Using Pilates For Healing After Breast Cancer - Naomi Aaronson

  Using Pilates For Healing After Breast Cancer by  Naomi Aaronson MA OTR/L CHT CPI

 

 

   Breast cancer is the most common cancer in the United Kingdom. In the last ten years rates have increased by 5%. Both women and men can get breast cancer, but it is more prevalent in women. Many breast cancer  survivors  have had  to go through debilitating surgery and treatment.   These women   are left with physical, cognitive, and emotional scars.  Pilates is an excellent modality to help survivors regain mobility, strength, and endurance as well as enhancing the mind body connection .. However, it is important to know the issues these women face if you are working as a Pilates instructor or use Pilates  as part of  an  exercise  program. Included below is a brief description of some of  the  implications of breast cancer surgery and treatment .

Most  women receive surgery  which is local treatment to remove the cancerous tissue. The  surgeries involve  removal of breast  tissue  along with lymph nodes producing  scars, limited range of motion, musculoskeletal pain, lymphedema and loss of function. In addition, many women must undergo systemic treatments which can include chemotherapy, hormonal treatments, and biological treatment. The biggest side effect that all of these treatments  have in common is fatigue. However, chemotherapy can result in peripheral neuropathy, “chemo- brain”, sarcopenia, infection  risk,  weight gain, anemia, and premature menopause leading to osteoporosis.  In addition, hormonal treatment such as tamoxifen  can cause weight gain, hot flashes, and increased risk of uterine cancer. Other hormonal treatments  such as the Aromatase Inhibitors can cause joint pain and osteoporosis. Biological treatments such as Herceptin  can cause heart and lung problems. Finally, radiation which is another type of local treatment  can contribute to fatigue, lymphedema ,  and brachial plexopathy.  These side effects can last from 12-24 months  and some for years after . Finally, there are psychological issues such as changes in body image,  fear of death, and reactions such as anger or depression  that can complicate the recovery process.   I urge you to learn more about breast cancer  treatments to really understand it’s effects upon mind and body.

Why Pilates?

Pilates can help to restore mind and body integration because it is a low impact exercise regimen that strengthens the scapular, abdominal /back and pelvic core musculature while emphasizing deep breathing. If the core is strong, there is an improved ability to use more distal musculature. Other benefits include the following:

1)     Improves lymphatic drainage by it’s emphasis upon deep breathing along with  abdominal exercises which help pump excess lymphatic fluid back towards  the heart

2)     It strengthens  middle back musculature such as the rhomboids and middle trapezius  through exercises such as body extension, swan ,  and diamond. This promotes better posture often impaired after breast surgery.

3)     If fatigue, anemia, or infection risk is a factor, Pilates can be done  in individual sessions.. In addition,  It  can accommodate special needs and considerations as it  can be performed  standing, seated, prone, side-lying, or supine..  For example, the supine position is excellent as it p rovides proprioceptive  input  to the scapula stabilizers. Proprioception which is ones awareness of the body in space  is often  decreased  after injury or surgery.

4)     Pilates can improve scapula-humeral rhythm since so much emphasis is placed upon use of the scapula stabilizers including the middle trapezius, rhomboids, and latissmus dorsi.  The upper trapezius muscle and pectoralis are often overworked especially post surgery when pain and tightness  is a factor.

5)     Since osteoporosis is a concern, many Pilates exercises can be modified, adapted, or eliminated from the traditional Pilates repertoire.  For example, keeping the head down during  the hundred and double stretch leg stretch and eliminating rolling like a ball and rocker are some suggestions .

6)     The emphasis in Pilates is minimal repetitions of an exercise done with correct form. This is perfect for someone at lymphedema risk  or whose fatigue is limiting endurance. Lymphedema is the build up of protein rich fluid in the chest, arm, or armpit after lymph node removal and/ or radiation.  If someone  has  lymphedema, it is advised that they wear a compression garment when using resistive equipment . If they are at  lymphedema risk, it is best to proceed slowly and cautiously with resistive equipment or using the Cadillac or reformer. 

 

 

Helpful Hints

1)     Be sure to work with a trained rehabilitation specialist who is familiar with the issues that can arise including peripheral neuropathy, lymphedema, post mastectomy pain syndrome and axillary web syndrome .

2)      If client has osteoporosis/ osteopenia in the spine do not perform any exercises that involve spinal flexion, lateral flexion or spinal rotation. This includes the mermaid, saw, and  criss- cross. If there is osteoporosis/ osteopenia in the hip, do not perform exercises such as leg circles or side lying series if the exercise involves hip external rotation and flexion

3)     Prone position may be difficult after surgery. Use of towels , wedges , or therapy balls can assist. If not possible, the exercise can be  modified to be performed seated or standing .  Pilates  can accommodate different bodies and needs through  simple  modifications.

4)     Progress your clients slowly and teach them to listen to their bodies. 

5)     If at lymphedema risk, do not increase the repetitions the same time as you increase the weight.   In addition, start with light  resistance.  Wait and  see how the individual responds to  the resistance before  increasing resistance. 

6)     Side-lying may also be difficult. You may need to place a support under the head and arm and lower the affected  arm for comfort.

7)     Be sure to obtain a complete medical history with dates of surgery, radiation, chemotherapy and breast reconstruction.  There are many different protocols  especially for breast reconstruction. It is  advisable to work within the doctors   guidelines especially when beginning a strengthening program.  It is highly advised to obtain medical clearance especially if women are undergoing treatment or have multiple health problems.

 

I have divided the recovery  process into 3 phases post – surgery.  The exercises are performed on the mat.  The goal here is  for clients to learn the correct Pilates principles while restoring  range of motion and strength safely. The times provided are only approximations and general guidelines , as every client is unique and doctors recommendations can vary.

Post – Operative - exercises  ( protective phase with drain in place  )   Day 1- Day 10  Deep breathing, scapular protraction/ retraction,  scapular elevation/ depression, and bridging can be safely performed. Clients will be recovering and will most likely be referred  for rehabilitation  if needed . You probably would not be seeing anyone at this time.

 

Return to function  exercises  ( drains removed)  Day 10- Day 24:   Arm scissors, cane raises, side lying shoulder flexion/ extension,  side- lying series, bridging,  along with phase 1 exercises. You may need some of the modifications indicated in the helpful hints section.  It is best to communicate with healthcare providers, so that care is coordinated.

 

Getting Stronger  exercises  (  Day 24 and beyond): Use of toning balls or  bands.  Return to function  exercises  with resistance along with traditional Pilates exercises such as the swan, mermaid with toning balls, swimming, hundred, and  criss cross can be performed.  However, this must be considered within  limitations of pain, range of motion, and endurance. Women who have received breast reconstruction using flaps will follow a different protocol. 

   In conclusion,  Pilates is an excellent  modality to restore  wellness .  Many of my clients have found that it takes time to master Pilates, but the benefits are extremely  valuable.  They report feeling stronger, have  less swelling , and feel  more relaxed after participating in the exercises. I  recommend that you undergo further study before working with this population. This will  ensure that your clients receive maximum benefit  safely and effectively. Learn more how Pilates can help your breast cancer survivors recover through our CD, Return to Life: Breast Cancer Recovery Using Pialtes.

 

Naomi Aaronson MA OTR/L CHT CPI is an occupational therapist, certified hand therapist, and mat Pilates instructor who believes in the power of exercise in recovery. Naomi’s articles have been featured in IDEA Fitness Journal, Occupational Therapy ADVANCE, and Women and Cancer magazines. She is  the co- author of  the  continuing education courses;  Return to Life: Breast Cancer Recovery Using Pilates, Breast Cancer Recovery: On Land and In Water and The Breast Cancer Recovery  Exercise Program which can be purchased on her website.   Naomi offers   live continuing education courses through Integrated Rehabilitation and

Fitness. She can be contacted at  recovercises@aol.com     or at her website at www.recovercisesforwellness.com