Stretching After Cancer Surgery: What to Ask

There is no universal answer to when you can start stretching after cancer surgery, and any page that gives you one is guessing. The honest version is that it depends on which operation you had, what was removed, whether you have drains, whether tissue was moved for reconstruction, and how your particular healing is going.

So this page is about getting a real answer out of the people who have that information, and about the one complication that changes the rules more than any other.

The American Cancer Society is blunt about the sequencing: do not start any of these exercises without talking to your doctor or health care team first.

Its guidance for breast surgery gives a rough shape. You can begin when your health care team says it is OK, which usually happens a week or more after surgery. Some exercises should not be done until drains and sutures are out. Others can start soon after the operation.

That is two different categories of exercise with two different green lights, which is exactly why "when can I start stretching" is the wrong question. The better question is which movements now, which after the drains come out, and which after the follow-up appointment.

Get answers with numbers or landmarks in them, not adjectives.

• Which specific movements can I do this week?
• Which ones wait until the drains are out, and which until the stitches are out?
• Is there a lifting limit, in pounds, and for how many weeks?
• How high can I raise the arm on that side right now?
• How much range of motion should I have by six weeks, and what happens if I do not?
• Should I be seen by a physical or occupational therapist rather than working from a handout?
• I had reconstruction. Does that change any of the above?

Write the answers down. Postoperative instructions given verbally in a busy clinic do not survive the drive home.

ACS describes a standard set for after breast cancer surgery: the wand exercise, elbow winging, the shoulder blade stretch and shoulder blade squeeze, side bends, a chest wall stretch, and a shoulder stretch.

The dosing is specific and modest. ACS says to do each exercise 5 to 7 times, twice a day, until you get back to your normal flexibility.

The most important instruction is about sensation. You should not feel pain as you do them, only gentle stretching. Pain is a signal to stop and ask, not something to work through.

ACS also says to tell the team about unusual swelling or tenderness. Mild burning, tingling, numbness, or soreness in the arm or chest wall can happen, and is still worth mentioning if it concerns you.

If lymph nodes were removed from your underarm, this section matters more than the rest of the page.

NCI defines lymphedema as swelling caused by a buildup of lymph fluid in the body between the skin and the muscle. Treatment for breast cancer often involves surgery that removes one or more lymph nodes in the underarm area, and NCI states that this increases the risk of lymphedema. Radiation adds to the risk when it causes scar tissue that blocks the flow of lymph fluid.

Learn the early signs now, because early treatment is easier than late treatment. NCI names two:

• A heavy, full, or tight feeling in the area where you had surgery or radiation therapy.
• Swelling. When you press on the swollen area, a dent may remain in the skin.

Other things worth watching on that side: rings, sleeves, or watch straps getting tight, a difference in how the two arms look, or aching that does not match what you did.

NCI says to contact your doctor as soon as you notice heaviness, swelling, or other signs of lymphedema. Do not wait for a scheduled appointment.

On movement itself, NCI is encouraging rather than restrictive. Exercise is a natural pump for the lymph system. It can improve the flow of lymph fluid and keep the heart healthy, which may help treat lymphedema.

That is a meaningful shift from older advice, which told people to protect the arm by using it as little as possible. The current approach is to build activity back gradually and under guidance. Ask specifically whether you can be referred to a certified lymphedema therapist, and ask before you start heavier lifting rather than after.

The principle carries across, but the specifics do not. Adapt your questions.

Abdominal or pelvic surgery. Ask for a lifting limit in pounds, when you can start any core or trunk work, and how to protect the incision when you cough or get out of bed.

Chest or lung surgery. Ask about breathing exercises and shoulder movement on the operated side, and whether you should be using a device to expand the lungs.

Head and neck surgery. Ask about neck and shoulder movement and about jaw opening, and ask whether you should see a physical therapist or a speech pathologist.

Any surgery with a port or catheter still in place. ACS advises avoiding strength training that uses the muscles in that area, because it could dislodge it.

• Pain increases during or after the exercises, rather than easing.
• The wound opens, leaks, bleeds, or the edges pull apart.
• Redness spreads around the incision, or the area becomes hot, or there is discharge.
• Your temperature reaches 100.4°F (38°C) or higher.
• The arm, hand, leg, or the area near the surgery swells, or feels heavy, full, or tight.
• A calf becomes swollen, red, warm, or painful. That needs same-day assessment.
• New numbness, weakness, or a sudden loss of movement appears.
• Range of motion is going backward rather than forward.

• Am I where you would expect at this point, or behind?
• Can I be referred to physical therapy, and is there a cancer rehabilitation service here?
• What is my lymphedema risk, and should I be measured for a baseline?
• Is there anything I should avoid permanently on that side?
• When can I return to work, driving, and lifting my usual load?
• What would make you want to see me sooner than the next appointment?

Read next: What to Expect: Cancer Surgery, Recovery Timeline After Cancer Surgery, Returning to Exercise After Cancer Surgery, Surgery for Cancer, and Sleep Routine During Cancer Treatment.

• https://www.cancer.org/cancer/types/breast-cancer/treatment/surgery-for-breast-cancer/exercises-after-breast-cancer-surgery.html
• https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-pdq
• https://www.cancer.org/cancer/survivorship/be-healthy-after-treatment/physical-activity-and-the-cancer-patient.html
• https://odphp.health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
• https://www.cancer.gov/about-cancer/treatment/side-effects/infection