Breaking the Cord: From Restriction to Recovery After Breast Cancer Surgery
Jul 08, 2025“It felt like a tight string running from my armpit to my inner arm.
Every time I reached for something, it pulled.”
If that sounds familiar, you’re not alone. Axillary web syndrome (AWS), also known as
“cording”, is one of the most common side effects of breast cancer surgery. It frequently follows
procedures involving lymph nodes, such as sentinel lymph node biopsy (SLNB) or axillary
lymph dissection (ALND), and can also occur after radiation therapy.
AWS can affect up to 72% of breast cancer at various stages. Symptoms typically appear within 2-6 weeks post-surgery, but sometimes much later (1). It can make simple tasks like stretching, dressing, and lifting not only challenging but also painful (2,3).
The good news? AWS is highly treatable (4). With the proper evidence-based care and early
intervention, you can restore your movement and reclaim your confidence.
�� What Is AWS and Why Does It Matter?
AWS occurs when tight cords of scar tissue form under the skin, typically running from the
armpit down the inner arm, and sometimes as far as the wrist or chest wall (3). These “cords”
cause pain and restrict range of motion, especially during overhead reaching or stretching, often interfering with everyday activities.
❌ Why You Shouldn’t Ignore It
Left untreated, AWS can lead to chronic pain, shoulder stiffness, and fear of movement, all of
which delay both physical and emotional recovery and negatively impact quality of life (5).
�� Survivors who receive integrated cancer rehabilitation and a tailored exercise plan
report less pain, improved shoulder mobility, and greater confidence returning to their
daily life.
�� Healing Through Integration
Evidence-based approaches that combine Specialized Cancer Physiotherapy with Structured
exercise significantly accelerate recovery.
Manual therapy techniques, skin and tissue mobilization, and neurodynamic movements help
gently release the cords, while personalized exercise restores strength, mobility, and posture
(4,5,6,8).
��️ “I felt a pop—and suddenly I could lift my arm again. It was emotional.”
As pain decreases and mobility returns, a CETI OncoVie TM Cancer Exercise Specialist (CES)
introduces progressive, gentle routines that include light resistance training, scapular control
exercises, and postural-focused exercises tailored to each person’s stage of healing.
This isn’t about pushing hard—it’s about moving forward safely.
�� What Recovery Should Look Like
Patients who receive both physiotherapy and targeted exercise show faster recovery, less pain, and improved function compared to those who use only one approach.
✅A study involving 92 AWS patients revealed that after three weekly sessions, 98%
regained full shoulder range of motion, and 64% had no detectable cords after
around nine sessions (7). Early intervention plays a crucial role in reducing discomfort and
allowing the timely continuation of cancer treatments like radiation therapy.
�� You Are Not Alone in This Journey
Recovery from AWS doesn’t have to feel frustrating and isolating. With proper support, your
arm can regain its strength, mobility, and pain-free function.
You don’t have to choose between therapy and exercise. Well–integrated care bridges the gap
between surviving and truly living.
�� Ready to Reclaim Your Strength?
Whether you're a survivor or a professional, we are here to support your journey.
Let’s move forward—together.
Marie-Antoniette is a Doctor of Physical Therapy with extensive clinical, teaching, and research expertise, specializing in women's health including pelvic floor rehabilitation, Breast cancer rehabilitation, Prenatal and Postnatal Fitness & Therapeutic Yoga across Canada and Lebanon. A Licensed member of the "Ordre Professionnel de la Physiothérapie du Quebec", and the Order of Physiotherapists in Lebanon. I have delivered high-quality patient care, taught at the University of Montreal, and participated in research. I have committed to evidence-based practices, conferences, and continuing education courses.
She has her Doctorate in physical therapy (DPT) from the University of Montana, USA (2023), Rehabilitation Administration Certificate from the University of Montana, USA (2023), Qualification program in Physiotherapy (QPP) from the University of Montreal, Canada (2016), Master of Physiotherapy (MSc PT) from the Lebanese German University, Lebanon (2011), Bachelor of Physiotherapy from the Lebanese German University, Lebanon (2008), and Padma yoga and Physiotherapy (2021).
References:
1. Koehler, L., Day, A., Hunter, D., Blaes, A., Haddad, T., & Shanley, R. (2022). Five-year
cumulative incidence of axillary web syndrome and comparison in upper extremity
movement, function, pain, and lymphedema in survivors of breast cancer with and
without axillary web syndrome. Archives of Physical Medicine and Rehabilitation,
103(9), 1798–1806. https://doi.org/10.1016/j.apmr.2022.03.007
2. Yeung, W. M., McPhail, S. M., & Kuys, S. S. (2015). A systematic review of axillary
web syndrome (AWS). Journal of Cancer Survivorship, 9(4), 576–598.
https://doi.org/10.1007/s11764-015-0435-1
3. Dinas, K., Kalder, M., Zepiridis, L., Mavromatidis, G., & Pratilas, G. (2019). Axillary
web syndrome: Incidence, pathogenesis, and management. Current Problems in Cancer,
43(6), 100470. https://doi.org/10.1016/j.currproblcancer.2019.02.002
4. González-Rubino, J. B., Vinolo-Gil, M. J., & Martín-Valero, R. (2023). Effectiveness of
physical therapy in axillary web syndrome after breast cancer: A systematic review and
meta-analysis. Supportive Care in Cancer, 31(5), 257. https://doi.org/10.1007/s00520-
023-07666-x
5. Koehler, L. A., Haddad, T. C., Hunter, D. W., & Tuttle, T. M. (2018). Axillary web
syndrome following breast cancer surgery: Symptoms, complications, and management
strategies. Breast Cancer: Targets and Therapy, 11, 13–19.
https://doi.org/10.2147/BCTT.S146635
6. Torres-Lacomba, M., Prieto-Gómez, V., Arranz-Martín, B., Ferrandez, J. C., Yuste-
Sánchez, M. J., Navarro-Brazález, B., & Romay-Barrero, H. (2022). Manual lymph
drainage with progressive arm exercises for axillary web syndrome after breast cancer
surgery: A randomized controlled trial. Physical Therapy, 102(3), pzab314.
https://doi.org/10.1093/ptj/pzab314
7. Borg, M. B., Mittino, L., Battaglia, M., Loro, A., Lanzotti, L., Invernizzi, M., & Baricich,
A. (2023). Tolerability, safety and efficacy of a specific rehabilitation treatment protocol
for axillary web syndrome: An observational retrospective study. Cancers, 15(2), 426.
https://doi.org/10.3390/cancers15020426
8. González-Rubino, J. B., Martín-Valero, R., & Vinolo-Gil, M. J. (2025). Physiotherapy
protocol to reduce the evolution time of axillary web syndrome in women post-breast
cancer surgery: A randomized clinical trial. Supportive Care in Cancer, 33(4), 326.
https://doi.org/10.1007/s00520-025-09373-1
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