12/03/2025
Breast cancer is one of the most common diagnoses worldwide, and survival rates continue to rise. Yet despite how many individuals navigate this diagnosis, breast cancer rehabilitation remains one of the most underdeveloped and misunderstood areas of physiotherapy.
Ask most clinicians what breast cancer rehab involves, and the answers typically fall into two categories:
Shoulder range of motion exercises
Lymphedema assessment and management
While these are vital components, they represent only the tip of the iceberg. Post-breast cancer rehabilitation is far more complex—physically, emotionally, and functionally—than our current systems acknowledge.
Why Breast Cancer Rehab Is More Than We’ve Been Taught
Breast cancer survivors rarely present with a single issue. Instead, they often arrive with a constellation of symptoms shaped by surgery, radiation, chemotherapy, hormonal therapy, and the emotional experience of survivorship. These can include:
Chest wall tightness and restricted rib mobility
Scar adhesions or sensitivity
Post-radiation fibrosis and tissue stiffness
Persistent or neuropathic pain
Postural changes
Axillary web syndrome (cording)
Fatigue and deconditioning
Pelvic floor dysfunction (from hormonal treatments or surgical menopause)
Sleep disturbances
Body image concerns
Cognitive overload (“chemo brain”)
Emotional overwhelm
These symptoms can compound, overlap, and evolve over time—often months or years after treatment ends.
Yet many rehabilitation programs still focus narrowly on the shoulder joint and swelling management. This leaves a significant gap between what survivors need and what the system currently provides.
A Whole-Person Problem Requires a Whole-Person Approach
Breast cancer does not affect “just the breast.” It affects the entire person—including their musculoskeletal, lymphatic, cardiovascular, psychological, hormonal, and social systems.
To treat breast cancer survivors effectively, physiotherapists must broaden their clinical view.
1. The Chest Wall: A Forgotten Region in Rehab
Surgical scars, expanders, reconstructions, and radiation can profoundly affect the mobility of the ribs, diaphragm, intercostals, and pectoral muscles. Chest wall dysfunction can lead to:
Breathing difficulties
Reduced exercise tolerance
Postural compensations
Persistent pain
Limited shoulder mobility despite “good ROM”
Yet chest wall therapy is rarely emphasized in training.
2. The Nervous System
Nerve injuries—including intercostobrachial nerve damage—can result in numbness, hypersensitivity, or neuropathic pain. Gentle desensitization and neural mobilization can be life-changing but are rarely discussed.
3. The Bio-Psycho-Social Impact
Breast cancer affects identity, sexuality, relationships, and confidence. Trauma-informed care and supportive communication skills are essential tools—not optional extras.
4. The Pelvic Floor Connection
Hormonal treatments, early menopause, and chemotherapy can cause pelvic floor dysfunction, vaginal dryness, dyspareunia, stress incontinence, and low libido. Few patients are ever told physiotherapy can help with this.
5. Long-Term Survivorship Needs
Even years after treatment, survivors may face late-onset lymphedema, fatigue, joint pain, or reduced fitness. This is not a “short-term rehab” population—they need long-term support options.
Why This Matters: The Hidden Burden on Survivors
Many breast cancer survivors feel abandoned once their oncology treatments end. They’re cleared by their surgeon and oncologist, but they are not fully recovered.
Without comprehensive physiotherapy:
Pain persists
Stiffness limits daily function
Fatigue undermines confidence
Intimacy suffers
Exercise feels impossible
Mental health declines
Survivors deserve more than a few shoulder exercises and a pamphlet on lymphedema. They deserve a rehab system that recognizes the complexity of their experience and supports them across all dimensions of recovery.
A Call to Action for Physiotherapists
Breast cancer rehabilitation represents an enormous opportunity for the profession:
For students: a chance to contribute to an evolving area of practice
For clinicians: an opportunity to develop niche expertise and fill a major care gap
For the profession: a chance to advance physiotherapy as an essential pillar of cancer survivorship care
We need:
More education
Better clinical pathways
Stronger interprofessional collaboration
Increased awareness among patients and providers
A broader understanding of what breast cancer rehab truly encompasses
And most importantly—we need physiotherapists who are willing to step into this uncharted territory with curiosity, skill, and compassion.
The Future of Breast Cancer Rehab Starts With Us
Post–breast cancer physiotherapy is not a “special interest”—it is a vital, emerging field with tremendous impact. Survivors deserve clinicians who understand the complexities of their journey and can guide them toward meaningful recovery.As physiotherapists, we are uniquely positioned to fill this gap.
Shoulder rehab matters. Lymphedema care matters. But breast cancer rehabilitation is so much more.It’s time we treat it that way.
https://www.linkedin.com/pulse/beyond-road-most-travelled-real-depth-postbreast-cancer-anshul--cip2c
