Breast Cancer Patients and Physiotherapy

Breast cancer treatments—whether surgical, radiation, chemotherapy, or hormone-based—bring remarkable advances in survival but often leave patients with long-term functional and systemic challenges.

This article outlines the most common post-treatment issues, evidence-based interventions, and practical guidelines for physiotherapy management of breast cancer patients.

Common Issues After Breast Cancer Treatment

Upper Extremity Impairments

• Restricted Shoulder Range of Motion (ROM): Frequently affects flexion, abduction, and external rotation, making both daily activities and positioning for radiation therapy more difficult.
• Lymphedema (BCRL): Affects 20–25% after axillary lymph node dissection, and ~5% after sentinel biopsy. It reduces physical and social functioning, causes pain, and may lead to recurrent infections (erysipelas).
• Muscle Weakness & Instability: A loss of up to 25% strength, often resulting in shoulder dysfunctions.
• Axillary Cord Formation (Cording/AWS): Painful cords that restrict mobility, sometimes extending beyond the elbow.
• Pain Syndromes: Includes post-mastectomy pain syndrome (PMPS).
• Scar Adhesions: Restrict mobility and lymphatic flow.
• Sensory Changes: Numbness, tingling, and paresthesia due to nerve damage or chemotherapy.

Systemic and Whole-Body Issues

• Cancer-Related Fatigue (CRF): Persistent fatigue, often long-lasting.
• Postural Changes: Protective postures (kyphosis, shoulder protraction) common after surgery.
• Chemotherapy-Induced Polyneuropathy (CIPN): Occurs in 30–60% of patients, leading to balance issues and falls.
• General Musculoskeletal Problems: Chronic pain and reduced mobility.
• Weight Changes: Weight gain is common during treatment.
• Radiation-Induced Lung Injury: Dyspnea and chest tightness in ~1–5% due to lung fibrosis.

Key Physiotherapy Interventions

Lymphedema Management

Complex Decongestional Therapy (CDT) is the gold standard. It combines:

• Manual lymphatic drainage (MLD)
• Compression therapy (garments, bandaging)
• Exercises with diaphragmatic breathing
• Skin maintenance
• Patient education

Exercise (Grade A evidence):

• Safe and effective, both aerobic and resistance training.
• Progressive resistance training improves strength without increasing lymphedema risk.
• Compression garments should be worn during exercise.

Compression Therapy:

• First-line for early lymphedema (Stage I).
• CDT for moderate to late stages (II–III).

Exercise & Sports Therapy

• 150 minutes/week of moderate activity recommended.
• Resistance and aerobic exercise are safe from 4–8 weeks post-surgery, depending on the procedure.
• Exercise is effective against CRF and CIPN.
• Balance and dexterity training support neuropathy patients.

Scar Therapy

• Manual scar mobilization, massage, and stretching (after wound healing, ~4–6 weeks).
• Prevents restrictions, pain, and impaired lymph flow.

Posture and Trunk Mobility

• Proprioceptive neuromuscular facilitation (PNF) and mirror-based corrections help restore upright posture.
• Exercises like “block game” and wall-sliding support trunk control and serratus anterior strengthening.

Respiratory Support

For patients with radiation-induced lung injury:

• Diaphragmatic breathing
• Endurance training
• Lung stretching (“moon position”)
• Secretion mobilization and effective coughing

Physiotherapy Guidelines Across the Cancer Journey

I. Prehabilitation (Before Treatment)

• Goals: Enhance ROM, strength, psychological readiness.
• Interventions: Shoulder exercises, Nordic walking, relaxation techniques.

II. Postoperative Phase (Early Hospital Period)

• Goals: Prevent circulatory issues, edema, and pulmonary complications.
• Start mobilization day 1 (except after reconstructive surgeries).
• Begin arm/wrist/elbow exercises early; delay shoulder exercises until day 3–5 depending on surgery type.
• Gentle breathing and thrombosis prophylaxis exercises.

III. Rehabilitation Phase (Early & Late Ambulatory)

• ROM restoration: Daily home program for at least 3 months.
• Lymphedema care: CDT with tailored compression.
• Therapeutic exercise: Endurance, resistance, and safe sports therapy.
• Fatigue & neuropathy: Low-intensity endurance, walking, balance/dexterity training.
• Posture correction & scar therapy are essential to long-term function.

Summary of Physiotherapy Guidelines

• Prehabilitation: Improve fitness, ROM, and mental readiness.
• Postoperative: Start early mobilization, protect against edema and pulmonary complications.
• ROM Training: Daily exercises to restore shoulder mobility, essential before RT.
• Lymphedema Management: CDT (compression, exercise, skin care, education; MLD optional).
• Exercise Therapy: Aerobic + resistance; safe with compression; ≥150 minutes/week.
• Scar & Posture Work: Manual techniques, stretching, posture correction strategies.
• Systemic Complications: Tailored exercise for fatigue, neuropathy, and lung injury.
• Surveillance: Ongoing monitoring for early detection of lymphedema and other complications.

Breast cancer patients often face challenges that extend beyond physical impairments. The journey is marked not only by pain, fatigue, and mobility limitations, but also by emotional distress, fear, and changes in self-image. As physiotherapists, it is essential to recognize this dual burden. Our role goes beyond restoring function—we are also part of the patient’s broader support system. By combining evidence-based physical interventions with empathy, encouragement, and respect for each individual’s mental and emotional state, we can help patients regain independence, confidence, and quality of life. Supporting both the body and mind ensures that recovery is not just about survival, but about living well.

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