By: Sara Gagliano, PT, DPT, CLT-UE, Coordinator of Specialty Practice, Breast Oncology & Pelvic Health

A breast cancer diagnosis can feel overwhelming and bring a lot of questions all at once. What happens next? What will my body feel like after surgery? When should I start physical therapy? When can I get back to my normal routine?

As a certified breast oncology rehabilitation specialist, I want you to know you are not alone. We are here to walk alongside you through this process and help take care of you as you navigate the journey.

You may be preparing for surgery, chemotherapy, or other treatment. But how do you take care of your body during this time?

Physical therapy is an important part of the process, and an incredible tool, that most people don’t know about early in their diagnosis. Your physical therapist can be a constant in your treatment process, with frequent touchpoints, and can be a source of ongoing support and guidance.

Here are some of the things I like to cover with my patients early in the process:

  • When to start physical therapy
  • How physical therapy can help after surgery
  • What physical restrictions or symptoms you may experience after surgery or during chemotherapy and/or radiation
  • When you can get back to your normal routine
  • What are your goals?
  • Who is on your breast cancer team?
  • Local resources for support

Who Is On My Breast Cancer Care Team?

Typically, someone will have several doctors on their care team. When someone finds out they have breast cancer from a biopsy, they’re usually first referred to a breast oncology surgeon. From there, further diagnostics are performed to determine what path of treatment comes next. Different scenarios may have a patient undergoing surgery first, while others may need to begin their treatment with chemotherapy. If radiation is recommended, that is typically completed following surgery.

Most people will have a medical oncologist, who is like the quarterback of their care planning. Additionally, a radiation oncologist for radiation therapy and a plastic surgeon if breast reconstruction is needed. You’ll usually meet all of these providers early on to determine the treatment plan. Please note, every person’s treatment may look different depending on their pathology results and doctors’ recommendations!

When Should I See A Physical Or Occupational Therapist For Breast Cancer?

I recommend starting care sooner than later! Often, patients are referred to us following surgery to work on mobility restrictions, strength deficits, swelling management, and return to previous function. We also help our patients with lymphedema, both prevention and management. Physical therapy can typically start three to six weeks after surgery, depending on your breast oncology or plastic surgeon’s recommendations.

However, most people don’t know that physical therapy can also help you throughout other phases of your treatment. For example:

  • Before any treatment begins to get your baseline status, meet your therapist, and establish your goals
  • Before surgery to build strength and stamina in preparation
  • During chemotherapy to work on building strength and stamina, safe exercise strategies, side-effect management
  • During and/or after radiation therapy to improve or maintain chest and shoulder mobility, swelling management

How Do I Find a Physical or Occupational Therapist Who Specializes in Breast Cancer Rehab?

When you’re choosing a therapist, look for one of these credentials to ensure they have specialized training in oncology rehab or lymphedema.

  • Certified breast cancer rehabilitation specialist through the Physiological Oncology Rehabilitation Institute (PORi)
  • Certified Lymphedema Therapist (CLT)

Certified specialists aren’t available in every area, so many people see a general physical therapist instead. We’re lucky at Spooner to have several certified breast oncology rehabilitation specialists on our team across multiple locations.

Find a Spooner breast cancer oncology rehab specialist near you.

View Spooner Locations for breast oncology rehabilitation.

If you have access to a certified specialist, we recommend establishing care. They bring a higher level of specialized care. If there isn’t one near you, a general orthopedic physical therapist can help you regain range of motion and improve your functional abilities.

What Kind of Physical Symptoms Might I Experience From Breast Cancer Treatment and/or Surgery, and When?

After Surgery

It’s very typical to have decreased range of motion in the arms, specifically with reaching overhead. You will also probably feel tightness and soreness through the chest and likely have swelling in the chest.

Lymphedema

Lymphedema is swelling caused by a buildup of lymph fluid in your tissues. The axillary lymph nodes in your armpit help filter and drain lymph fluid from that side’s arm, chest, and should blade area. When lymph nodes are removed during the lymph node biopsy or affected by radiation, this has the potential to reduce the capacity of the lymphatic system in the affected arm or breast and lead to someone experiencing lymphedema.

Lymphedema is typically associated with having more lymph nodes removed, but not always. Sometimes it happens in people who’ve had just a few lymph nodes removed for the lymph node biopsy. Lymphedema is also the most likely to occur in the first three years following surgery.

Lymphedema is not always visible swelling. Sometimes, it can feel like heaviness, aching, numbness, tingling, or a sense of fatigue in your arm or breast that you don’t feel on the other side.

Physical therapy for lymphedema can include prevention, swelling and symptom management, and resources for self-management.

During Chemotherapy

Physical restrictions during chemotherapy can include joint aches and pains, muscle weakness, fatigue, and decreased stamina. An individualized exercise plan can help mitigate some of these symptoms.

After Radiation

Radiation can make the breast, axilla and surrounding soft tissue tight and have the sensation of stiffness, resulting in range of motion restrictions. Swelling can also increase in response to radiation.

How Does Therapy Help After Breast Surgery?

Physical therapy after surgery can help with range of motion limitations, swelling management, and decreased strength, which can all be common during post-operative recovery. Therapy will also help you in navigating tasks at home or your return to work. The physical therapy plan will also depend on the type of surgery and reconstruction that was done. Exercise and other activities may seem daunting after surgery, but I want patients to know that we are here to help you back into your routines safely, confidently, and at the pace that is comfortable for you.

As for a typical timeline, physical therapy usually starts three to six weeks after surgery and will depend upon your individual surgeon’s recommendations.

When Can I Go Back To My Normal Routine After Breast Cancer Treatment?

After surgery, you will likely have lifting and activity restrictions for six weeks. Every physician is different in their recommendations, but six weeks is typical.

Many people can expect to return to their normal routines and work toward their previous level of function or fitness within about twelve weeks after surgery. You may not feel 100% at that point, but you should be making steady progress toward your goals.

During chemotherapy, we encourage you to continue your normal activities and exercise routine as much as you comfortably can. If you’re feeling up to it, staying active can be an important part of your treatment journey.

What resources are there for women with breast cancer?

Support can be regional, so your local organizations are the best place to start. These are the ones we recommend to our patients most in Phoenix:

In the age of social media, it is really easy to get connected. If you aren’t sure where your local resources are in your state, you can try joining local Facebook groups or asking your local providers.

Is it too late for physical therapy if my surgery was years ago?

It is never too late to begin physical therapy. Sometimes people can experience the after effects from breast cancer treatment months or even years after treatment finishes. Even if it has been a while, physical therapy can still help you move and feel better. A lot of people think that after breast cancer treatment persistent symptoms are just what you have to live with. You don’t have to and we can help you!

We’re Here to Support You

Every breast cancer journey is different, and so is the path toward recovery. Whether you’re preparing for treatment, recovering from surgery, or dealing with symptoms years later, you don’t have to figure everything out on your own.

Our Spooner Breast Oncology Rehabilitation team is here to answer your questions, understand your goals, and help you feel more confident about what comes next.

CONNECT WITH THE SPOONER BREAST ONCOLOGY TEAM!

A complimentary movement assessment is a great opportunity to meet with a member of our team, talk through your concerns, and learn how physical or occupational therapy may help you along the way.