Occupational Therapy Treatment of Axillary Web Syndrome
After breast cancer surgery, we expect soreness and stiffness. But when a tight, rope-like band suddenly appears under the arm and limits shoulder movement, it looks like something scary is happening and feels exquisitely tender. This condition is called Axillary Web Syndrome (AWS), often referred to as cording, and as an Occupational Therapist in Evanston, IL, who specializes in breast cancer rehabilitation, I want you to know: this is not an uncommon response to breast surgery, and you will get better. Having care from an Occupational or Physical therapist with advanced training in breast cancer rehabilitation will help your recovery.
What Is Axillary Web Syndrome?
Axillary Web Syndrome is a common post-surgical complication following lymph node removal (sentinel or axillary dissection). It’s characterized by cord-like structures under the skin, typically running from the armpit down the inner arm, sometimes extending to the forearm, wrist, or even the thumb. It is not unusual to see cords on the body underneath or alongside the breasts.
I have even seen this issue in people who did NOT have breast surgery but had other surgical interventions, for example, hand surgery causing cording near the thumb. The condition can also happen when people have breast implants for cosmetic augmentation, described in the medical literature as “Mondor’s disease,” which sounds awful, but AWS and Mondor’s are treatable conditions that can resolve with time and the right interventions.
The “cords” are believed to be hardened lymphatic vessels or fibrosed tissue in the walls of the lymphatic vessels. A theory as to why this happens is that the lymphatic fluid that does not normally coagulate becomes clotted, causing a blockage. Though the science does not entirely understand why cording occurs, trust that it is NOT a manifestation of ongoing cancer. The web or cord can cause:
- Tightness in the armpit or along the arm
- Pain or discomfort with movement
- Limited shoulder mobility
- Pulling sensations with activities like reaching, lifting, or dressing
For some people, these symptoms appear days after surgery; for others, weeks or even months later.
Why Occupational Therapy Matters
As a Certified Lymphedema Therapist and Occupational Therapist, I’ve seen firsthand how unsettling AWS can be. Many clients fear it means their healing is off-track or that they’re doing something wrong. But the truth is: cording is common, manageable, and often resolves well with therapy.
Here’s how OT can help:
Gentle, Targeted Manual Therapy
Hands-on techniques are at the heart of AWS treatment. These include:
- Myofascial release to soften the cords and surrounding tissue
- Manual lymphatic drainage (MLD) to support lymphatic flow and reduce congestion
- Scar tissue mobilization to improve skin and tissue flexibility
- Instrument-assisted soft tissue mobilization such as cupping or dry needling
- Elastic taping to support tissue pliability
We always work gently and progressively. We never force painful stretching or “snap” cords, as that can cause trauma. Our goal is improved tissue pliability to allow for comfortable reaching and stretching.
Stretching and Mobility Exercises
Stretching plays a key role in resolving cording. Under the guidance of an OT, you’ll:
- Learn safe, progressive stretches to lengthen restricted tissues
- Improve shoulder and arm range of motion
- Reduce discomfort with daily activities like reaching or dressing
Each stretch is tailored to your comfort level and stage of healing. Incorporating rhythmic, slow movement and breathing exercises is a focus in your therapy.
Activity Adaptation and Education
AWS can make everyday tasks like washing your hair, fastening a bra, or reaching overhead difficult. We help you:
- Modify routines to reduce strain
- Understand what movements are safe (and which ones to temporarily avoid)
- Learn pacing and posture tips to support healing
Empowering you with knowledge can reduce anxiety and help you feel more in control of your recovery.
Monitoring for Lymphedema
While AWS is not an automatic trigger for lymphedema, having cording may increase your risk of lymphedema. It is important to monitor for early signs of swelling, provide preventative education, and recommend compression or drainage techniques if needed.
You can self-monitor for the following symptoms that can be due to lymphedema:
- Swelling in the affected area
- Heaviness
- Skin tightness
- Skin texture changes
Emotional Support and Reassurance
Feeling a strange new sensation after surgery can be frightening. Many people worry that cording means cancer has returned or that their body is failing them. In therapy, we create a safe space to ask questions, share concerns, and feel supported—not just physically, but emotionally.
When Should You Seek OT for Cording?
- You notice tight bands in your armpit or along your arm
- You have reduced shoulder range of motion
- You feel pulling, pain, or pinching when lifting, reaching, or stretching
- You want guidance on safe activity and prevention strategies
The earlier we intervene, the faster you can return to comfort and function.
You’re Not Alone—And You Don’t Have to Push Through the Pain
Cording can be worrisome, but it’s not a permanent condition. With skilled occupational therapy intervention, people experience significant improvement, pain reduction and improved motion—often within a few sessions. I have had people walk into a session barely able to raise the arm but by the end of the session show significantly improved mobility.
If you or someone you know is dealing with axillary web syndrome, don’t wait. There is compassionate, expert care available to help get you back to the activities and life you love.
If you need Occupational Therapy in Evanston, IL for breast cancer rehab, click the link below to reach my website for OT services.
Untangle the strands of tension—empower your body, reclaim your movement, and live with ease
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