Shoulder Flexibility Test After Breast Cancer
shoulder flexibility test
Marian Barnick

Marian Barnick

Registered Kinesiologist and Human Movement Specialist



Shoulder Flexibility After Breast Cancer

There are lots of things that feed my passion for work.  Usually it comes from the gratitude of my clients when they see the results of our work together.


But I also get really fired up when I see people struggle without success.  Especially in the breast cancer community – patients who have been to hell and back with treatment and are working so hard with their exercises or rehab program but still having  pain and limitations.   I know it’s not because of lack of effort – it’s because of their rehab program.


Last week I saw evidence of this very problem with a patient I’ll call Jane.  Jane was diagnosed with breast cancer.  She had surgery just over a year ago followed by chemo.  Jane showed me a note from the clinic she’d been attending for rehab.

shoulder flexibility test

The note indicated Jane was receiving stretching exercises for her neck and strengthening exercises for her right shoulder using free weights and pulleys.  Jane had been attending for months but wasn’t improving.  She was frustrated and didn’t know what she was doing wrong.



Jane came to see me for a Biomechanics Analysis because, as she said, she wanted to make sure that what she was doing was “right”.  She was frustrated because nothing was getting rid of the pain and tightness.  


She had been compliant with her program but wasn’t feeling any better, and was getting really stressed and upset that this may be the best she’s ever going to feel.  She was also worried she was causing more damage to her shoulder and her neck with the exercises she was doing.



The results of Jane’s functional assessment provided objective results that Jane was given the wrong program and it was limiting her progress and keeping her in pain.


Jane had no idea what she was doing was wrong (and why would she – she’s not a therapist) and was simply following the program given to her after surgery. 


Unfortunately, Jane is not alone in this struggle.


Foundations First Framework

The Foundations First Framework

There is a framework, a protocol, that is followed to restore function and encourage healing after an injury or after surgery.  And this framework is especially important for breast cancer patients because of the damage to tissue, adjuvant therapy, and cancer related fatigue.



The Framework of rehab is simply this:

#1 is mobility

#2 is stability

#3 is strength

And yes – it’s that easy.



Mobility First

Mobility is always the first phase of any rehab program – including breast cancer rehabilitation.


Due to swelling, tissue damage, inflammation, and the healing process from surgery, tightness occurs and limits range of motion.  Working on mobility with passive and active range of motion exercises and stretches not only helps to improve mobility but also reduces swelling and limits scar tissue formation.



Jane’s decreased shoulder mobility meant that her program should have focused on improving joint movement but her therapist jumped right past mobility and went right into strengthening.


shoulder range of motion

No Strengthening Tight Muscles

We’ve all seen the big muscle bound guy who walks around with his arms outstretched from the sides of his body.  That’s a guy who does strengthening exercises but doesn’t stretch.


When you strengthen a muscle you actually break down the fibres within the muscle.  As the fibres repair, they get bigger and stronger.  They also get tighter and shorter.


So if you’ve got decreased range of motion, as in Jane’s case, there’s no reason to be working on strengthening exercises that shorten and tighten her muscles.   


That has Jane fighting a losing battle and why she struggles to reach into her cupboard for her coffee cup, wash her hair, and put on a sweater.


Creating Your Shoulder Mobility Program

When there’s the need for rehabilitation after an injury or after surgery, the patient should receive a complete biomechanics assessment or functional movement assessment which includes a complete evaluation of range of motion.



If we don’t know how the joints are moving,  you cannot know if there are any movement deficits.


When I tested Jane’s right shoulder range of motion Jane wasn’t even able to reach overhead.  She had developed compensations to try and move her hand over her head and make up for the lack of shoulder range of motion.


She leaned forward from the mid back, she bent her neck forward until her chin almost touched her chest, and then raised her elbow up beside her head.  The actual amount of shoulder flexion wasn’t even 90 degrees, not even half of what’s considered full range of motion.

shoulder assessment

These compensatory movement patterns are what lead to additional pain and limitations.  That’s why Jane was getting neck pain, upper back pain, and of course, an increase in her fatigue.


Fatigue was increased because Jane was using way more muscles and more energy than necessary to complete her reaching tasks due to the lack of shoulder range of motion.  


If the shoulder joint was moving properly, her reaching tasks would be simple and not require the complex manipulation of her body to complete her functional requirements.   


This increases fatigue and is a real problem for breast cancer survivors with cancer related fatigue.  There just isn’t that extra energy to spare on unnecessary energy expenditures.

What Shoulder Stretches To Do After Surgery   

shoulder mobility


shoulder mobility exercises


There are lots of reasons why a joint may not move well and in Jane’s case, her decreased shoulder mobility was due to surgery and compounded by chemotherapy treatment.  To Jane, her right shoulder felt “really tight” like she was unable to push through and make it move.  It was also painful.



The Biomechanics Analysis not only confirmed the tightness in the shoulder but the results allowed me to prescribe the specific exercises and stretches needed to improve  joint range of motion.  



The shoulder’s an amazing joint with six different ranges of motion.  That’s another reason why evaluating joint range of motion is crucial to setup a proper rehabilitation program.  


(If you want to review the movements of the shoulder, grab this Free Download right Here  Shoulder Movement Freebie)



You don’t want to waste time and energy completing stretches and exercises you don’t need.  


For example, if your shoulder flexion results show good range of motion, then there’s no need to perform these stretches.  Concentrate on movements that are limited, for example, shoulder abduction or extension.

If you’re feeling like Jane, you KNOW you’ve got shoulder tightness but you’re having trouble trying to figure out what exactly is causing the problem.  


You’re probably wasting considerable time and energy trying everything instead of focusing on the exact strategies that can reduce your pain and improve your function.



You might be surprised, when you review objective results of your shoulder movements, where your limitations are coming from.  So I suggest you take the Shoulder Flexibility Test.  


This is a free online test that walks you through each of the six shoulder ranges of motion and has you rank your difficulty and ability with each motion.




The Shoulder Flexibility Test guides you through the proper way of performing each shoulder movement so you’re learning the proper body mechanics for each move.


Once you’ve completed the test, sign up for the personalized program that gives you the Three Starter Stretches based on your inputted scores.



This is so amazing for breast cancer survivors (and anyone with shoulder mobility problems).  How often do you go through a whole 60 minute stretch class and wonder if any of it was what you really need???



Unfortunately, you’re not alone if you’re frustrated and even overwhelmed with spending way too much time and energy on stretches you don’t need.  



Your stretching routine should NOT be taking you 60 minutes, not even 30 minutes!  


If you’re stretching to relax, that’s great.  If you’re stretching to increase flexibility, decrease pain, and get back to activities you love, STOP WASTING TIME!


Click the button below and do your own evaluation:


Check Out More
Better Body Biomechanics


No Excuses.  Right to your inbox, every week,  so you can stay informed and learn how to create better body biomechanics.

Don’t Worry – no spam, I promise.


You’ve made a great decision on signing up for Weekly Body Alignment Tips.

I know these tips are going to keep you on track to reaching your goals.

If you have any questions, please make sure to send me an email or DM.  I’m here to help.

body alignment