Abstract: Background: Axillary web syndrome (AWS) is a postoperative complication of breast cancer surgery associated with cord-like structures, pain, restricted shoulder movement and impaired upper-limb function. Existing syntheses have largely focused on whether physiotherapy works or which modality performs best; less attention has been given to initiation timing, dose, progression, supervision, adherence and recovery trajectory.
Objective: To evaluate exercise-based and multimodal rehabilitation for AWS, emphasizing timing, therapeutic dose, progression, treatment exposure and recovery trajectory, and to develop an evidence-informed Axillary Web Syndrome Precision Rehabilitation Framework (AWS-PReF).
Methods: The review is designed according to PRISMA 2020. Eligible interventions include therapeutic exercise, active/assisted ROM, stretching, progressive resistance, functional exercise, home/supervised programs and multimodal rehabilitation containing an active physical component. Planned sources are MEDLINE/PubMed, Embase, CINAHL, CENTRAL, Web of Science Core Collection, Scopus and PEDro, supplemented by trial registries and citation searching. FITT-PRO characterizes Frequency, Intensity, Time, Type, Progression, Rehabilitation context and Onset. RoB 2 and GRADE are planned.
Current evidence synthesis: Contemporary randomized evidence supports active rehabilitation as a central component of conservative AWS management. Improvements have been reported in pain, shoulder ROM, disability and recovery trajectory. Selected manual, lymphatic and scar-directed adjuncts may add benefit, but differences in treatment exposure complicate causal attribution. A 2026 network meta-analysis identified 14 RCTs involving 1,007 participants and 11 intervention categories while highlighting sparse networks, heterogeneity and model-dependent findings.
Conclusion: The unresolved question is increasingly not simply whether physiotherapy works, but how AWS rehabilitation should be prescribed. Active progressive rehabilitation appears to form the therapeutic foundation. AWS-PReF provides a hypothesis-generating pathway from symptom-sensitive mobility through capacity restoration and functional reintegration, but requires prospective validation.
Keywords: axillary web syndrome; breast cancer; rehabilitation; physiotherapy; therapeutic exercise; cording; shoulder range of motion; manual lymphatic drainage; functional recovery; systematic review.
Title: From Cording to Recovery: Timing, Dose, Progression, and Personalization of Exercise-Based Rehabilitation for Axillary Web Syndrome Following Breast Cancer Surgery (A Systematic Review and Evidence-to-Practice Framework AWS-PReF • FITT-PRO • AWS-CORE)
Author: Waseem Mumtaz Ahamed
International Journal of Life Sciences Research
ISSN 2348-313X (Print), ISSN 2348-3148 (online)
Vol. 14, Issue 4, October 2026 - December 2026
Page No: 12-20
Research Publish Journals
Website: www.researchpublish.com
Published Date: 07-October-2026