October is National Breast Cancer Awareness Month. It is very common for breast cancer patients to pain in and around the shoulder blade area, whether due to surgery, chemotherapy, or radiation therapy. Those treatments may have changed the muscles, ligaments, and collagen fibers in the treated area, which makes it harder to move the arm freely.
Most commonly, many women suffering from breast cancer decide to undergo surgery, whether it is a lumpectomy, biopsy, breast reconstruction or mastectomy. Due to the anatomy of the anterior (front) chest and shoulder musculature, the most typical shoulder diagnosis physical therapists see of breast cancer patients is a common post-op complication known as adhesive capsulitis, colloquially known as frozen shoulder.
Frozen shoulder is when the muscles of the anterior shoulder and chest become significantly tight, causing the shoulder capsule to tighten. When this occurs, the shoulder joint pulls forward, tightening the two most important postural muscles of the shoulder girdle – the upper trapezius in the back of the shoulder, and the pectoralis major in the front of the shoulder. Pain, stiffness and limited range of motion result, affecting the ability of a person to lift their arm up overhead or reach behind their back.
Recognizing that frozen shoulder can occur as a result of any of the aforementioned surgeries is the first step to understanding post-operative rehabilitation. Dr. Cheryl Abelow, owner of FlexPlus Physical Therapy & Balance Centers in MetroWest and physical therapist in Natick, "Adhesive capsulitis, or frozen shoulder, can be difficult to overcome if you let it go too long. It's very important to know how effective simple stretching and mobility exercises can be to help alleviate the signs and symptoms of adhesive capsulitis."
Good posture is the most important tool in alleviating the effects of frozen shoulder. This means standing or sitting up straight, looking straight ahead, with relaxed shoulders. Here are some examples of stretches to help correct the muscle imbalances:
1. Upper trap stretches: To stretch out the largest neck muscle, place one hand on top of your head and pull the head towards the same ear as the arm that is lifted. Hold for 30 seconds and repeat three times. For a more intense stretch, place the opposite arm behind your back.
2. Doorway pec stretch: Stand inside a doorway and rest both forearms on the door. Step forward with the right foot and gently lean in, feeling a good stretch on the front of both pecs. If the doorway is too wide or you have trouble resting your forearms along the doorway, use the corner of a wall to facilitate the same stretch. Hold for 30 seconds and repeat three times.
In addition to stretches, range of motion exercises are necessary to decrease shoulder capsule tightness and improve mobility of the arm. Here are some examples to help improve your range:
1. Pendulum circles: Rest one arm on the back of a chair or table. Stand while slightly leaning forward and allowing your arm to dangle. Circle the shoulder in small arcs, 30 times clockwise followed by 30 times counterclockwise. Repeat two more times each direction.
2. Wand exercises:
Holding a wand or cane or broom in your hand, lift the arms straight up in front of you as high as you can ten times. Perform 3 sets. This helps improve forward flexion and reaching overhead.
Hold a wand or cane in your hand, lift the arm straight out to the side of the shoulder you want to work on. Lift the arm as high as you can ten times. Perform 3 sets. This helps improve reaching the arm up and out to the side.
These exercises and stretches are only part of a comprehensive plan that a physical therapist would develop to treat adhesive capsulitis. You should always check with your doctor or a physical therapist before beginning any plan of care, especially if you have other health issues.
Donate to support breast cancer research at The National Breast Cancer Foundation.
If you or someone you know is suffering from shoulder pain or anything else, please call FlexPlus Physical Therapy & Balance Centers at (508) 650-0060 to set up an evaluation and get back on the road to recovery. We provide physical therapy in Natick and physical therapy in Southborough.
If you're not sure if physical therapy is for you, ask for a free consultation to meet our doctors and learn if physical therapy is the right choice for you!