Physio Nexus Academy · Clinical Treatment Framework
Post-Mastectomy Rehabilitation
Rehabilitation addresses shoulder mobility, strength, scar symptoms, posture, lymphedema risk and return to daily activity while coordinating with oncology care.
Clinical decision pathway
A structured plan, not a recipe
Understand
Screen safety, identify the likely clinical pattern and agree meaningful goals.
Select
Choose only interventions that match the patient's impairments and preferences.
Reassess
Repeat the same comparable sign or functional task after key interventions.
Progress
Build capacity and participation using measurable response, not session count.
Before choosing an intervention
Clinical reasoning
- 1Restore shoulder motion and strength while monitoring wound healing, pain and lymphedema risk.
- 2Progress arm use rather than promoting long-term fear of lifting.
- 3Manual lymphatic drainage is specialized and only one part of lymphedema care.
A practical starting sequence
First-session workflow
- 1Check wound status, shoulder ROM, pain, swelling and sensory symptoms.
- 2Measure arm circumference/volume when lymphedema concern exists.
- 3Begin gentle shoulder mobility and breathing.
Assessment & examination
- 1Shoulder ROM and strength
- 2Scar and wound healing
- 3Arm swelling and lymphedema signs
- 4Pain and sensory changes
- 5Functional reach and daily activities
Red flags & safety screen
- 1New unilateral swelling suggesting DVT or acute lymphedema complication
- 2Cellulitis
- 3Wound infection/dehiscence
- 4New unexplained severe pain
Indication · dosage · response
Manual therapy application
- 1Scar mobilization only after full healing.
- 2Gentle shoulder/thoracic mobilization if stiffness limits function.
- 3MLD only after appropriate swelling assessment and by trained clinicians.
Adapt to irritability and capacity
Exercise prescription & dosage
- 1Assisted shoulder flexion/abduction: 5–10 reps, several times/day early.
- 2Scapular control: 2–3 sets × 10–15 reps.
- 3Progressive resistance: 2–3 sets × 8–15 reps once healing allows.
- 4Aerobic activity: gradual return to regular walking/cycling.
Modalities & adjuncts
- 1Compression only when clinically indicated and properly fitted.
- 2TENS may be used for selected pain after screening.
Progression & regression rules
- 1Increase overhead range and resistance slowly.
- 2Progress lifting based on symptom/swelling response.
- 3Monitor for new persistent swelling.
Home programme
- 1Gradual return to arm use
- 2Skin care and swelling awareness
- 3Progressive strength rather than long-term arm avoidance
Outcome measures
- 1DASH
- 2Shoulder ROM
- 3Arm circumference/volume when indicated
- 4NPRS
Common clinical mistakes
- 1Keeping the arm protected for too long.
- 2Aggressive scar work before healing.
- 3Treating unexplained new swelling as routine lymphedema.
- 4Avoiding strength training unnecessarily.
Patient education & self-management
- 1Teach skin care and swelling awareness.
- 2Encourage gradual return to normal arm use.
- 3Explain when redness, fever or rapid swelling needs medical review.
Referral & escalation
- 1Medical review for cellulitis, rapid swelling, wound problems or suspected recurrence/other medical complication
Clinical use & safety note
This is an educational clinical framework, not an individual prescription or a substitute for diagnosis, medical assessment, local protocols or professional judgement. Exercise dose, manual techniques and adjuncts must be adapted to examination findings, irritability, comorbidities, precautions, patient goals and response. Obtain informed consent, work within training and scope, and refer when indicated. Do not apply every intervention listed to every patient.
The PNA treatment principle
The best plan is not the one with the most techniques. It is the one that identifies the patient's main problem, selects a defensible intervention, measures the response and steadily restores meaningful function.