Why Cording Happens & Gentle Ways to Treat It
Recovering from breast cancer surgery is a journey with many steps. While you may be prepared for incision healing and fatigue, some post-surgical effects can be unexpected and alarming. One such condition is Axillary Web Syndrome, more commonly known as "cording." You might suddenly notice one or more tight, painful, web-like cords running from your armpit down your arm. This can be frightening and severely limit your ability to lift your arm, stretch, or even perform simple daily tasks.
If you've discovered these cords, it's important to know that you are not alone, and this condition is treatable. Cording is a known side effect of certain breast cancer procedures, and understanding what it is, why it happens, and how it can be managed is the first step toward relief. These cords are not your muscles or tendons; they are part of your body's intricate lymphatic system reacting to the trauma of surgery.
This guide will provide a deep dive into Axillary Web Syndrome. We will explore the science behind why cording happens after breast cancer surgery and discuss the most effective, gentle ways to treat it. The focus will be on specialized therapies, such as axillary web syndrome massage and oncology lymphatic massage, which can provide significant relief, restore your range of motion, and help you feel more comfortable in your body again.
What is Axillary Web Syndrome (Cording)?
Axillary Web Syndrome (AWS), or cording, is a condition that can develop after breast cancer surgery, particularly procedures that involve the removal of lymph nodes from the armpit (axilla). It presents as visible and palpable rope-like structures that start in the armpit and can extend down the inner arm, sometimes reaching the elbow, wrist, or even the base of the thumb.
These cords become most noticeable and painful when you try to raise your arm overhead. The skin around them may look puckered, and the tightness can create a pulling sensation that restricts movement. While it can be alarming to see and feel, cording is not a sign of cancer recurrence. It is a physiological response to surgical disruption of the lymphatic and connective tissues in your axilla.
Key Characteristics of Cording:
Appearance: One or more thin, raised cords under the skin.
Location: Typically starts in the armpit and can travel down the arm.
Sensation: Pain, tightness, pulling, and stinging, especially with movement.
Functional Impact: Significant limitation in shoulder and arm range of motion, making it difficult to lift the arm.
Timing: Cording usually appears within several weeks to a few months after surgery, though it can occur earlier or later.
Understanding the origin of these cords is key to appreciating the gentle treatment they require. These are not muscles that need aggressive stretching but are inflamed and hardened lymphatic vessels that need specialized care.
The Anatomy of Cording: Why Does it Happen?
To understand why cording occurs, it's helpful to know a bit about the anatomy of your armpit. The axilla is a busy intersection of blood vessels, nerves, connective tissue (fascia), and, importantly, lymphatic vessels and nodes. The lymphatic system is a network responsible for draining fluid, waste, and immune cells from your tissues.
The Impact of Surgery on Lymphatic Vessels
Breast cancer surgeries like a lumpectomy or mastectomy often include a sentinel lymph node biopsy or an axillary lymph node dissection to check for the spread of cancer. During these procedures:
Tissue Trauma: The surgical process itself causes inflammation and trauma to the intricate web of tissues in the armpit.
Vessel Disruption: Small lymphatic and blood vessels in the area are inevitably cut, disturbed, or removed along with the lymph nodes.
Inflammatory Response: In response to this trauma, the body initiates a healing process. This involves inflammation, which can cause the surrounding lymphatic vessels to harden, thicken, and stick to the surrounding fascia.
Formation of Cords: These inflamed, thrombosed (clotted), and fibrotic (hardened) lymphatic channels are what form the "cords" you see and feel. When you stretch your arm, you are pulling on these anchored, inflexible vessels, which causes the pain and restricted movement characteristic of AWS.
Essentially, cording is a form of scarring and inflammation within the lymphatic pathways. It is a direct consequence of the surgical disruption necessary for cancer treatment. While any surgery in the axilla can cause it, cording is more common after an axillary lymph node dissection, where more tissue and nodes are removed, leading to a more significant inflammatory response.
The Critical Role of a Lymphedema Therapist
When you discover cording, your first instinct might be to stretch it forcefully, thinking it's a tight muscle. This can be counterproductive and intensely painful. The most effective and safest way to manage AWS is with the help of a qualified professional, such as a certified lymphedema therapist (CLT) or an oncology massage therapist with specific training in this area.
These specialists have an in-depth understanding of the lymphatic system and the unique changes that occur after cancer treatment. They can accurately diagnose cording and distinguish it from other post-surgical issues like scar tissue adhesions or nerve pain.
Why Professional Guidance is Essential:
Accurate Diagnosis: A therapist can confirm that what you are experiencing is AWS and rule out other complications.
Safe Techniques: They are trained in gentle manual therapy that releases the cords without causing further trauma or pain.
Personalized Treatment: They can create a treatment plan tailored to the severity of your cording and your stage of healing.
Comprehensive Care: They often incorporate other elements of post-cancer rehabilitation massage, such as managing scar tissue and promoting lymphatic flow to reduce the risk of lymphedema.
Attempting to treat cording on your own without guidance can exacerbate the inflammation or, in a worst-case scenario, cause the cord to rupture, which is extremely painful. Seeking professional help ensures a safer and more effective recovery.
Gentle Treatment: Axillary Web Syndrome Massage and Manual Therapy
The primary treatment for cording is gentle, hands-on therapy designed to release the tethered lymphatic vessels from the surrounding tissue. An experienced therapist will use a combination of techniques known as axillary web syndrome massage. This is not a deep tissue massage; it is a precise and gentle approach.
Techniques Used to Treat Cording:
Gentle Skin Stretching (Myofascial Release): The therapist will use slow, sustained pressure to stretch the skin and the superficial fascia around the cords. This helps to soften the tissues and encourages the cords to release their attachments. The stretching is done in different directions to gently "unstick" the hardened vessels.
Manual Traction: The therapist might gently bow the cord, like plucking a guitar string, applying light tension to encourage it to soften and lengthen. This is done carefully and within your pain tolerance.
Soft Tissue Mobilization: Specific hands-on techniques are used to mobilize the skin and underlying tissues perpendicular to the direction of the cord. This helps to break up the adhesions that are holding the vessel in place.
Manual Lymphatic Drainage (MLD): While not a direct treatment for the cord itself, MLD is often used in conjunction with AWS therapy. This gentle oncology-sensitive lymphatic therapy helps reduce the inflammation and swelling in the area, which can contribute to the formation and persistence of cording. It improves the overall health of the lymphatic system in the compromised area, promoting a better healing environment. You can learn more about how lymphatic drainage aids breast cancer recovery in Torrance.
Most patients feel an immediate improvement in range of motion and a reduction in pain after the very first session. The goal is to gradually release the cords over several sessions, restoring full, pain-free movement.
The Connection Between Cording and Lymphedema
Cording and lymphedema are two distinct conditions, but they are closely related as they both stem from disruption to the lymphatic system.
Cording (AWS) is caused by inflammation and fibrosis of the lymphatic vessels.
Lymphedema is caused by an accumulation of lymphatic fluid due to impaired drainage.
Having cording does not automatically mean you will develop lymphedema, but some studies suggest it may be an early sign of lymphatic system dysfunction, potentially increasing your lymphedema risk. The inflammation and hardening of lymphatic vessels in AWS can further impede the flow of lymph fluid, contributing to the potential for future swelling.
This connection highlights the importance of seeing a lymphedema massage therapist for cording. This professional is uniquely qualified to treat both conditions. While addressing the immediate problem of the cords, they can also implement a lymphedema risk reduction therapy program. This may include:
Manual Lymphatic Drainage: To improve overall fluid flow.
Education: Teaching you signs and symptoms of early lymphedema.
Compression Garment Fitting: Recommending a sleeve if you are at high risk.
Exercise Guidance: Providing safe exercises to promote lymphatic health.
Treating cording effectively is a proactive step in caring for your lymphatic system and potentially reducing your long-term risk of developing chronic lymphedema.
What You Can Do at Home: Gentle Stretches and Self-Care
Under the guidance of your therapist, there are several things you can do at home to support your treatment and manage symptoms. It is crucial that you only perform exercises and stretches recommended by your healthcare provider or CLT, as doing the wrong movements can make things worse.
Supervised Stretching Routine
Your therapist will likely give you a set of specific, gentle stretches to perform daily. These are meant to maintain the gains in range of motion achieved during therapy, not to forcefully break the cords.
Wall/Doorway Stretches: You might be instructed to stand in a doorway and place your hands on the frame at shoulder height, then slowly step forward to feel a gentle stretch. Or, you might do "wall spiders," where you face a wall and slowly walk your fingers up the wall as high as you can without significant pain.
Pulley Stretches: Using an over-the-door pulley system allows you to use your unaffected arm to gently lift and stretch the affected arm.
Pendulum Swings: Bending at the waist and letting the affected arm hang down, you can make gentle circles to promote shoulder mobility.
The Golden Rule: Never stretch into sharp pain. You should feel a gentle pull or tension, but if you feel a sharp, stinging pain, you are pushing too far. Stop and ease back.
The Importance of Movement
While painful, it's important not to immobilize your arm completely. Lack of movement can cause more stiffness and scar tissue to form. Throughout the day, try to move your arm gently within its pain-free range. Simple activities like brushing your hair or reaching for items on a shelf (as tolerated) can help maintain mobility.
Deep Breathing Exercises
Deep, diaphragmatic breathing is a powerful tool for lymphatic health. The pressure changes in your chest cavity during deep breaths create a vacuum effect that helps pump lymphatic fluid from your extremities back toward the center of your body. Try to practice 5-10 deep belly breaths several times a day.
Fibrosis After Radiation: A Compounding Factor
Many breast cancer patients undergo radiation therapy after surgery. Radiation can cause its own set of tissue changes, primarily the development of fibrosis. Fibrosis is the thickening and hardening of connective tissue, essentially a type of internal scarring.
If you have fibrosis after radiation, the tissues in your chest, shoulder, and armpit can become tight, stiff, and less pliable. This can compound the issues of cording, creating even more restriction and discomfort. The hardened tissue from radiation can further compress lymphatic pathways, making both AWS and lymphedema more likely.
A skilled oncology massage therapist can use fibrosis massage therapy techniques. This involves gentle, sustained pressure and stretching of the radiated tissues to help soften them, improve their mobility, and release the tension they place on underlying structures, including the lymphatic cords. This specialized form of post-surgical lymphatic drainage is essential for managing the combined effects of surgery and radiation.
Finding the Right Therapist for You
When seeking treatment for cording, it is vital to find a therapist with the right credentials and experience. You want someone who is more than just a massage therapist; you need a healthcare professional with specialized training.
Look for these qualifications:
Certified Lymphedema Therapist (CLT): This is the gold standard. CLTs have undergone extensive training (typically 135 hours or more) in Complete Decongestive Therapy, which includes MLD, compression, and management of conditions like AWS.
Oncology Massage Training: A therapist trained in oncology massage understands the contraindications and specific needs of cancer survivors, such as how to work around ports, surgical sites, and radiated tissue.
When searching, use terms like "MDT or MLD therapist near me," "oncology-trained lymphedema therapist," or "axillary web syndrome treatment." Don't hesitate to ask about their specific training and experience with cording and post-mastectomy patients.
Our clinic specializes in providing safe and gentle manual lymphatic drainage and post-cancer care. If you need help, please contact us to schedule an assessment. We can discuss a personalized treatment plan and provide information on our prices.
Moving Forward with Confidence
Discovering cording can be a distressing setback in your recovery, but it is a manageable and treatable condition. With the right professional care, you can effectively resolve the pain and tightness, restore your arm's full range of motion, and get back to your life.
Remember that cording is a sign that your lymphatic system has been through a major trauma and needs support. Addressing it promptly with gentle, specialized techniques like axillary web syndrome massage is not just about relieving the immediate symptoms; it's a crucial part of your long-term breast cancer recovery lymphatic massage plan. By working with a qualified therapist, you are taking a proactive step toward better lymphatic health and reducing your risk of future complications.
Your body is resilient. With patience, gentle care, and expert guidance, you can overcome cording and continue on your path to healing and balance.