Treasure Your Chest with Pilates – Michele Larsson
Breast cancer has been a serious health issue within the fitness and Pilates
community for many years. Eve Gentry, Pilates master teacher, had a radical
mastectomy in 1955. My mother died of the disease in 1983 and I was
diagnosed in 1994. One in eight women will get breast cancer in their lifetime.
With those statistics, you will most likely have a breast cancer survivor or one
that is currently battling breast cancer as a client at some point in your Pilates
career.
A diagnosis of breast cancer does not mean that one needs to stop exercising.
The American Cancer Society recommends exercise even though they “still do
not know a lot about how exercise and physical activity affect recovery from
cancer, or the effects on the immune system. But regular moderate exercise,
such as brisk walking, has been found to have health benefits for the person
with cancer.” Some form of aerobic activity is especially beneficial, like
undertaking a Pilates exercises routine.
Joseph Pilates’ reference to the “internal shower” is especially beneficial to this
population. Pilates exercise can improve the oxygen carrying capacity of the
blood and calm the mind by connecting each movement to a breath, an inhale
and an exhale. Pilates also maintains and improves muscle tone, balance,
flexibility and coordination.
In order to build a program for breast cancer clients, you need their doctor’s
permission (if they are still in treatment), information about the kind of surgery
they received (lumpectomy, mastectomy, reconstruction) and their level of
fitness. No two breast cancer clients are the same, therefore their response to
illness, fitness level and degree of medical care all affect what they can do in a
session. Nowadays, doctors rarely take out the pectoral muscle while
performing a mastectomy. If they do, it is referred to as a radical mastectomy.
Because there is a certain amount of pain and discomfort involved in stretching
out the scar tissue in order to regain range of motion in the shoulder, this early
rehabilitation is usually done by a physical therapist. That being said, in my
practice I have seen the following: a radical mastectomy, plus removal of the
skin; a stent placed in a vein so that chemotherapy can be administered
frequently; breast reconstructions using part of the latissimus dorsi; implants
under the skin, implants under the muscle; and preventative double
mastectomies with reconstruction. Therefore, it is important to get as much
information as to the type of surgery and reconstruction as you can. Each client
must be treated differently.
When you see a client soon after surgery follow the “Reach to Recovery”
recommendations listed on the American Cancer Society’s web site. I start
people with the Wall Crawl for range of motion in the shoulder (see description
below). For example, if the client has had lymph nodes removed under her arm,
and most do, treat that side as a shoulder injury. The client’s doctor will want
the client to be able to lift her arm above her head if she needs radiation
therapy. Therefore, exercises that re-gain and maintain range of motion are
good. There is usually scar tissue in the arm pit from the removal of lymph
nodes, and depending on the type of surgery, across the chest. Scar tissue is
laid down randomly in the body and does not lie in a neat order like muscle
tissue, therefore, it can bind to muscle, fascia and tendon, consequently
interfering with the normal movement of a joint. As their range of movement in
the shoulder increases you can add more arm movements. Begin without
weight because the removal of lymph nodes can result in edema (swelling) in
the arm and once this happens it is very difficult to reverse. So, avoid exercises
that involve lifting weight or carrying heavy weight with the arm hanging straight
down.
If the client is still in treatment, they may experience fatigue. This is not a
fatigue that is cured by rest; it is a result of their treatment. Do not push through
this fatigue. This is the time to shorten the workout and focus on pre-Pilates
work, such as a little footwork on moderate weight and short walks.
As a practical guideline, eliminate arm work except range of motion exercises,
use moderate weight, rest frequently, stretch and breathe. Avoid arm pumps in
Hundreds, weight bearing arm exercises, rowing, etc. Once the clients’ energy
and range of motion in the affected side(s) improve, you can add exercises as
appropriate. Eventually with your guidance, the client will be able to do a full
Pilates workout. Remember, these restrictions are not permanent.
Here is a sample Pilates lesson for a client after surgery:
Warm-ups:
• Arm circles, modified to pain free range of motion.
• Pre-Pilates, i.e. walking, footwork
• Wall Crawl: Stand facing a wall, crawl your fingers up the wall as far as you
can and then slide them down the wall. Do not let the client raise their
shoulder while doing this exercise. The scapula can move outward and upward
but keep the upper trapezius relaxed.
Reformer:
• Hundreds (no arm movement and focus on breath)
• Swan (modified with arms down by the side)
• Stomach Massage
• Short Box
• Running
• Pelvic Lift
• Eve’s Lunge
Trapeze Table:
• Supine Leg Springs (Without holding the bars; use a sticky pad under the
client to keep them from sliding)
• Push Through
• Saw
• Side Bends (With no spring attached to the Push Through bar)
Note: The following exercises should not be included in the lesson until the
client advances: Roll Over and/or Short Spine, Co-ordination, Rowings, Pulling
Straps, Backstroke/Teaser, Long Stretch Series, Chest Expansion, Long Spine,
Knee Stretches and Mermaid.