Axillary cording, or axillary web syndrome, can be a very stubborn, painful, and unexpected side effect of breast cancer. If you tried the basic cording exercises from my first guide but still need more relief, this one’s for you. These are the more advanced techniques I use with patients when the simple stretches aren’t quite enough.
My name is Kelly Sturm, and I’m a Doctor of Physical Therapy, Board-Certified Oncology Clinical Specialist, and Certified Lymphedema Therapist.
In my practice, I find that about 30% of my patients need these more targeted approaches. In this guide, I’m sharing additional gentle exercises, along with simple techniques, to help get rid of stubborn axillary cording, ease tightness, and improve mobility.
Always make sure you’re cleared by your doctor before starting these exercises, as every recovery journey is unique.
This guide is part 2 in my axillary cording videos from my breast cancer recovery series. Looking for earlier stages in recovery, or for more basic stretches and techniques to get rid of cording? Download my free Breast Recovery Roadmap for all 8 phases.
Breast Cancer Treatment and Cording
A mastectomy or lymph node removal is a major surgery, and understanding the recovery process can help you feel confident in your healing journey as you resume daily activities and regular exercise in the healthiest way possible. The recovery time for someone after a mastectomy can range from 3-12 weeks and depends on whether the person has had breast reconstruction or not.
Cording is a common side effect of surgery and can impact each individual differently. Most people develop cording 2-8 weeks after surgery; however, for some, it can appear weeks or even months later.
What is Axillary Web Syndrome (AWS)?
Axillary web syndrome (AWS), also called cording, is a common side effect of breast cancer surgery, such as a mastectomy or getting lymph nodes removed. I like to describe cords as fibrous, tight bands that may be attached to hardened scar tissue.
These bands typically begin in the armpit area and run down the inner arm. While they are invisible to the eye, someone may feel discomfort in the impacted area and experience a limited range of motion or discomfort.
What Are The Common Side Effects of AWS?
Cording can present itself differently for everyone; however, common symptoms someone may experience include:
- Limited range of motion
- Painful tightness or discomfort in the armpit
- A visible tight cord or band-like structure underneath the surface of the skin, starting in the armpit and running down the inner arm
Exercise Guidelines
These exercises and techniques can only be done as long as someone is cleared by their doctor first for safety, as everyone has a different breast cancer surgery and recovery experience.
If you would like to follow along with a video of a certified physical therapist modeling these exercises, you can watch the YouTube video linked below.
Exercise Details
These exercises are meant for someone who has already tried basic cording exercises for after breast cancer surgery, and hasn’t found the relief they are looking for. If you are looking for additional shoulder or arm exercises after breast surgery, visit my blog post Exercise After Mastectomy: Guide From a Physical Therapist.
We’re going to go through 2 gentle exercises that focus on mobility to help release cording, decrease pain, and improve mobility, followed by several techniques with different tools that someone may find helpful.
These exercises are safe to do as part of a daily routine, as long as you’re cleared by your doctor first. All exercises should feel mild to moderate – stop if you feel significant pain or strain.
Equipment Required
Dycem (optional)
Foam Roller
Butterfly Chest Stretch
This first stretching exercise helps with mobility and releasing a cord by flossing, or gliding, the nerves into tension and out of tension. This can sometimes be more helpful than a held stretch, because it allows you to mobilize the cord.
- Begin lying on your back in a comfortable position with your feet on the ground and your hands behind your head.
- Your elbows should start pointed towards the ceiling. Gradually open your elbows out towards the sides.
- Slowly come back to the starting position.
- Complete this motion back and forth 10 – 15 times.
Sidelying Chest Openers With Reach
This is another mobility arm movement that can help get a tight cord unstuck from the scar tissue it may be bound to.
- Begin lying on your side with your bottom arm underneath your head for support. Your affected arm should be on top.
- Extend your top arm straight out in front of you. If you are someone with more tension, you may need to start with a bent elbow.
- From there, exaggerate the reach out in front of you and then slowly open up towards the wall behind you. Open up until you feel the tension and a mild to moderate stretch.
- Come back to your arm extended, reaching in front of you.
- Repeat 8 to 10 times
Remember that we want to keep our movements mild and not painful.
Techniques for Getting Rid of Cording
The following techniques are additional early intervention measures someone can take to help alleviate cording symptoms.
Butterfly Chest Stretch With Dycem
Dycem is a tool that is found in a lot of rehab facilities and that many physical therapists use in their practice. It is used to help with gripping and works well with mobilizing tissue that has cords. Someone can also use Dycem to gently massage around the scar tissue to help release tension and mobilize tissue.
Since the Dycem is placed right where the cord starts, which is typically close to scars, it is important that all of your scars and incisions are healed, and you have clearance from your doctor or healthcare team first.
- Begin lying on your back in a comfortable position with your feet on the ground and your hands behind your head.
- Your elbows should start pointed towards the ceiling.
- Place your Dysem directly on the skin, in your armpit, where the cord starts, and apply a small amount of taut pressure towards your opposite hip.
- Hold the tension and gradually open your elbows out towards the sides.
- Slowly come back to the starting position.
- Complete this motion back and forth 10 – 15 times.
The use of Dycem helps isolate exactly where someone feels their cord is bound down, rather than stretching the entire area.
Skin Rolling or Soft Tissue Mobilization
This technique helps work and release some of the scar tissue where cording can be bound down. This technique does look different for each individual, and I always encourage someone to find a local medical professional who can help them with the right treatment, taking into account individual techniques and safety.
Many providers will put someone in various positions with tension as they are rolling the tissue.
This demonstration shows rolling the tissue on your arm. You start by gently picking up the tissue and rolling it through your fingers. I like to use the analogy of kneading dough with a very light pressure.
Frequently Asked Questions
How to get rid of cording after mastectomy?
Different exercises and techniques can help you get rid of cording after a mastectomy. Gentle stretching exercises that target the chest wall and pec area can help release tightness and improve stiffness in the affected area. Utilizing techniques such as skin rolling or the use of Dycem may also help relieve tightness.
For a more detailed review of getting rid of cording, you can watch this YouTube video from certified physical therapist Dr. Kelly Sturm.
How long does cording take to go away?
How long cording lasts is different for everyone and can vary, depending on the severity of the cording as well as an individual’s response to treatment. For some people, cording can go away on its own, but for others it requires physical therapy and can take several weeks for symptoms to improve.
Is cording the same as lymphedema?
No, cording is not the same condition as lymphedema. Both are conditions that can result from breast cancer surgery and the disruption of the lymphatic system; however, cording is described as tight rope-like bands that extend down the arm, while lymphedema is a condition of increased swelling.
Do compression sleeves help with cording?
Compression sleeves don’t directly treat cording since cording is tight bands of tissue rather than swelling. That being said, they have been found to be helpful indirectly to help decrease the inflammation and swelling that increases the risk of cords. Using a compression sleeve when appropriate, in combination with stretching and movement exercises, seems to be helpful.
Final Thoughts
Living with axillary web syndrome after surgery doesn’t have to be your new normal. I’ve worked with many breast cancer patients who have successfully improved their symptoms, gotten rid of their cords, and regained a full range of motion. Once you’ve completed treatment and have clearance from your healthcare provider, start with early intervention and gentle stretching exercises or a physical therapy program.
