October is breast cancer awareness month. According to BreastCancer.org, approximately one in eight women will develop breast cancer and over 250,000 new cases of invasive breast cancer are expected to be diagnosed in the United States.

The effects of breast cancer treatment – both during and after – can have long term effects on the body. We’ve compiled some physical therapy exercises to help support the healing process for both survivors and those still battling breast cancer.

Posture matters

Whether you’ve had surgery, radiation or both, your body goes into protect mode. In terms of your posture, protection mode means slouching forward or rounding your shoulders inward. This will lead to even tighter soft tissue in the front of the chest (pecs), axilla, and shoulders which can eventually lead to pain or a frozen shoulder.

For good posture and alignment, you want:

• *the center of your ear to line up with the tip of your shoulder
• *the tip of your shoulder should be in line with your hip, knee, and ankle.
• *your breast bone (sternum) should be directly over the top of your pubic bone, not too far forward or back.
• *grow tall from the crown of your head while keeping the above alignment

It’s not easy to maintain good posture, but being aware is half the battle! If you feel you are having difficulty finding the correct posture / alignment, ask your physical therapist to help you!

Strength Training is a Good Thing

A study done in 2008 at the University of Pennsylvania, found that an upper body strengthening program could help lessen the effects of lymphedema, a common complication from breast cancer (Kathryn H. Schmitz, 2009). Building strength also helps with being able to maintain a better postural position and improves overall function and ease of movement.

Remember to BREATHE

Breathing is important for obvious reasons, but it also has several other beneficial effects. Practicing diaphragmatic (belly) and lateral rib breathing (breathing into sides or back) can help:

• *relax tense muscles around the head, neck, and chest
• *strengthen some of the postural muscles in and around the rib cage
• *relax your pelvic floor muscles which can become over tightened as a protective / guarding mechanism in the body.

Practicing breathing also helps to calm your mind and clear your head and is used in most mindfulness or meditation practices.

Scar mobilizations

After radiation therapy or breast surgery, there may be a significant amount of scar tissue around the armpit, collarbone, or chest. This scar tissue or connective tissue restrictions can become quite painful and adhered to the muscles, fascia, and bones below. This can limit mobility and further add to a guarded, protective posture.

There are certain scar mobilization techniques that can be used to help move the scar tissue and improve the mobility of the muscle, fascia, and soft tissues. A physical therapist can instruct you in specific scar mobilization techniques that are right for you. However, you can start by very gently trying to desensitize the scar tissue yourself.

To do this:

• *make sure the incisions are well healed
• *using some lotion or coconut oil, gently massage the scar with small circles.
• *You also can gently pull the scar in all directions with the pads of your fingers.

You may feel some tenderness, but there should be no major pains or bruising. The tenderness should not last very long.

Exercises

Stretching can be very helpful for preventing the protective posture and allowing the scar tissues to further adhere. Here are a couple of upper body stretches that can be very helpful. All stretches should be held a minimum of 30 seconds and repeated 2-3x/day.

Door pec stretch:

• *Stand in a doorway with your arms in the doorway, arms elevated to 90 degrees from your sides and your elbows bent
• *Lunge one foot forward while keeping your arms in the doorway
• *Keep your chest up and head in line with your body (don’t jut your chin forward)

You will feel a stretch across your chest, front of shoulder, and possibly in your armpit. This will stretch your pec major. You can stretch your pec minor by doing the same stretch, but move your hands down to the sides of your body in the doorway with the elbows straight. (See pictures).

Neck stretches

You also want to stretch the muscle on the front of your neck because these are connected by fascia to the chest muscles and fascia.

For a scalene stretch:

• *put your right hand on your chest, just below your right collar bone and give a little downward (toward your feet) pull.
• *turn your head to the left and look up to the ceiling, slightly tilting your head back until your get a stretch in the front of your neck.
• *Make sure you keep your shoulders relaxed and don’t hike them towards your ears! (See picture)

Upper back strengthening

It is also beneficial to strengthen your upper back to fight off that protective posture, improve your overall ease of being able to move, lift, carry, and to prevent further chest adhesions.

If you have an exercise ball at home, a nice exercise for improving your upper back strength, is called T’s and Y’s:

• *lay across the ball, chest down, legs out straight (can put feet against wall for increased stability)
• *put your arms at your sides with the elbows straight.
• *bring them up to a 90 degree angle like a T
• *with your thumbs to the ceiling, lift your arms up and squeeze your shoulder blades together gently. You don’t have to squeeze them as hard as you can.
• *Do 10 repetitions in the T position. (see pictures)
• *Next, move your arms forward, about 45 degrees from your ears, and do the same thing. Now you are in the Y position.
• *With your thumbs to the ceiling, lift your arms and squeeze your shoulder blades together and down towards your low back.
• *Repeat 10 times in the Y position. (See pictures).

We hope that whatever stage of diagnosis or healing you are in, you are able to find these tips useful in managing your symptoms. We highly recommend seeing a physical therapist to have a full evaluation of the soft tissues, posture, strength, and functional movement. The physical therapist will also help set goals that are personal to you and your needs to improve your quality of life and return to full function. Call us at Rebalance Physical Therapy if you have any questions!

Article written by Elayne Geba

Citations:

Weight Lifting in Women with Breast-Cancer–Related Lymphedema

Kathryn H. Schmitz, Ph.D., M.P.H., Rehana L. Ahmed, M.D., Ph.D., Andrea Troxel, Sc.D., Andrea Cheville, M.D., Rebecca Smith, M.D., Lorita Lewis-Grant, M.P.H., M.S.W., Cathy J. Bryan, M.Ed., Catherine T. Williams-Smith, B.S., and Quincy P. Greene

N Engl J Med 2009; 361:664-673August 13, 2009DOI: 10.1056/NEJMoa0810118