Axillary Web Syndrome / Cording

Axillary Web Syndrome (AWS), also known as "cording," is a condition that often occurs after breast cancer surgery, particularly following a mastectomy or sentinel lymph node biopsy. It’s characterized by tight, rope-like structures under the skin, usually in the armpit area, which can limit arm mobility and cause discomfort.

Physical therapy for Axillary Web Syndrome aims to:

1. Increase Range of Motion (ROM): Improving shoulder and arm mobility is one of the primary goals. This is achieved through stretching and strengthening exercises.

2. Reduce Pain and Discomfort: Manual therapy and specific techniques can help alleviate tightness and discomfort caused by the cording.

3. Improve Functional Strength: Restoring normal function for daily activities like lifting, reaching, or carrying items.

Common Physical Therapy Techniques for AWS:

1. Stretching Exercises:

   • Gentle Stretching of the Shoulder and Arm: These exercises focus on improving the range of motion. A therapist may guide you through stretches to elongate the cording.

   • Towel Stretching: Holding a towel behind your back with both hands and gently pulling it upward to stretch the shoulder muscles and axilla area.

2. Manual Therapy (Soft Tissue Mobilization):

   • Cording Release Techniques: A physical therapist might use hands-on techniques to massage the affected area and break down the cords. This can help to improve flexibility and reduce the cord's tightness.

   • Myofascial Release: A gentle technique aimed at releasing muscle tightness and restrictions in the fascia (connective tissue surrounding muscles).

3. Scar Mobilization:

   • This helps release any adhesions formed in the tissue around the scar site, allowing for better mobility and reducing tension on the cording.

4. Strengthening Exercises:

   • Scapular Stabilization: Strengthening the muscles around the shoulder blade can improve posture and shoulder function.

   • Range-of-motion exercises for the shoulder joint: Gradual strengthening of the shoulder muscles to support better functional movement.

   • Resistance band exercises to improve the strength and endurance of the arm and shoulder muscles.

5. Postural Training:

   • Correcting any postural imbalances that may be contributing to strain on the affected arm, such as rounded shoulders, can help prevent further complications.

6. Aerobic Exercises:

   • Activities such as walking or using a stationary bike can improve circulation and overall physical function, which may reduce the feeling of tightness or discomfort.

If you're dealing with AWS, it’s essential to work closely with your physical therapist to avoid over-stretching or pushing yourself too hard too soon, as this could lead to more discomfort or injury.