Breast Cancer Care: Alleviating Chest & Shoulder Tightness During Treatment
With October being Breast Cancer Awareness month, I thought this would be a great time to discuss strategies for managing symptoms during breast cancer treatment and recovery. As a physical therapist specializing in women's health, I've seen firsthand how breast cancer treatment creates new areas of tension and discomfort in the body. Today we'll explore some ways you can manage these side effects both at home and at the clinic.
Treatment Side Effects & Symptoms
Two common treatment approaches for breast cancer include radiation therapy and surgical procedures, such as partial or total mastectomies. While these treatments play an important role in breast cancer care, they can also lead to side effects that affect daily activities and overall mobility.
Patients undergoing radiation therapy may experience skin changes, fatigue, breast swelling, tenderness, discomfort, and tightness throughout the chest and shoulder region. Similarly, following a mastectomy, patients may experience decreased shoulder and chest wall mobility due to swelling, tissue restrictions, and scar tissue formation around the surgical area.
Alleviating Muscle Tension & Tightness
A common source of discomfort during and after breast cancer treatment is tightness across the front of the chest, through the pectoral muscles, and into the armpit. These restriction can make it difficult to raise the arm overhead, reach behind the back, get dressed, or comfortably perform everyday activities.
The good news is that there are strategies to help improve mobility and manage these symptoms. Gentle movement, appropriate stretching, and physical therapy can help address chest and shoulder tightness, improve range of motion, and support a return to daily activities.
Let's review some strategies to help manage chest wall and shoulder tightness during and after breast cancer treatment, with the goal of maintaining mobility, improving comfort, and supporting recovery.
1 - Self-Massage for Chest and Shoulder Tightness
Gentle self-massage can help address tension in the muscles and connective tissues (fascia) throughout the front of the chest, shoulder, and armpit. These areas may become tight following surgery or radiation therapy, potentially contributing to restrictions in shoulder movement.
Use light to medium pressure and slow movements, working across the front of the chest and toward the armpit. Avoid excessive pressure, particularly around any sensitive skin, healing incisions, or areas affected by radiation. This can be done over your clothes or on bare skin with a little lotion.
⚠️ When to Stop: This technique may cause discomfort, but it should not be painful. If it is painful, lighten your pressure, and if pain persists, stop doing the massage. Do not massage over any fresh surgical incisions or other open wounds.
2 - Shoulder Mobility Exercises
Gentle shoulder and chest mobility exercises are a great way to work on improving range of motion without unnecessarily increasing fatigue. The following movements may help improve mobility and flexibility.
Try incorporating these exercises 3–4 days per week, as tolerated and in accordance with your healthcare team's recommendations. Move slowly and stay within a comfortable range. Avoid forcing the movement or pushing through pain.
Seated Towel Slides
These seated towel slides should be performed on a stable surface like a table or bed. With palms facing down, slide the towel across the surface, hinging at your hips so that the push comes from the movement of your torso leaning forward, rather than your shoulders pushing out. Your arms should feel relaxed as you gently increase the mobility and range of motion of your shoulders. Repeat for 10 reps.
Doorway Pec Stretch for Chest
Standing in a doorway, place your palm against the wall and lunge through the doorway with the same-sided leg. Repeat for about 10 reps. Next, move your hand further down the wall to around hip-height, and perform the lunges again. Repeat on the opposite side. You should feel a gentle stretch across the pectoral muscles of your chest.
Step-Back Doorway Shoulder Stretch
Standing in front of a doorway, grab the edge of the doorframe with one arm around head-height, and press the other palm flat against the wall in front of you. Take a small step back, bending forward at the hips and feeling a gentle stretch in the shoulder and armpit area. Repeat on both sides for 10 reps each.
Dowel Pendulums - Shoulder Mobility Exercise
Using a dowel (such as a PVC pipe, wooden dowel, or other household item like a lightweight mop or broom), hold the dowel diagonally in front of you, and gently swing it up and down diagonally in an arcing movement. Next, holding the dowel horizontally, swing up and to the side. You should feel this movement in your shoulders, the bottom hand should be driving the movement, while the upper hand stays relaxed. Repeat on both sides for 10 reps each.
3. Swelling & Edema Management
If you’re experiencing fluid buildup and discomfort around the chest and shoulder, manual lymphatic drainage can help to manage that swelling or edema.
The lymphatic system helps regulate fluid levels throughout the body. It consists of a network of vessels and lymph nodes that transport excess fluid back into the circulatory system. During breast cancer treatment, some lymph nodes may be affected by radiation therapy or removed during surgery, which can impair lymphatic drainage and increase the risk of swelling, including lymphedema.
A trained healthcare professional can help to determine the most appropriate swelling-management strategies. Manual lymphatic drainage is a gentle technique used to aid the body in moving excess fluid along. Here’s how it works:
Step 1: Begin with proximal lymphatic pathways.
Lymphatic drainage techniques typically begin by preparing the central and nearby lymphatic pathways. This involves very light, gentle skin-stretching movements rather than deep massage. The appropriate areas and sequence depend on the individual's surgical history and lymph node treatment.
Step 2: Address the shoulder and upper arm.
Gentle, superficial strokes may be used to encourage fluid movement along appropriate lymphatic pathways. The direction of these strokes should be individualized, particularly if lymph nodes have been removed or treated with radiation.
*Important Disclaimer: Manual lymphatic drainage requires individualized instruction, especially after breast cancer surgery or radiation therapy. Avoid assuming that fluid should always be directed toward the armpit on the affected side. A certified lymphedema therapist or oncology-trained physical therapist can teach the safest and most appropriate technique for your situation.
Physical Therapy for Breast Cancer Care
A specialized physical therapist can provide a personalized plan of care to reduce pain, alleviate tension, and improve mobility. If you're in the San Diego area, consider Rehab United your trusted partner in breast cancer care and recovery. Our dedicated pelvic health team is trained to provide support for an array of women's health issues, including oncology care and post-mastectomy recovery. We also provide manual lymphatic drainage services through our medical massage partner, Resolve Wellness. Their specially trained massage therapists provide effective care for post-op recovery, oncology massage, and lymphatic drainage.
About the Author: Madison Hasley, PT, DPT - Madison graduated from the University of Wisconsin-River Falls with a bachelor's degree in Exercise and Sports Science and earned her Doctorate of Physical Therapy from Regis University in Denver, Colorado, in 2025. During her DPT program, she worked with mentors who guided her toward her specialty in Pelvic Health. She is now a Pelvic Health specialist at Rehab United of San Diego, specializing in women's health, including pregnancy and postpartum care.
This Article was Medically Reviewed by: Brynn Frauenhoff, PT, DPT - Brynn is the Pelvic Health Department Lead at Rehab United of San Diego. Brynn earned her Doctorate of Physical Therapy from Baylor University. She has since taken continuing education courses to hone her knowledge in Pelvic Health, including Herman and Wallace 1 and 2A, Female Chain Reaction, and ICE Pelvic Live. With this training, she is able to better understand and treat the pelvic floor in conjunction with the rest of the body.