This aim of this review is to systematically review the efficacy of various postoperative physical therapy modalities and timing of physical therapy following treatment of breast cancer on pain and impaired range of motion (ROM) of the upper limb. Eighteen randomized controlled trials were included in the review. Three studies examined the effect of multifactorial therapy: 2 studies confirmed that the combination of general exercises and stretching is effective for the treatment of impaired ROM another study showed that passive mobilization combined with massage had no beneficial effects on pain and impaired ROM. Fifteen studies investigated the efficacy of a single physical therapy modality. One study of poor quality revealed evidence supporting the beneficial effects of passive mobilization. The only study investigating the effect of stretching did not find any beneficial effects. No studies were found about the effectiveness of myofascial therapy in the postoperative phase. Five studies found that active exercises were more effective than no therapy or information on the treatment of impairments of the upper limb. Three studies supported the early start of exercises for recovery of shoulder ROM, whereas 4 studies supported the delay of exercises to avoid prolonged wound healing.
The reviewed data shows multifactorial physical therapy (ie, stretching, exercises) and active exercises to be effective to treat postoperative pain and impaired ROM after treatment for breast cancer. High-quality studies are needed to determine the effectiveness of passive mobilization, stretching, and myofascial therapy as part of the multifactorial treatment. In addition, the appropriate timing and content of the exercise programs require additional investigation.