Question
How quickly can a client begin exercising a shoulder after a mastectomy? Are there specific exercises to perform with the upper extremity to minimize scarring? How often should the exercises be performed?
Answer
If you are seeing patients post-surgically, you will want to talk to the surgeon. After a mastectomy, you also want to think about other surgical procedures the patient may be having or may have had. Some women will have a mastectomy without concurrent surgeries; however, a lot of women are now getting reconstruction at the time of surgery or getting spacers in planning for implants. The short answer is that you want to wait until after the drains are removed. You want to see that the patient is starting to get healing of their tissues.
As far as specific exercises to perform with the upper extremity to minimize scarring, there is no research on specific guidelines that you can follow. Most surgeons have some recommendations. What we have done is give our surgeons the exercises and general range of motion activities that we recommend. We do not want the patients doing anything that is going to cause impingement of the shoulders. Our surgeons, at one point, were giving out shoulder abduction, but we got rid of that and gave them a more appropriate shoulder flexion exercise. We have found that, in general, wall walking is not a good exercise post mastectomy. If a patient does not have good range of motion, as they walk their arm up the wall, they will just elevate their shoulder girdle and will end up with an impingement. I would stay away from wall walking. Sometimes sitting in a chair and doing trunk forward flexion and walking the arm forward on the table will actually give great shoulder flexion and allows the scapula to separate from the shoulder flexion movement.
