Axillary web syndrome (AWS), commonly called cording, is a condition in which one or more tight, rope-like cords develop under the skin of the armpit. The cords can run from the underarm down the inner arm toward the elbow or wrist, and sometimes across the chest wall. They're usually most visible — and most uncomfortable — when you raise the arm or reach overhead, and many people describe the sensation as a "guitar string" being pulled.

AWS most often appears in the weeks to months after breast cancer surgery, particularly procedures involving the lymph nodes such as a sentinel node biopsy or axillary lymph node dissection.

On its own, AWS is generally not dangerous. It's considered a benign, often self-limiting condition rather than a sign that something is medically wrong. That said, it can be painful and can meaningfully restrict shoulder and arm movement — which may interfere with daily activities, exercise, and even positioning for ongoing cancer treatment such as radiation.

The good news is that cording tends to respond very well to physical therapy. Because a cord can occasionally be confused with other issues, any new cord accompanied by redness, warmth, or swelling should be evaluated by a clinician to rule out other causes.

Common signs include:

• Visible or palpable rope-like cords in the armpit, inner arm, or chest
• A pulling or tightness when lifting or reaching the arm
• Pain along the cord, especially with stretching
• Reduced shoulder range of motion — difficulty raising the arm fully
• Tenderness in the underarm region

AWS is thought to result from disruption and scarring of the superficial lymphatic vessels and small veins, often following surgery in the underarm area. Trauma to the region, lymph node removal, and the body's inflammatory healing response all appear to play a role. While the condition is most strongly linked to breast cancer surgery, the exact mechanism isn't fully understood.

Although AWS is most commonly seen after breast cancer surgery, it isn't exclusive to it. Cases have been reported after other procedures in the underarm, after infection or trauma, and — more rarely — with no identifiable cause, sometimes called idiopathic AWS. If you notice cording without a history of surgery, it's worth having it assessed so other causes can be ruled out.

Yes. AWS is far more common in women because it's closely tied to breast cancer surgery, but men can develop it too — for example, after treatment for male breast cancer, a lymph node biopsy, or other procedures in the axilla.

AWS usually responds well to conservative, hands-on care, and physical and occupational therapy is the first-line approach. Treatment may include gentle manual therapy and cord/scar mobilization, guided stretching and range-of-motion work, manual lymphatic drainage techniques, and a personalized home program. Many people see meaningful improvement within a few weeks of consistent therapy.

Gentle, pain-respecting stretches — such as supported wall-walking with the fingers, doorway stretches, and assisted overhead reaching — are commonly used. The right stretches and the right intensity depend on your stage of healing, so it's best to have a therapist demonstrate technique and dosage rather than pushing into sharp pain on your own.

Lymphedema is chronic swelling — most often in an arm or leg — that occurs when the lymphatic system can't drain fluid efficiently. It frequently develops after lymph nodes are removed or treated with radiation, such as arm swelling after breast cancer treatment.

The recognized gold-standard treatment is Complete Decongestive Therapy (CDT), a comprehensive program that combines manual lymphatic drainage (a gentle, specialized hands-on technique), compression bandaging and fitted garments, targeted exercise, and careful skin care. It's typically delivered in two phases: an intensive reduction phase, followed by a long-term maintenance phase you manage at home with your therapist's guidance.

Lymphedema is typically diagnosed by a physician — your oncologist, surgeon, or a lymphedema specialist — and assessed in detail by a Certified Lymphedema Therapist (CLT). Diagnosis often involves your medical history, a physical exam, and limb measurements, with imaging used in less clear-cut cases. Early evaluation matters, because lymphedema is much easier to control when it's caught and managed early.

Many people with lymphedema fly without trouble, but cabin pressure changes and long periods of sitting can sometimes trigger or worsen swelling. If you're at risk, it's often recommended to:

• Wear a properly fitted compression garment during the flight
• Stay hydrated and move regularly
• Do gentle arm or leg exercises in your seat
• Avoid heavy carry-ons or tight clothing on the affected side

Mild puffiness after any flight is common and usually relates to inactivity and pressure rather than the lymph nodes themselves. Because the right precautions depend on your situation, check with your therapist before traveling — especially for long-haul flights. Persistent, painful, or one-sided swelling after a flight should always be evaluated.

They're often confused but are distinct conditions. Lymphedema is a buildup of lymph fluid that can affect one or both limbs and often involves the hands or feet. Lipedema is a disorder of abnormal, symmetrical fat accumulation — usually in the legs, sometimes the arms — that characteristically spares the feet, feels tender, and bruises easily.

The two can also occur together (lipo-lymphedema). An accurate diagnosis matters because the emphasis of treatment differs between them.

A DIEP flap is a type of breast reconstruction that uses skin and fat from the lower abdomen — sparing the abdominal muscle — to rebuild the breast. Because it involves both the chest and an abdominal donor site, recovery affects posture, core stability, and shoulder/arm mobility.

Physical and occupational therapy supports recovery with gentle range-of-motion work, posture retraining, scar and soft-tissue mobilization once incisions heal, swelling management, and a gradual, safe return to core engagement and daily activities. Therapy is always timed to your surgeon's healing protocol.

Yes. Reconstructions that draw tissue from other donor sites — such as SGAP (buttock) or TUG/PAP (inner thigh) flaps — also create a second surgical site that benefits from rehabilitation. The principles are the same: protect healing tissue, restore mobility gradually, manage scarring and swelling, and rebuild strength and function in step with your surgeon's clearance.

Yes. Once incisions have healed, scar and soft-tissue mobilization can improve the flexibility and appearance of scars, reduce tightness and adhesions, and restore comfortable movement. Therapists use targeted hands-on techniques and teach you self-massage so you can continue progress at home. Scar work begins only after your surgeon confirms the area is ready.

Manual lymphatic drainage is commonly used after surgery to help reduce swelling and bruising and to support comfortable healing. It's a light, specific technique — quite different from a deep-tissue massage — and is best performed or guided by a trained therapist, with timing matched to your procedure and your surgeon's recommendations.

Current lactation guidance has shifted toward cold rather than heat for inflammatory mastitis. Cold compresses help calm inflammation, swelling, and pain, while applying heat can increase inflammation and is generally discouraged for acute mastitis. (A brief touch of warmth just before a feed is sometimes used to encourage letdown, but cold is preferred for the inflammation itself.)

Aggressive deep massage of the breast is also no longer recommended, as it can worsen tissue swelling — gentle, lymphatic-style techniques are now favored. If you have a fever, worsening redness, or feel generally unwell, contact your healthcare provider, as you may need medical treatment.

Approaches that are generally recommended include:

• Frequent, comfortable nursing or pumping
• Gentle lymphatic drainage toward the armpit, rather than firm pressure on the duct
• Cold compresses between feeds to reduce swelling
• Anti-inflammatory measures as advised by your provider

For stubborn or recurrent clogs, some clinicians use therapeutic ultrasound. Avoid very aggressive massage, which can aggravate the area. Persistent or painful blockages, or any signs of infection, should be evaluated by your provider.

Yes. Gentle, guided exercise during and after radiotherapy can help maintain shoulder mobility and reduce stiffness, and therapy can also address skin tightness, scar restriction, and fatigue. Your program should be coordinated with your oncology team and tailored to your treatment schedule and skin condition.

Lipedema often becomes noticeable or worsens during times of hormonal change — puberty, pregnancy, and menopause. Some people first recognize it after pregnancy or a cesarean, typically as disproportionate, tender swelling in the legs (and sometimes the arms) that doesn't respond to diet the way ordinary weight gain would.

Conservative management — manual lymphatic drainage, compression, exercise, and skin care — can help with comfort and swelling. An accurate diagnosis is the first step, since lipedema is frequently mistaken for general weight gain or lymphedema.

Thera Rehab provides specialized physical and occupational therapy across the following areas:

• Breast Cancer Rehabilitation — pre-hab, post-hab, and throughout treatment (mastectomy, lumpectomy, DIEP flap, and more)
• Lymphedema Treatment & Management — Complete Decongestive Therapy (CDT), MLD, and compression garment fitting by LANA-certified therapists
• Lymphatic Care & Wellness — manual lymphatic drainage for post-surgical recovery, postpartum wellness, lipedema, and general wellness
• Plastic Surgery Recovery — MLD, scar management, and fibrotic tissue prevention after liposuction, abdominoplasty, BBL, and more
• Scar Management & Prevention — for surgical, radiation, trauma, and C-section scars
• Mastitis & Clogged Milk Duct Treatment — evidence-based, same-week appointments available
• Axillary Web Syndrome (Cording) — hands-on treatment and guided home programs
• Orthopedic Rehabilitation — post-surgical recovery, injury rehab, arthritis, back and neck pain
• Occupational Therapy & Hand Therapy — ADL training, fine motor therapy, adaptive equipment assessments
• Oncology Rehabilitation — fatigue management, strength and endurance, lymphedema prevention
• Concierge Rehab — in-home or in-clinic, across NYC and surrounding areas

Yes — for patients who prefer to recover at home or have difficulty traveling, Thera Rehab offers concierge and in-home physical and occupational therapy throughout Manhattan, Brooklyn, Queens, the Bronx, Staten Island, Long Island, Westchester, and New Jersey. Care is delivered one-on-one by a licensed therapist at a time that fits your schedule.

In-clinic sessions are also available at our Midtown Manhattan location — steps from Penn Station. Learn more about our concierge program →

Referrals: No referral is needed to get started. New York State's Direct Access law allows you to begin physical or occupational therapy without a physician's referral for up to 10 visits or 30 days. After that, a prescription is required to continue — our team will help coordinate this with your doctor.

Insurance: Thera Rehab is an out-of-network provider. We provide detailed superbills after each session, which you can submit directly to your insurer for reimbursement. We also accept HSA, FSA, HRA, DCFSA, and LCFSA cards directly at the time of service.

To verify your out-of-network benefits before your first visit, email us at info@thera-rehab.com with your insurance details and we'll help check your coverage.

The first step is a one-on-one evaluation, where a therapist reviews your history and goals and builds a plan tailored to you. To schedule, call us at (917) 319-4492, email info@thera-rehab.com, or book directly online. No referral needed for your first 10 visits.