Cancer and Range of Motion & Joint Pain

Cancer and Range of Motion / Joint Pain

“Since I have been on hormonal therapy, my cancer has not returned, but every morning I wake up achy and uncomfortable. I have found that with a little daily yoga I feel better again.”

— Dora, age 68, breast cancer survivor

Joint Pain and Cancer

Cancer and cancer treatments can lead to a decreased range of motion and increased joint pain. Joint pain or discomfort, known as arthralgias, can have many implications for people affected by cancer, and the following will provide some insights into these conditions.

Causes of Joint Pain

Causes of joint pain include reasons that may or may not be directly related to the cancer or its treatment, and the pain level can be affected by many factors. Joint pain can be due to a variety of causes, such as arthritis, medications, infections and other inflammatory conditions and should be diagnosed by physician to determine the cause and an appropriate treatment plan, including any integrative therapies to use.


Arthritis is an inflammatory condition which can be a source of pain, especially osteoarthritis, as it strikes older people, who are largest population affected by cancer.


Cancer treatments, including chemotherapy, may cause joint pain. Some of the chemotherapy drugs that can cause pain include:

  • Abraxane
  • Methotrexate
  • Taxotere

Hormonal Therapies

Some of the hormonal therapies used as adjuvant therapies for breast cancer can cause joint pain, achiness and stiffness.

For post-menopausal breast cancer patients with estrogen-receptive cancers, a standard adjuvant treatment is aromatase inhibitor (AI) therapy. In some cases, AI’s can significantly reduce the risk of recurrence and include the brand names of:

  • Arimidex
  • Femara

Pain related to the AI therapy is called AI-associated musculoskeletal symptoms (AIMSS). This pain is frequently symmetric, occurring in the hands, arms, knees, feet, and pelvic and hip bones. It is a significant concern for oncologists, as it is seen in about half of survivors taking AI therapy within six months of starting treatments, according to a 2013 study by Bao, et al, and discontinuation of the therapy due to musculoskeletal pain is estimated at 15%.

A 2013 study published in the Journal of the Korean Surgical Society found no significant risk factors in the development of AIMSS other than prior use of Tamoxifen, a hormonal therapy typically given to premenopausal women.

Range of Motion

For people with a cancer diagnosis, a decreased range of motion (ROM) can occur and can be due to a variety of reasons. A reduced ROM can result from pain and tightness due to the cancer process, the effects of treatment and lack of activity either before, during or after cancer treatment.

Surgical Pain – Surgical patients can experience post-surgical pain and the development of scar tissue (adhesions), which inhibit movement.

“Frozen shoulder” – This condition, technically called “adhesive capsulitis,” is a range of motion issue that can be common after breast and lymph node surgery, or in any procedures that prevent movement of the arm. It occurs the capsule of connective tissue around the shoulder joint thickens and tightens, restricting movement.

Frozen shoulder usually develops in three stages over several months. These stages are:

  • Freezing stage – Any shoulder movement causes pain and range of motion decreases. For some people, the pain can be worse at night and affect sleep.
  • Frozen stage – Pain may begin to diminish but the shoulder becomes stiffer, and ROM diminishes further.
  • Thawing stage – The range of motion in the shoulder starts to improve.

Radiation – After radiation therapy, some patients develop pain and limited movement either due to skin irritation, or radiation fibrosis, which is a scarring of healthy tissue. Radiation fibrosis can cause a variety of issues including pain, stiffness, reduced range of motion and lymphedema.

Lymphedema – Lymphedema is a condition of swelling, usually in the arms or legs, which results from injury to the lymph nodes, commonly after cancer treatments. Lymphedema can cause a variety of symptoms, including swelling, tightness, tingling and affect range of motion.

Postural issues – Many people experience a collapsed or hyperkyphotic posture due to reasons including: Western culture (sitting in chairs, at computers, etc.), aging, menopause, osteoporosis and weakness.  Postural imbalances due to pain or scarring after surgeries and cancer treatments can also effect posture.

Integrative Care for Joint Pain and Range of Motion

There are many treatments to improve range of motion and alleviate joint pain, in both allopathic and integrative modalities. Various exercises and movements, such as those done in yoga, fitness programs, physical therapy or Tai Chi may improve joint pain and increase ROM.  For example, some movements for Frozen Shoulder suggested by the Mayo Clinic include:

  • Walking the fingers up the wall
  • Folding at the waist and letting the arm hang, making circular and pendulum-type movements.

Yoga can help improve range of motion in a gentle way. A study published in a 2011 International Journal of Yoga states:

“Improved flexibility is one of the first and most obvious benefits of yoga. With continued practice comes a gradual loosening of the muscles and connective tissues surrounding the bones and joints; this is thought to be one reason that yoga is associated with reduced aches and pains. Yoga helps to build muscle mass and/ or maintain muscle strength, which protects from conditions such as arthritis, osteoporosis and back pain.”

Versions of Tai Chi and Qigong have showed positive results for cancer survivors in many studies. A study by Mustian, et al, in a 2006 Journal of Supportive Oncology showed increased functional capacity by breast cancer survivors who practiced tai chi chuan.

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