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If you have symptoms of AWS, ask your doctor to refer you to a physical therapist or other medical professional who specializes in breast cancer rehabilitation. If possible, contact someone who has seen patients with cording. 


It’s not a good idea to wait and see if the condition will resolve on its own. 

Your natural reaction to the pain of cording will be to avoid moving the arm and shoulder, which can lead to more tightness in the shoulder and chest area. Over time, this may cause more serious problems with function and mobility. Moving and stretching under the guidance of an experienced therapist are the best ways to resolve the condition and stop the pain.

Click each image to enlarge. 

All photos © Charlotte Ottaiano

Together, you and your medical advisors can develop a treatment plan that’s right for you.
Your plan may include:

1. Stretching and Flexibility Exercises

Your therapist can work with you to help you learn exercises that gently stretch the cords and improve your pain-free range of motion. They can teach you exercises to do yourself at home.

2. Manual Massage Therapy

Your therapist may also gently massage the cord tissue. Using manual therapy, your therapist would gently pull the tissue on your outstretched arm, starting in the upper arm and moving down into the forearm. This sometimes causes the cord to snap or break, and you may even hear a “popping” sound. It’s not usually painful, and it often brings relief by extending the pain-free range of motion in your arm.

3. Low-Level Laser Therapy

Some therapists use a small device to apply low-level laser beams directly to the skin. Laser therapy can help break down the hardened scar tissue. This technique is a non-invasive modality which promotes healing and pain relief.

4. Cupping

This protocol involves the use of suction cups directly on the skin. The suctioning effect helps promote the flow of previously stagnant blood. Healing is promoted by improving circulation in the area of pain. This technique is also effective at lifting scar tissue in areas of restriction caused by post-surgical scars i.e. post-mastectomy with reconstruction. 

5. Decongestive Lymphatic

This is a hands-on approach to treatment whereby a therapist uses a broad range of tools and techniques to reduce pain and mobilize soft tissue. 

6. Dry Needling

Physical therapists use acupuncture style needles to release trigger points in areas of pain to allow for better mobility, function, and promote return to activity. Functional dry needling releases muscle knots and resets motor points, thereby providing pain relief.

7. Moist Heat

Your therapist may apply warm, moist pads directly to the cords as part of your therapy. However, it is important to use caution when doing this: Prolonged heat can increase the production of lymph fluid, which can lead to fluid overload – a condition known as Lymphedema. If your therapist recommends moist heat, be sure that they are experienced in its use for cording!

All of these treatments focus on releasing the tight scar tissue that makes up the cords. 

You may notice that releasing the cord in one part of the arm or chest can magnify tightness in other areas. For example, releasing the cord in the upper arm and elbow will reduce pain and improve range of motion, but the wrist and forearm may feel tighter at first.  This occurs not because the cording is getting worse, but because the scar tissue is still “stuck” in those other areas.


Even after cording is resolved, it’s a good idea to continue with the stretching and flexibility exercises. These can help keep the joint and soft tissue mobile during additional treatments, such as radiation therapy.


For further information about cording treatments, contact Pratt Physical Therapy, one of the leading specialists in breast oncology rehabilitation.

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