This information describes how to do exercises to help you regain your range of motion after your axillary lymph node dissection or lumpectomy with axillary lymph node dissection.
Start doing these exercises on the first day after your surgery, unless your healthcare provider gives you other instructions.
Deep Breathing Exercise
Deep breathing can help you relax and ease discomfort and tightness around your incision (surgical cut). This is also a good exercise to help relieve tension.
To do this exercise, sit comfortably in a chair and take a slow, deep breath in through your nose. Let your chest and belly expand. Now, exhale slowly through your mouth. You can repeat this several times.
Arm and Shoulder Exercises
Doing arm and shoulder exercises will help you regain full range of motion on the side where you had your surgery, which is called your affected side. With full range of motion, you will be able to:
- Move your arm over your head and out to the side.
- Move your arm behind your neck.
- Move your arm to the middle of your back.
Do each of these exercises 10 times. Do this 5 times a day. Keep doing this until you have regained full range of motion and can use your arm as you did before surgery in all of your normal activities. This includes activities at work, at home, and in recreation or sports. If you had reduced movement in your arm before surgery, your goal will be to regain as much movement as you had before.
If you quickly regain your full range of motion, continue doing these exercises once a day, instead of 5 times a day. This is especially true if you feel any tightness in your chest, shoulder, or under your affected arm. These exercises can help prevent scar tissue from forming in your armpit and shoulder. Scar tissue can limit your arm movements later.
If you still have trouble moving your shoulder 4 weeks after your surgery, tell your surgeon. They will determine if you need more rehabilitation, such as physical or occupational therapy.
Before you start, gather the following supplies:
- 4 pieces of tape. You’ll use these to mark your progress with some exercises.
- A stopwatch, timer, or watch with a second hand. You’ll use this to time some exercises.
The shoulder roll is a good beginning exercise, since it gently stretches your chest and shoulder muscles.
- Stand or sit comfortably with your arms relaxed at your sides.
In a circular motion, bring your shoulders forward, up, backward, and down (see Figure 1). Try to make the circle as large as you can and get both of your shoulders to move at the same time. Do this 10 times.
- If you have some tightness across your incision or chest, start with smaller circles, but increase the size as the tightness gets better.
- Now, switch directions and do 10 shoulder rolls in the forward direction. Bring your shoulders backward, up, forward, and down.
You may find that the backward direction is a little tighter across your chest than the forward direction. This will get better with practice.
The shoulder wings exercise will help you regain outward movement of your shoulder. You can do this exercise while sitting or standing.
- Place your hands on your chest or collarbone.
- Raise your elbows out to the side (see Figure 2).
- Slowly lower your elbows.
- After 10 repetitions, slowly lower your hands back down to your lap.
If you experience discomfort while doing this exercise, hold your position and do the deep breathing exercise. If the discomfort doesn’t go away, don’t raise your elbows any higher. If the discomfort goes away, finish the exercise.
If you had surgery on both of your breasts, do this exercise with both arms, one arm at a time. Don’t do this exercise with both arms at the same time. This will put too much pressure on your chest.
Stand with your feet slightly apart for balance. Raise your affected arm out to the side as high as you can (see Figure 3). Start making slow, backward circles in the air with your arm. Be sure you’re moving your arm from your shoulder, not your elbow. Keep your elbow straight.
- Increase the size of the circles until they’re as large as you can comfortably make them. Be sure to complete at least 10 full backward circles. If you feel any aching or if your arm is tired, take a break. Continue doing the exercise when you feel better.
- Slowly lower your arm to your side. Rest your arm for a moment.
- Next, raise your affected arm out to the side as high as you can. Start making slow, forward circles.
- Increase the size of the circles until they’re as large as you can comfortably make them. Be sure to complete at least 10 full forward circles. If you feel any aching or if your arm is tired, stop before 10 circles.
- Lower your arm to your side.
The W exercise can be done standing, sitting, or lying on your back. Doing this exercise with your back against a wall may help you position yourself properly.
Form a “W” with your arms out to the side and palms facing forward (see Figure 4). Try to bring your hands up so that they’re even with your face. If you can’t raise your arms that high, bring them to the highest comfortable position.
- Pinch your shoulder blades together and downward, as if you’re squeezing a pencil between your shoulder blades.
- If you feel discomfort in the area near your incision, stop at that position and do the deep breathing exercise. If the discomfort passes, try to bring your arms back a little further. If the discomfort doesn’t pass, don’t reach any further. Hold the furthest position you can and squeeze your shoulder blades together for 5 seconds.
- Slowly bring your arms back down to the starting position. Repeat this exercise 10 times.
You can do the back climb in a sitting or standing position. You will need a timer or stopwatch for this exercise.
Place your hands behind your back and grasp the hand on your affected side with your other hand (see Figure 5). If you had surgery on both breasts, use whichever arm moves most easily to grasp the other. Do this stretch for one arm at a time only. Don’t do the stretch with both arms at the same time.
- Slowly slide your hands up the center of your back as far as possible. Hold the highest position for 1 minute.
- If you feel pulling or stretching near your incision, stop at that position and do the deep breathing exercise. If the tightness goes away, try to slide your hands up a little further. If it’s still there, don’t slide your hands up any further.
- Hold the highest position you can for 1 minute. You should feel a gentle stretch in your shoulder area.
- After 1 minute, slowly lower your hands.
- If you had surgery on both breasts, repeat the exercise using your other arm.
Hands behind neck
You can do the hands behind neck exercise in a sitting or standing position. You will need a timer or stopwatch for this exercise.
- Stand or sit comfortably with your feet on the floor. Clasp your hands together on your lap.
Slowly raise your hands toward your head, keeping your elbows together in front of you and not out to the sides (see Figure 6). Keep your head level. Don’t bend your neck or head forward.
- Slide your hands over your head until you reach the back of your neck. When you get to this point, spread your elbows out to the side. Hold this position for 1 minute. If you aren’t able to get into this position, reach up and stretch your elbows back as best you can. Breathe normally. Don’t hold your breath as you stretch your body.
- If you have some tightness across your incision or chest, hold your position and do the deep breathing exercise. If the tightness gets better, continue with the movement. If the tightness stays the same, hold the position you are most comfortable in for 1 minute.
- Slowly come out of the stretch by bringing your elbows back in front of you and sliding your hands over your head. Then, slowly lower your arms to your lap.
Forward wall crawls
You will need 2 pieces of tape for the forward wall crawl exercise.
- Stand facing a wall. Your toes should be about 6 inches from the wall.
- Reach as high as you can with your unaffected arm and mark that point with a piece of tape. This will be the goal for your affected arm. If you had surgery on both breasts, set your goal using the arm that moves most comfortably.
Place both hands against the wall at a level that’s comfortable. Crawl your fingers up the wall as far as possible, keeping them even with each other (see Figure 7). Try not to look up toward your hands or arch your back.
- When you get to the point where you feel a good stretch, but not pain, do the deep breathing exercise.
- Return to the starting position by crawling your fingers back down the wall.
- Repeat the wall crawl 10 times. Each time you raise your hands, try to crawl a little bit higher
- On the tenth crawl, use the other piece of tape to mark the highest point you reached with your affected arm. This will allow you to see your progress each time you do this exercise.
As you become more flexible while doing this exercise, you may need to take a step closer to the wall so that you can reach a little higher.
Side wall crawls
You will also need 2 pieces of tape for the side wall crawl exercise.
- Stand with your unaffected side closest to the wall, about 1 foot away from the wall.
Reach as high as you can with your unaffected arm. Mark that point with a piece of tape (see Figure 8). This will be the goal for your affected arm. If you’ve had surgery on both breasts, set your goal using the arm that moves most comfortably.
- Turn your body so that your affected side is now closest to the wall. Crawl your fingers up the wall as far as possible. When you get to the point where you feel a good stretch, but not pain, do the deep breathing exercise. Return to the starting position by crawling your fingers back down the wall.
- Repeat this exercise 10 times.
- On your tenth crawl, use the other piece of tape to mark the highest point you reached with your affected arm. This will allow you to see your progress each time you do the exercise.
- If you had surgery on both breasts, repeat the exercise with your other arm.
You shouldn’t feel pain while doing this exercise. It is normal to feel some tightness or pulling across the side of your chest. Focus on your breathing until the tightness decreases. You should breathe normally throughout this exercise. Don’t hold your breath.
Be careful not to turn your body toward the wall while doing this exercise. Keep your body at a 90-degree angle to the wall.
After your surgery, you may have some swelling or puffiness in your hand or arm on your affected side. This is normal and will usually go away on its own.
If you notice swelling in your hand or arm, raise your arm above your head several times a day while doing hand pumps. To do hand pumps, slowly open and close your fist 10 times. Doing this will help drain the fluid out of your arm.
You may also raise your arm a few times a day for about 20 minutes at a time. To raise your arm while sitting or while lying on your back, rest your arm on a few pillows next to you. Your arm should be raised above the level of your heart. Don’t hold your arm straight up over your head for more than a few minutes. This can cause the muscles of your arm to get tired.
If you’re able to sleep on your unaffected side you may place 1 or 2 pillows in front of you and rest your arm on them. If the swelling doesn’t go down within 4 to 6 weeks, call your doctor or nurse.
If you have any questions, call the Rehabilitation Service at 212-639-7833.