So many people have been told to regain their arm movement after breast cancer surgery by using the exercise: walk your fingers up the wall. People are told to gradually work towards getting their fingers higher and higher up the wall. Unbeknown to most breast surgeons, this exercise places people at risk of losing their natural shoulder movement.
I posted my concerns regarding the “walk up the wall” exercise on Linkedin yesterday- as I was hoping to snatch the attention of breast cancer surgeons, oncologists and cancer clinic breast care nurses across the world, with who I have made professional connections. The great news is other leaders in oncology rehab agreed and provided their support to the Linkedin post.
Nicole Stout, a leading Physical Therapist in the USA, has published widely on the need for Surveillance Pathways and oncology rehab for cancer survivors to reduce pain and functional limitations, shared my concerns and added:
If you do only ONE THING for the rest of your professional career: stop giving women ‘wall walking exercises’ after #breastcancer surgery. STOP. The mechanics of the scapula WILL become dysfunctional, your patient WILL develop compensatory strategies. You can do better with scapula muscle recruitment and stabilization exercises.
Molly Sleigh, an Oncology Rehabilitation Specialist in the USA added:
Denise Stewart Yes we’ve had to hold many discussions, in particularly with the plastic surgeons, to explain why we do not begin immediately post-op with overhead reach.
In our clinic, we begin post-op (care) with scapular mobilization ONLY. This must improve before reaching overhead to avoid impingement. Thanks Denise!! We hate those damn wall walking exercises too.
Sally Kerr, an Australian Physiotherapist and Lymphoedema therapist added:
Totally agree; as well as assessing scarring, muscle, and fascial limitations to movement (and resolving these) the dynamic action of the shoulder girdle needs assessment and rehabilitation to prevent ongoing issues. Not just a couple of post-operative sessions but over the time frame of tissue healing.
Well, I don’t need to add much more to explain my concerns- as these skilled and experienced therapists have offered great explanations as to why this exercise is wrong and why people need to have good shoulder care and care over a much longer period of time than is usually expected and advised by most breast surgeons.
In the Linkedin post I added two research paper reviews as I know that doctors prefer to see that new ideas are evidence-based:
1. Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection 2014
2. Serratus Anterior Fatigue Reduces Scapular Posterior Tilt and External Rotation During Arm Elevation 2021
But it's not a new idea! There's heaps of research describing poor shoulder recovery. In the late 1990s, lymphoedema research papers reported on the issue of persistent arm swelling, as it was new then! and often reported that women had on average 20-30 degrees loss of arm movement.
Prof Delva Shamley found muscle changes, smaller size and lower electrical impulses, at the shoulder way back in 2007. Delva reported finding 3 or 4 muscles at the shoulder has significantly less nerve signalling especially when lowering the arm from a raised position. Delva's team also found that the chest muscles, pectoralis major and minor, were significantly smaller on the side of surgery and radiotherapy than on the other side.
This finding of a reduction in the size of the chest muscles and increased stiffness has been reimagined in way more complicated and technical research methods in 2019.
So the research does support that there are real impairments at the chest, following surgery and radiotherapy.
This also means that arm-stretching has not worked in the past to regain good shoulder movement and function.
The great news is that in 24 hours, some doctors have read the post. Because the post remains active ( forever), I'm hoping for many more shares, reads and thumbs-up responses.
The bad news is that most people after breast cancer surgery don’t get the ongoing support they need to help them gain good shoulder movement and reduce the pain that can be associated with tightness at their chest and breast.
So this means that women (and men), need to take their own informed action after breast surgery.
I would suggest these recommendations should be considered:
1. Cease doing walk up the wall exercises especially if your chest feels tight or stiff.
2. Find an oncology therapist with scar skills; either local or online, to help gain more elasticity at your chest and better shoulder movement. Type in your postcode here: www.foundation96.com
3. Share this news with your local doctor and breast cancer connections.
I’m happy to help you if you don’t have a local therapist.
There’s a lot you can learn to do differently, even in an online video appointment.