your side.

You can also do this by grasping your hands together as you bring your arms out, up above your head

or by using a stick to help the movement.

Repeat this about three times.

Shoulder out to the side in lying.

Lying with your arm down by your side, palm facing upwards

take your arm slowly out to the side as far above your head as you can.

Again, you may need to bend your elbow a little bit.

Hold for 10 seconds and slowly lower back down to the side.

Again, repeat about three times.

In lying, place your hands behind your head

and then let your elbows drop out to the side until you feel a stretch across the chest wall.

Hold for 10 seconds and then slowly bring it back and relax.

Repeat this about three times.

Hand behind back using towel.

The aim of this exercise is to make sure that you take your hand of the affected side as far as you can

using the unaffected side to assist you.

Repeat this exercise about three times.

The final section, we’re going to discuss some strengthening exercises

that we suggest you start between 4 - 6 weeks after your surgery.

However, if you have any concerns, or if your wound has not fully healed

then please speak to your surgical team before starting any strengthening exercises.

With a small weight, say about 1kg or a water bottle or a can of beans or something like that

starting with your arm down by your side, take your arm forwards and up

as far above your head as you comfortably can then slowly lower down by your side.

Again you can repeat this exercise about five times.

Shoulder strengthening out to the side.

Using a small weight start with your arm down by your side

and then slowly take it sideways up above your head as far as you comfortably can

and then slowly lower back down to the side

and repeat about five times.

The final strengthening exercise in this section, again with a small weight with your arm down by your side

and then take your arm up above your head halfway between forward and out to the side at an angle

and again slowly lower back down to the side and repeat about five times.

Standing press-up.

Stand facing the wall about a foot away

bring your hands up to shoulder height onto the wall

and then do a standing press-up, leaning into the wall and then bring yourself back to the upright position.

Repeat about five times.

In standing or sitting, pinch your shoulder blades together down and in

hold for 10 seconds and then relax, repeat this exercise three times.

Physiotherapy introduced at an early stage can really help prevent

any long-term complications and problems.

For information, help, or if you just want to chat

call the Macmillan Support Line on 0808 808 00 00

or visit macmillan.org.uk