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 your situation. That includes which operation you had and what was removed. It also includes 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 in the coming 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. It includes the wand exercise, elbow winging, the shoulder blade stretch and shoulder blade squeeze. It also includes 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.

Mild burning, tingling, numbness, or soreness in the arm or chest wall can happen, because surgery can irritate nerves. ACS says to keep doing the exercises unless you notice unusual swelling or tenderness. If you do, tell your healthcare team right away. ACS also says to call your doctor if tightness in the chest or armpit does not ease as you exercise.

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. 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.

NCI also lists numbness or tingling in the area. In an arm or leg, it lists swelling that makes it look larger than the other one, weakness, and trouble moving it.

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.

NCI advises talking with your doctor to find an exercise program that is safe for you. Ask specifically whether you can be referred to a certified lymphedema therapist. Ask before you start heavier lifting rather than after.

Breast surgery is only one example. 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 central line in the chest still in place. ACS advises avoiding strength training that uses the muscles in the area of the catheter, because it could dislodge it. Ask your team what is safe.

Call 911 or go to the nearest emergency department if:

• The incision splits open, or you can see tissue through the gap.
• Bleeding from the wound will not stop.
• You have chest pain or trouble breathing, especially with a swollen calf.
• You have sudden numbness or weakness, especially on one side of the body, or sudden trouble speaking, seeing, or walking (CDC).

Do not drive yourself.

Call your care team right away, at any hour, if:

• Your temperature reaches 100.4°F (38°C) or higher.
• Redness spreads around the incision, or the area becomes hot, or there is discharge.
• The wound leaks or bleeds, or the edges start to pull apart.
• Pain increases during or after the exercises, rather than easing.
• 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 (CDC).
• New numbness or weakness comes on, even slowly.

If you are on chemotherapy, call right away, day or night, for chills, a sore throat, mouth sores, or any other sign of infection. CDC says fever can be the only sign (CDC). The same caution is wise after a stem cell transplant or CAR T, or with low white cells. CDC's list is written for chemotherapy, so this wider group is this site's cautious rule.

Call your care team within a day or two if your 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
• https://www.cdc.gov/cancer-preventing-infections/patients/symptoms.html
• https://www.cdc.gov/blood-clots/risk-factors/cancer.html
• https://www.cdc.gov/stroke/signs-symptoms/index.html