Hi, I’m Renee Leahy, and I’m a physiotherapist with the psychosocial oncology programat The Ottawa Hospital Cancer Program.This video was developed to provide you with general guidelines and information on exerciseto help you recover from your breast surgery.Remember, everyone is different, follow the suggestions that feel right for you.If you have recently been diagnosed with cancer, it is important to take special care of yourself.Studies show that one of the best ways to do this is by staying physically active.It is wise to include some regular form of exercise to your daily life even during cancer therapy.Moderate aerobic exercise such as riding a bicycle, or taking a daily walk, as well asthe use of lightweights for strength training can enhance your physical wellbeing, and encourage your recovery.A question I often get from patients is how much exercise do I have to do.We often suggest 150 minutes of moderate exercise per week, such as a brisk walk,or 75 minutes of more vigorous exercise per week.If you are already there, fantastic, keep up the great work.These guidelines will apply at all times with exception of the 4 to 6 weeksfollowing your breast surgery which I will go into in detail later.In this video we will be going through the arm exercises that will be important following your breast surgery.The goals of doing these exercises are to minimize any pain and stiffness that may happen after surgery.To assist in return of your full range of motion, to regain your strength, to improve your overall sense of wellbeing,and to give you a greater sense of control, you can be an active participant in your own recovery.These exercises are something that you can do to make yourself better.These exercises are also important if radiation is part of your treatment plan.The radiation team may ask you to raise your arm in a position like thisas this is the best position for treatment.In the first 4 to 6 weeks following your breast surgery, you should use youraffected arm as normally as possible.It’s allowed to be uncomfortable, but not painful.You can use your arm for light activities such as brushing your hair or brushing your teeth.Be sure to pace yourself, and balance periods of activity with periods of rest.You can walk making sure that you’re allowing your arms to swing freely by their sides.And also maintain a good posture.Some things to avoid during the 4 to 6 week period after your surgery.You should not get out of bed using the arm on the side of your surgery.You should avoid sudden movements until your drain is removed and the incision is healed.Do not lift greater than 2.5 poundsfor two weeks after your surgery.And do not lift more than 10 pounds until 6 weeks after your surgeryDo not drive if you have limited movement of your arm, or if you have a drain,or if you are taking pain medication with narcotics.If you have any questions about these guidelines, please contact a member of your healthcare team.I will be reviewing two phases of exercises.The first set are to be done right after surgery.The second set is to be done once your drain is removed, or after five days.These exercises can be found in a booklet that will be given to you by your healthcare team.Anna will help me to show you the exercises to be done right after surgery.The first exercise is called pump it up.This exercise helps reduce swelling after surgery byusing your muscles as a pump to improve your circulation in your affected arm.This exercise can be done sitting, or lying down.Slowly open and close your hand. Repeat 15 to 25 times...approximately 3 times per dayThen slowly bend, and straighten your elbow. Repeat 15 to 25 times...3 times per day.The next exercise is shoulder shrugsand shoulder circles.This exercise can be done sitting or standing.Lift both shoulders up towards your ears, hold for 5 to 10 seconds then slowly drop them down.Repeat 5 to 10 times. Gently rotate both shoulders forward, and then slowly backwards.Repeat 5 to 10 times in each direction... approximately 3 times per day.The next exercise is arm lifts.This exercise can be done sitting or standing.Clasp your hands together, and slowly lift your arms upward until a gentle stretch is felt.Hold for one to two seconds then slowly return to your start position.Repeat 5 to 10 times...approximately 3 times per day.The next exercise is shoulder blade squeeze.This exercise helps improve movement,in your shoulder blade region, and helps your posture.Gently squeeze your shoulder blades together, keep your shoulders level,and take care not to lift up or shrug your shoulders.Hold for five to ten seconds, relax, and return to your start position. Repeat 5 to 10 times.This can be done approximately 3 times per day.The next set of exercises are called the first stage of healing.These exercises can begin once your drain is removed, or after 5 days if you do not have a drain.The next exercise is called the wand exercise.This exercise helps improve the forward movement of your shoulder.You will need a wand to do this exercise. You can use a broom handle, stick, or a cane.You should not feel any pain or pinching during these exercises.If you do, stop the movement before the point of pain or pinching.To start, lie on your back with your knees bent. Hold the cane with both hands.Your palms should be facing down, and your hands shoulder width apart, and your elbows straight.Lift the wand over your head as far as you can go until you feel a gentle stretch.Your unaffected arm will help lift the wand. Hold for one or two seconds then lower your arms.Repeat 5 to 10 times... approximately 3 times per day.The next exercise is called winging it.This exercise helps improve movementin the front of your chest and shoulder joint.To begin, lie on your back with your knees bent.Bring your hands behind your neck with your elbows pointing upward.If you are unable to comfortably place your hands behind your neck,place your fingers on your forehead with your palms facing up.Move your elbows apart, and down to the bed, hold for 1 to 2 secondsRepeat 5 to 10 times...approximately 3 times per day.The next exercise is to help your posture.This exercise helps to improve movementin your shoulder, and your posture.You may find it easier to check your movements by standing in front of a mirrorGently squeeze your shoulder blades together, and then rotate your thumbs so that your palms face forward.Hold for 5 to 10 seconds, relax, and return to the start position.Repeat 5 to 10 times...approximately 3 times per day.The next exercise is wall climbing.This exercise helps increase movement in1your shoulder joint. Try to reach a little1higher up the wall each day.1Stand facing the wall as close as is comfortable. Place both your hands on the wall at shoulder level.1Use your hands to slide up the wall, as high as you can go, until you feel a stretch.1Hold for 5 seconds, slowly return to the start position.1Repeat 5 to 10 times...approximately 3 times per day.1The next exercise is called snow angels.1This exercise can be done sitting,1or lying down on the floor or bed.1First, extend your arms out at your sides, move them up to your head,1and down to your thighs as though you are making a snow angel.1Repeat 5 to 10 times...approximately 3 times per day.1Once you are getting good movement in your shoulder, try this more advanced stretch.1This exercise is called side bends.1It helps to improve movement on1on both sides of your body.1Sitting with your hands clasped together in your lap, slowly lift your arms up overhead.1When your arms are above your head, bend at your waist and move your body to the right.1Hold 1 to 2 seconds.1Return to the centre, and then bend to the left, holding for 1 to 2 seconds.1Repeat 5 to 10 times... approximately 3 times per day.1When doing the exercises you should see an increase in your pain free movement,1and a gradual decrease in the feeling of stretch under your arm, and across your chest.1Keep doing these exercises until you have returned to1what you could do before surgery.1On average this may take up to 2 or 3 months.1If you shoulder movement is not improving within the first 3 to 4 weeks1after surgery, let your healthcare team know.1You may need a referral to a physiotherapist.1Many patients I work with ask about lymphedema following breast surgery.1Lymphedema is a buildup of lymph fluid either in the arm or the chest wall on the side that you have had surgery.1This can occur when lymph nodes have been removed or damaged,1and there is more fluid than your lymph system can handle.1Sometimes this excess fluid is slow to leave the tissues, leading to a swelling of the arm or your chest wall.1Some early signs and symptoms of lymphedema may include:1tightness of the skin, shirt sleeves becoming tight, swelling in the arm or chest wall,1decreased movement or decreased flexibility.1Some people describe a tingling sensation in their arm, or a feeling of heaviness in the limb.1Do not fear lymphedema, it is not painful, it is not life threatening, and it can be controlled with self management.1Early recognition and treatment of lymphedema provides the best outcomes.1We hope that you have found this information helpful.1Just a reminder: talk to your healthcare team if you have any questions or concerns.
