7- Keep it Moving – Home Exercise Program (HEP) and Scar Tissue Mobilization for Post-Mastectomy

Road Map to Recovery

1. Mastectomy
2. 6 weeks of tissue healing
3. Rehab to normalize shoulder mobility and core strength –> Return to function
4. Reconstructive breast surgery
5. Rehab to continue shoulder strengthening and activity specific –> Return to activity/sport/work

Home Exercise Program (HEP)… What is that?

Physical therapists provide some “homework” for you to perform on days you don’t have a session to maintain the progress achieved with your therapist.  These usually include exercises to keep working on your range of motion (ROM), strength, and good posture.  

During your physical therapy sessions, your PT will assess your mobility, strength, endurance and more, and create a home program specific to your needs. It will also include scar tissue mobilization. 

Scar Tissue Mobilization

Scar tissue can be tender to touch, painful, stiff, and cause discomfort with everyday tasks like reaching for overhead cabinets, dressing, washing your hair, and even just trying to stretch from sitting. 

Start by pushing skin around your scar very gently. Sink your finger down until you feel resistance and then gently move your fingers up, down, left, and right. Go around your scar and hold for a few seconds at spots that you notice are more “stuck”.  Move in towards the scar and onto the scar. You may need to adjust the pressure depending on how sensitive you are.  If it is causing too much pain, back off and mobilize the surrounding tissues instead. 

Exercises to get you started

1. Dowel-Assisted Shoulder Mobility: 

Using the dowel, you’re going to have the unaffected arm help your arm move.  The arm you are trying to improve should be relaxed with no tension throughout the movement. See if you notice your shoulders shrugging up. Try to keep them down and relaxed. The video shows 3 motions: Flexion, Abduction, and External Rotation

2. Towel Slides: 

Grab a towel and place your hand on the wall.  You’ll move your hand in various positions in a pain free range at first. Make sure your shoulder stays down and back off if it is too painful.  with no tension throughout the movement. See if you notice your shoulders shrugging up. Try to keep them down and relaxed. The video shows 3 motions: Flexion, Diagonals (both ways!), and Rainbows

3. Shoulder Blade Squeezes: 

You want to strengthen the muscles between your shoulder blades as well.  While keeping your shoulders down, squeeze your shoulder blades together to the center towards your spine. Your chest shouldn’t pop out and make sure you’re breathing! 

4. Rows:

This one is the next step after you master the shoulder blade squeezes. If you have a elastic band, hold the ends while hooking the center to a sturdy surface. Keeping your shoulders from shrugging up, squeeze your shoulder blades back together while also pulling the band back. Your arms and shoulders should be working together.  Control the band from snapping your arms forwards and repeat. 

If you have more questions, please book an appointment with Dr. Ann DeGrey, PT, DPT, SCS or Dr. Lei Lee, PT, DPT for more information and to develop a plan!